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Dr. Thomas

Why Does My Root Canal Tooth Hurt?

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Man holding the side of his face, portraying a root canal dental emergencyA dentist completed a root canal on my top right premolar in 2018. I had no problems with the tooth until last month. Now the tooth hurts daily, although the pain is not nonstop. How long do I have before I need to see a dentist? Will I need a second root canal on this tooth? Thank you. Mark from Helena, MT

Mark,

Thank you for your question. Dr. Thomas would need to examine and x-ray your tooth to determine if it is reinfected and needs further treatment, but we will explain why a root canal tooth may hurt years after treatment.

Why Does Your Root Canal Tooth Hurt Again?

If your root canal tooth hurts again, it probably means that the tooth did not heal completely, and the infection flared up again. When a dentist does not remove all the infected pulp from a tooth or misses a hidden canal, you can experience future complications. According to the Journal of the American Dental Association, other factors that can contribute to root canal failure include:

  • Under- or over-filling a tooth with dental filler material
  • Perforations in the root canal systems
  • Dental instrument separation, or break off, into the root canal system

How Common Is Root Canal Failure?

Root canal failure occurs in about one in ten procedures. Infection may take months or years to flare up if a tooth does not heal completely. The infection lingers when a dentist cannot see deep inside tooth canals or reach curvy channels. Only dentists with advanced training and endodontists (root canal specialists) have the instruments needed for challenging tooth channels.

What Is the Treatment for Root Canal Failure?

Repeat root canal treatment or root canal surgery is the treatment for root canal failure. If your dentist does not have advanced root canal therapy training, they will refer you to an endodontist. The endodontist will take these steps:

  • Find the infected root
  • Remove the infection
  • Fill the tooth
  • Seal the tooth

During root canal surgery or apicoectomy, a dentist or endodontist will access the tooth through the bone and the root tip instead of the crown.

Schedule an appointment promptly. After an examination and x-rays, an endodontist or dentist trained in root canal therapy will determine whether your tooth is savable. Otherwise, they will recommend tooth removal and a dental implant.

Sugar Land, Texas, dentist Dr. Siny Thomas sponsors this post.

The Cap Broke on My Root Canal Tooth, and It Hurts

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About seven years ago, I had a root canal on a molar tooth, and my dentist put a cap on the tooth. In December, the cap broke off, and a small chip went inside the tooth. I had a lot of pain in the hole and some bleeding. I went back to the dentist, and he cleaned the tooth and said that he removed most of the chip, but part of it broke off. It is so tiny that he did not think it would bother me. He put the cap back on my tooth. It felt better for a while, but now it is throbbing inside. I do not know if I am panicking, but I think I feel pressure in my cheek and eye. Do I need antibiotics? Will I need another root canal, or am I going to lose the tooth? – Thanks. Kip from Utah

Kip,

Your description sounds like the tooth is infected again, and you need to see your dentist. When your dentist did your first root canal, the filling material did not stay in place. After your crown broke, saliva might have contaminated the filling material and your tooth.

Why Antibiotics Are Not Enough for Your Tooth Infection

Diagram of a tooth in need of root canal treatment due to decay, damaged pulp, and an abscess at the root.

If repeat root canal fails, you may need tooth removal and an implant. See a specialist first.

Antibiotics may not be enough to resolve your tooth infection for these reasons:

  • The pain and swelling you describe can travel into your jawbone, bloodstream, and even your brain and cause dizziness.
  • Although antibiotics can help control the infection, they will not remove it. If you delay treatment, the infection will get worse. And it can become resistant to antibiotics.
  • Eventually, your dentist or a specialist might need to extract your tooth. Although a dental implant mimics a natural tooth, no form of tooth replacement is as effective as a natural tooth. Preserve your tooth and see your dentist right away.

If your dentist cannot resolve the issue, ask him to refer you to an endodontist—a root canal specialist. Root canal specialists and dentists with advanced training in root canal therapy have tools that reach deep into the canal to access infection and debris. If they can save your tooth, your dentist can restore it with a new crown.

Dr. Siny Thomas, a Sugar Land, Texas cosmetic dentist, sponsors this post. Read about Dr. Thomas’s efforts to offer the best dental care in Sugar Land.