Root Canal Pain Continues

Root Canal Pain Continues
Stanley Markman, DDS
If you have had root canal treatment and the pain has been present for more than 3 months after
repeated post-operative visits, you likely have a pain problem. Patients often look for another
dental procedure for reversal. Unfortunately, another dental procedure is not likely to reverse
your problem. Still, I see people who have had second and third root canal treatments and even
apical surgery in an effort to eliminate the pain. The thing that can be most frustrating is when
the root canal treatment was done, in the absence of pain, for preventative reasons. An example
might be when decay is encroaching on the pulp of the tooth and the dentist believes that doing
a root canal treatment before a crown preparation might prevent the need for root canal therapy
after the crown is inserted.

So what’s the problem? We may not know the exact reason, but we do know that statistically, somewhere
between 3-6% of root canal treatments will result in continuous post-operative pain. Secondly, a
small percent of the population has the genetic makeup to develop that type of chronic pain. What
happens is that the part of the nerve that enters into the pulp of the tooth develops an irreversible
neurogenic pathology, not visible or recognizable with tests. The dental pain has changed into chronic
or neuropathic pain and becomes a medical problem. Often the pain is referred to as phantom pain.

How do we diagnose it? The diagnosis is made mainly by patient symptoms. Pain is continuous with
variable intensities. Sometimes the pain level is low and sometimes it’s high resulting in
excruciating pain. Sometimes the pain occurs mainly when the tooth is touched. We often do a diagnostic
test by injecting the painful area with local anesthesia. What we find is that the patient reports
numbness but the pain, though lower, is still present.

How do we treat it? We treat the pain, not the tooth. We rely on medication for treatment delivered
in one of two ways. One way is to use systemic medications to reduce the level of pain. Another way
is to use the topical application of medication which is delivered to the patient in a medical delivery
device. Both methods will help to reduce pain. Sometimes we use both methods at the same time. When we
use topical medication, the benefit is that there are no side effects that often occur when we use
systemic medication. Sometimes there is a trial-and-error period during which time we have to try
different combinations of medications to control your pain. Our main objective is to have you stop thinking
about pain and simply focus on taking your meds a couple of times a day.

How long will you have to take medication? We do not know the answer to that question. Often, with
the passage of time, the pain level will dissipate. Don’t ever give up hope for pain relief! Many of
our patients have benefitted from such treatment.