PAIN MANAGEMENT FOR ROOT CANAL TOOTH
Cosmetic Dentist of Katy
(281)579-6066

Root canal pain happened when a tooth nerve becomes infected either by decay invasion, injury, necrose due to trauma or repeated insults. These causes lead to inflammation of the canal and since the tooth is the hard tissue and cannot expand to accommodate the inflammation, thus the pressure accumulated and compressed on the nerve. Fluid dynamic movement in and out of canal causes the nerve to fire, thus the patient feels the throbbing or pulsing of a tooth.

Root canal procedure normally divided into two appointments, the first one is to remove all the decay, remove the blood vessel and nerve bundles(together we call them root canal), thorough irrigation and allowed the infection to drain.  Many times a tooth that needs a root canal therapy usually has been exposed to insult for a long time (decay, filling fractures and expose nerve, gum boil, infection under the crown, already dead tooth).  A cyst may have already been develop underneath the apices (can be seen on the x-ray).  This cyst has a lining which enclosed the pus, infection infiltrates, inflammatory products, and bacterial toxin.  That is how our body isolates and attacks these infections.  In these situations, we must prescribed antibiotic that will penetrated into bone (Clindamycin or Keftab) to patient before the start of root canal therapy, then start the root canal, then wait for the infection to be in controlled while patient finished with his or her antibiotics before filling the root canal in the second appointment.  Cortical steroid (Medrol dose pack) can be prescribed after the second appointment to further control the inflammation.  Even doing so, these patients may have some residual pain (dull ache for few days) due to the fact that the cyst will take time to resolved.  In the case of the infection barely started such as in the case of removing large caries that is close to the nerve, tooth prep for a crown that encroached on the nerve, acute trauma to the tooth (fell and break a tooth), antibiotics can be prescribed to patient, root canal started and finished at the same appointment.  These patient most likely will not have much residual pain, if any.  It is the amount of infection trapped in the bone at the apices of the infected tooth that causes residual pain.  Root canal procedure, in my opinion, is the very reason why people fear the dentist.  Usually these patients waits until the infection blows up, having the root canal done, then having residual pain so much that he or she prejudged the dentist, and chose to never see his or her dentist again.  I tried my very best to gain the confidence and trust in the patient by doing other procedure before having to start a root canal on the patient unless in the case of emergency for this reason.  Nevertheless, when done right, the pain can be controlled and the tooth can be saved for a very long time.

     Pain Management Before Your Root Canal Appointment:

  1. View the patient education about root canal therapy, the consent form, the preop and postop instruction under services menu. This will help you to further understand the origin of root canal pain.
  2. Contact our office for prescription of antibiotics such as Kevtab, Amoxicillin, or Clindamycin. Your pain medication will not help you much without having taken these antibiotics. Remember, it is the inflammation of the canal that causes the nerve to fire.
  3. We recommend you take a non-narcotic, anti-inflammatory analgesic like Motrin or Alleve before your appointment to increase your comfort.  We also may prescribe narcotic analgesic for the severe pain. Please take none of these medications if you have a bad reaction or are allergic to them.
  4. Please do not take any aspirin for 10 days before treatment.
  5. Medications prescribed by your physician should be taken at their regular time and dosage unless otherwise instructed by Dr. Bui.  Please tell us of any over the counter or prescribed medications you are presently taking.
  6. You may want to avoid chewing on the side of your mouth that has the infection
  7. Sleep with your head in an elevated position if you do not have any physical limitations
  8. Eat a soft diet and avoid hard, chewy and sticky foods.
  9. Alcoholic beverages must be avoided 12 hours before treatment
  10. Do not smoke for 12 hours before treatment

What to expect after the root canal treatment:

1. It is not uncommon for a tooth to be uncomfortable or even exhibit a dull ache immediately after receiving root-canal therapy.  This should subside within a few days (or even weeks). This occurs because of conditions, which existed before treatment was started.  Experience shows that if there was pain prior to treatment there maybe a degree of pain that will continue for a few days after the procedure.  Remember that pain radiates.  You may feel sensations of discomfort that are not related to the treated area during the healing process. This can be created by inflammation in this area and/or due to increase in blood volume that natural occurs in the healing process. 

2. Another phenomenon which leads to residual inflammation at the apices of the root of the teeth and at times can cause severe pain.  This phenomenon is referred to as flareup.  Flareup results from the bacterial/bacterial product being pushed to the other side of the apices, trapped in bone, and causing inflammation as the apices is seal (after the canal fill).  The inflammatory infiltrates cannot be drain and try to expand the hard tissue (bone will not expand) and thus compress on the nerve.  This is especially true when the patient already developed a cyst at the apices of the treated tooth (can be seen on radiograph).  When throbbing, severe pain begins after the root canal treatment, please contact our office so we can prescribed an strong anti-inflammatory medication (cortical steroid such as Medrol dose pack) and also a strong antibiotics (usually Clindamycin 300mg).

3. Severe pain is also a result of crack tooth, of which patient is biting on something hard.  Root canal treated tooth tend to be weaker than the non-root canal treated tooth and thus should be taken out of occlusion at the start of root canal therapy and be restored with the full coverage crown as soon as all the pain or inflammatory symptom disappear.  If crack tooth happens, the only solution is extraction.

4. Your tooth will be sensitive to biting pressure and may even appear to feel loose.  This feeling is a result of the sensitivity of nerve-ending in the tissue just outside the end of the root, where we will clean, irrigate, place a filler and sealer material and a filling.  This feeling will be short-lived.  Warm salt-water rinses for two days after treatment will help.

5. Sleep with your head in an elevated position if you do not have any physical limitations
6.
Alcoholic beverages must be avoided for 48 hours (2 days) after the treatment.
7. Do not smoke for 72 hours (3 days) after root canal therapy.

8. Antibiotics, if taken, will take a day for it to begin to work. Finish all the antibiotics even if the pain subsided. Antibiotics must be taken at a full dosage to prevent the bacterial re-infection and becoming resistant.

9. Contact our office if you think you have crack tooth, uncontroll pain, persistent gum boil (raised, pimple like on the gum) that would not go away couple days after root canal finished, bad drug reaction, fever and/or malaise (may be a sign of persistent infection).

 

PLEASE CONTACT OUR OFFICE IF YOU HAVE ANY SEVERE PAIN TO YOUR MOUTH. OUR OFFICE ALWAYS WILL HELP ANYBODY IN EMERGENCY WITH OR WITHOUT APPOINTMENT. WE WANT TO HELP YOU SO CALL US AT (281)579-6066. DR. BUI ALSO CAN BE REACHED AT HIS CELLULAR PHONE (832)641-4438.