Question I had a straightforward root canal 12 days ago on tooth 24 (lower front L incisor) after it showed up with a small abscess on x-ray (confined to the the space below tooth 24). I'd had a bit of sensitivity in the tooth - hence the x-ray at my regular checkup - but not much. I have healthy teeth and gums and just a few molar fillings.
RCT was performed by an endodontist, who said he was careful to ensure this was a single root. Ever since the root canal was performed I have had a constant ache in or around that tooth. It is not a shooting or throbbing pain, it is sort of like a sensitivity or a cold feeling, literally all the time, it doesn't go up or down in intensity. It is not unbearable but it is pretty debilitating because it is moderately painful all the time so it's very difficult for me to think about anything else - hard to work even though I sit in an office all day, hard to go through my daily routine. It is slightly sensitive to tapping but not at all sensitive to biting or hot or cold.
I have not chewed on the tooth much at all since the RCT, to give it a chance to heal. It had no decay so I don't need a crown, and I'm waiting until it "settles down" to get a permanent filling. It has never been in occlusion and I've never been a grinder.
After one week my endodontist agreed to see me again - he said it was normal to have this pain and said to keep taking ibuprofen and acetaminophen - at best these help me only a tiny bit, the pain is still always there. There was a little bump under my gum, which he "drained" but he said nothing really came out. Since yesterday (5 days since the draining) there is a little pimple down there. I'd taken penicillin for 1 week, 3 days before and 3 days after the RCT treatment day. The endodontist said there was no need to go on another antibiotic yet (at the one-week follow up), but wrote me a clindamycin prescription if the pain continued past the weekend (which it now has).
My questions: (1) Is it normal to have continuous, distracting pain for nearly 2 weeks after a root canal given the abscess was small (2-3 mm below the root) and in the front of my mouth? (2) Should I take another antibiotic or is that very unlikely to help at this stage? Is clindamycin the best one to take? - the risk for C. diff infection is kind of scary to me. (3) My endodontist mentioned apicoectomy as an option if the pain doesn't go away, but this seems to typically be used for people with bigger infections or people who become symptomatic months or years after an original RCT. How long do you think I should wait before I agree to apicoectomy, and what are the odds it will make the pain go away? I'm certainly not opposed to doing it if it will stop the pain (because the pain is starting to ruin my life), although I don't want to be overly impatient or subject that area of my mouth to more trauma if it will just increase the pain rather than decrease it. (4) Should I ask the endodontist to check whether there might be a 2nd root (by x-ray or opening up the temporary filling again), or is this unlikely?
Thanks so much for your help!
Answer normally you do not have these issues. once root canals are done, things are usually back to normal. this is highly unusual. one possibility is some residual infection. see if the clindamycin works (it is a very good antibiotic for a flareup). if it still does not work, you may need the apicoectomy or a retreat (perhaps there is a hidden canal the endodontist missed). you can always get a second opinion from a different endodontist (use a specialist here, not a general practitioner). take it one day at a time. eventually it should end up fine. good luck,
