Q I had a root canal last week. I am still having pain. I thought they took the nerve out? Is this normal?
Oh yes it is, and I am speaking as a patient! This is extremely common. Dr. Julie Kennedy, our team’s extraordinary endodontist educated us:
Like any medical or dental surgical procedure, pain is expected for a few days following treatment while the inflammation wanes.
Here are the top five reasons one would have more lingering pain for days weeks and months after root canal treatment:
A high bite requiring a simple adjustment. Teeth are suspended in the bone by ligaments which allow the tooth to bounce into the surrounding bone, already inflamed form the procedure itself.
Teeth, especially multirooted teeth, can have more than one canal system. Canals that are hard to find or calcified can be missed, leading to pulp tissue that is not fully removedPossible complications such as perforations ,instruments that have broken through the roots into the bone and ligaments surrounding the tooth.
Root fracture is a common source of pain after root canal treatment and is of particular concern since it may be hard to diagnose (figure 1).5 Although new
technologies such as three-dimensional imaging and microscopes have increased diagnostic ability, vertical fractures can still be hard to ascertain. Isolated periodontal pockets and a history of sharp pain that progresses to a dull throbbing pain upon mastication/palpation are common signs of fracture. Other common risk factors for fracture include: the lower second molar (most likely tooth to fracture), clenching/bruxism, large amalgam restorations, thermal injury, psychological stress, teeth with existing erosions.
The periodontium surrounding the tooth can be a source of pain, especially if there is a concurrent periodontal lesion along with an endodontic lesion.. In addition, gum recession can exposed root surfaces, which can then lead to sensitivity and tooth pain. Food impaction, especially if the tooth is temporized, can also mimic tooth pain. Gingival irritation from the rubber dam clamp used during the root canal can simulate tooth pain, but it is usually temporary and can be alleviated with rinses or medicaments.
Persistent pain after root canal therapy can be likely if the etiology of the pain is not tooth related. Pain syndromes stemming from shingles, trigeminal neuralgia, idiopathic periodontalgia/odontalgia, and phantom tooth pain have also been reported to be psychogenic aspects of tooth pain that could persist after root canal treatment.