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Dentistry/Extreme Pain after Root Canal


A week and a half ago, my veneer on #8 cracked into pieces while eating.  My dentist polished the underlying tooth tissue and made a temporary tooth while the new veneer was ordered from the lab.  I began experiencing moderate pain from #8, the tooth directly below and radiating pain into my jaw. I controlled this pain by using ibuprofen several times a day. I returned to the office 1 week later because the pain had increased and was not been helped by ibuprofen.  My dentist could not find a cause for the pain and referred me to an Endodontist for a consultation.  The Endodontist immediately gave anesthetic shots without discussing the issue with me.  I asked why I was being numbed and he said he was going to do a root canal on #8.  I asked if he had seen infection and he said no, but I really only had 3 choices to stop the pain.  1.  Pull the tooth 2. Have the root canal 3.  Leave and endure the pain.  I was confused as to how to proceed, but being in extreme pain, I consented for the root canal.  It procedure was concluded successfully and I was sent home with no pain meds or antibiotic as it was deemed unnecessary.  Within minutes, the anesthetic began to wear off the the pain began.  I called back to my dentist and was put on a z-pac and given Lortab for pain every four hours.  The Lortab didn't fully control the pain and had to be taken every 2 hours for even minimal relief.  Swelling ensued in the gum, cheek, beside the nose and up to the eye area.  The gum was extremely hard and warm to the touch.  I went back to the Endodontist who was at a loss as to the cause of the pain.  He stated the root canal was a total success and the tooth was not infected to begin with, so there was no infection to spread.  He stated that perhaps the pain could be as a result of a needle track infection.  He prescribed Percocet 5-325MG plus Penicillin 500MG and Metronidazole 250MG to be used in combination and advised to stop the Z-pac.  There was no relief of pain and I went to the hospital Emergency Room yesterday were I was given a Dilaudid shot and a prescription for Dilaudid 2MG.  They did a CT Scan which showed some infection in the sinus cavity.  Today is exactly 1 week after root canal treatment.  The pain has lessened to an extent but still requires pain medicine every four hours.  The swelling in the eye area and cheek has diminished, but the gum area where the anesthetic injections were given is still extremely painful and hard to the touch.  I cannot smile on the right side.  I am worried that I might have experienced some kind of nerve damage from the injections and no provider I have seen seems to know how to proceed.  Do you have any suggestion of what I should do.  Should I try to see another Endodontist? Dentist?  I have been out of work for 1 week and suffering with unending pain.  I can only eat small quantities of soft foods such as soft bread or mashed potatoes, etc.  I am very concerned because I usually have a high pain tolerance and have had 3 medical surgeries and did not even have to fill the pain med prescriptions afterwards.  Can you offer any advice?

Hi Seba,
Sorry to hear about recent dental issues.  Complications like you describe after root canal treatment are possible, though they are uncommon.

From what you describe, it sounds like a significant dental infection.  Antibiotics can take 2-3 days to hit their max effectiveness in terms of blood levels.

You will know that you are adequately responding to the antibiotics by the size of the swelling and your pain level.  As long as the swelling appears to be decreasing in size and the pain is decreasing as well, I would not be too alarmed.

You can always get a 2nd opinion, but I would suggest you follow-up with the treating endodontist.  I know it's frustrating, but these complications can occur in very infected teeth.  From everything you've described, it sounds like your team of doctors are handling things well.

Best of Luck,
KG Amin, DMD
Austin Center for Endodontics


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Ketan Amin, DMD


Graduating from Harvard School of Dental Medicine, I received a broad understanding of both medicine and dentistry. I continued my training at New York University, as a dental specialist in endodontics, which concerns root canal therapy, related surgeries, as well as diagnosing and managing various forms of pain occurring in the head and neck


Dentistry; Specialist in Endodontics (Root Canal Therapy).

American Association of Endodontics American Dental Association American Academy of OroFacial Pain

Harvard School of Dental Medicine-Doctorate in Dental Medicine (DMD) New York University College of Dentistry-Certificate, Endodontics

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