Expert: Mark Bornfeld DDS - 7/21/2005

Question
Hello,
I had a root canal treatment on a tooth that was throbbing, but not excruciating pain.  My dentist said a lot of blood came out and most of the nerve was dead already.  After the first day, I was doing fine.  I went in the next day to have it finished.  When my dentist started packing the tooth, i felt a pressure extend into my face.  It is now the second day after and the tooth is still painful when i bite down on it.  I am also having a feeling of pressure above the tooth (2nd molar in front of wisdom tooth) on the side of my nose and over my eye.  Is this normal?  My dentist says it should go away in a couple of days, but I am nervous something more serious is wrong.  No one in my family who has had a root canal treatment has any pain like this.  My mother stated she had a reaction to the cement used, but my dentist does not seem to think this could be causing it.  When I look at pictures of NICO, the pain associated with it is in the same spot as my pain,  COuld this be NICO?  I am on Vicodin and Penicillin.  The Vicodin seems to relieve the pain in the gum around the tooth(which I assume is from the novacaine), but does nothing for the pressure.  I should also mention I clench my teeth when I am sleeping, but I wore my nightguard last night and it did not relieve the pressure.  The pressure is also not always constant but an on and off thing.  I also notice it more prevalent and constant in the evening.
Thanks for your help.

Answer
Dear Keith,

A finding of postoperative pain following a root canal treatment is not uncommon, regardless of the degree of success of the outcome. One cannot infer too much from the subjective symptoms, unfortunately; a successful root canal treatment can often feel much the same as a treatment that is not successful. Certainly, at only two days after completion of treatment, you are in the time window where everything could very easily turn out well.

Root canal treatment itself can cause inflammation in the tissues surrounding the tooth, which would account for your symptoms. This inflammation eventually resolves, although it may take several weeks to resolve completely. However, you should see an improving trend in the severity of the symptoms within a week. If you do not, it would then be appropriate for you to report back to your dentist for a follow-up.

I would be inclined to discourage you from taking the information available on the internet too seriously. Much of what you find is controversial or outright unreliable; clinical entities such as NICO fall into that category. Certainly, it would be unwise to attempt a self-diagnosis based solely on your subjective assessment of the condition. Most reliable diagnoses rely on much more objective information than you can obtain on your own. It would be far more productive to discuss any dental concerns you have with your dentist.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY