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Dentistry/pain after root canal retreatment

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Question
Hello. I had a root canal redone 3 weeks ago. (The initial procedure was done by a general dentist and was too short and too narrow).
After the re-treatment initial procedure pain, I was pain-free, but still taking 7 days of  Cleocin antibiotics. After I finished those antibiotics, I remained pain-free for another 4-6 days, but then the pain resumed, so the endodontist put me on a 5-day Z-pack. I was again pain-free  after starting about the 2nd day  of those meds. Friday was my last day of that 5 day prescription, and that day, the tooth pain resumed and has continued now for the past 3 days. I called the on-call endodontist, and he reassured me, as did the my regular endodontist, who did the work, that it was common and nothing to worry about that I was still having intermittent tooth pain. He said that the Z-pack antibiotic actually lasts 10 days, and the root canal filling has antibiotic in it, and he chooses to wait 4-6 weeks for the return visit to make sure that all pain is over before they does the sealing. He suggested that this is inflammation and general healing pain, not an infection or a root canal re-treatment failure, and to just wait it out. Sometimes the pain is about a 5-7 on a scale of 1 to 10, sometimes milder. It kind of feels like someone smacked me hard in the jaw. Could all this just be part of the healing process? I thought that I would have no further pain after the first few days of the re-treatment. I'm not trying to put you on the spot, but I just thought that I'd ask your opinion. Thank you very much.

Answer
Nellie -  You are correct to question the continuation of the pain and discomfort after the redo and a course of antibiotics.  Usually, if the root canal is successful is eradicating the pain and any infection, pain with gradually subside over a few days and the pain is completely gone within 5-7 days.  The fact that there has been a recurrence of the pain usually indicates that some type of a continuing problem exists.  What could that be?   Well there could be a fracture within the tooth.  There could be a microscopic nerve canal not seen on xray. There could be a problem not within the tooth, but in the bone and ligament holding the tooth to the bone.  I, of course, cannot tell you which is the cause.  

If the pain continues and this doctor cannot arrive at a reason, then seeing a different office might be appropriate.  If no doctor can come up with a cause, then that does not usually bode well for the tooth.  Sometimes a simple surgical procedure, called an apicoectomy, can remove any problems, but sometimes the tooth needs to be extracted.  So if the pain does not resolve, get another opinion.

I am sorry that I cannot give you a definitive and specific cause, but seeing a different endodontic office might be beneficial.  If you have additional questions, feel free to contact me again.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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