Do antibiotics post root canal work? Or failed root canal?

[Squashface]

Can anyone help me? I had a root canal on my crowned front upper tooth 4 weeks ago. It was done by a very skilled endodontist and he said it had all gone well when checking the x-ray afterwards.

I’ve had very mild pain/tenderness since it was done, but only when I push the back of my tooth with my tongue. I can eat and bite into food without any pain. I also get a bit of throbbing in the tooth when I going running. I posted last week about this as I was slightly concerned it hadn’t significantly improved (see post “Mild Pain 3 Weeks after Root Canal”). It’s hard to say if it’s getting better or worse as it seems to fluctuate day to day, but it’s by no means ever severe pain so I don’t feel the need to take painkillers.

Today I rang the dental clinic to ask whether I should be concerned. I was told it’s fairly normal for there to be some tenderness for a few weeks. But if it doesn’t go away by next week, they’ll prescribe antibiotics as their maybe a lingering infection in the tissues surrounding the tooth. The way this was said it sounded fairly standard.

I was given a 7 day course of amoxicillin prior to the root canal as there was an abscess and with Covid-19 I may not have been seen quickly. After the 7 days there was still a bit of throbbing and some pain. Does this mean the bacteria may be resistant to amoxicillin? Should I ask for a different antibiotic if I am told I need to take more? Also has anyone ever found that antibiotics get rid of pain after a root canal? When ever I google anything it just says pain and/or infection after a root canal indicates a failure, so the root canal procedure needs redoing. The endodontist still thinks the root canal is good.

If anyone can shed any light that would be great.

 

[MountainMama]

I wouldn’t jump to the conclusion that it has failed yet. I did have a failed root canal on my front tooth, but I was also told it was not common. I had a very large, undetected, abscess on my tooth as well, so the root canal just didn’t cut it.
I had antibiotics prescribed prior to the root canal, to help shrink the abscess, and then prescribed again when I still had tenderness. I had pain when biting and pain alongside my nose where the infection was irritating the trigeminal nerve. I ended up having an apicoectomy to try to save the tooth. My endodontist told me that as long as there was improvement, even if very small, it was a good sign. I never had that. The pain ended up getting worse, not better, which was how it was determined as failed.
I had quite a few rounds of antibiotics before it was considered failed. The endodontist said that if the lingering infection was outside the tooth, the antibiotics would help.

 

[Squashface]

Thanks for this MountainMama! Unfortunately the pain suddenly progressed overnight and it’s feeling quite a bit worse. Still no where near as bad as the original abscess, but there’s an uncomfortable throbbing pain. I guess if there is still a bit of infection and my body can’t fight it on it’s own, it’s likely to get worse at some point! I’ll give the dental clinic a call in a bit and hopefully get some antibiotics.

 

[Squashface]

Do you think I should ask for something different to amoxicillin this time?

 

[Gordon]

I would hope that the dentist would automatically prescribe something else without you asking them to!

 

[Squashface]

Just spoke to the dental practice- they’ve prescribed me 400mg x3 for 7 days of Metronidazole. Really hope it works!!

 

[MountainMama]

Just spoke to the dental practice- they’ve prescribed me 400mg x3 for 7 days of Metronidazole. Really hope it works!!

Good luck! I hope they work for you!

 

[Gordon]

Remember not to drink alcohol while taking them and take them on a full stomach.

 

[Squashface]

Thanks Gordon! Luckily I read the packaging carefully- it’s my birthday tomorrow and I definitely would’ve had an alcoholic drink if I hadn’t know. From the sounds of it, mixing Metronidazole with alcohol has pretty nasty side effects!!

 

[Squashface]

Gordon- I was wondering whether the tooth has an open apex. I mentioned on my previous thread that the endodontist showed me that there was no defined end to the root on the X-ray. But I was a little woozy from the Valium I’d taken, so I didn’t properly take in what he was saying. Could that be an open apex? If so, does that effect the success rate of the root canal?

 

[Gordon]

Many happy returns. A single glass of wine or beer is probably OK, I'd avoid spirits though. No seances!
Yes, if the nerve has died off before the root has fully formed then there could be an enlarged apex. Whether it will affect the success of the treatment kind of depends on just how enlarged it was, there are ways around it though.

 

[Squashface]

The antibiotics seem to have helped my front tooth. Since Saturday there’s been very little pain. Yesterday there was no pain at all, but today there’s a little bit of pain when I press on the tooth with my tongue. I’ve got 2 tablets left, so I’m slightly concerned the pain isn’t completely gone yet. Is it possible that me “testing” the tooth by prodding at it is causing these flare ups? I guess I’m worried this will end up being a complicated case and I’ll lose my front tooth. Really can’t afford an implant right now!

 

[Squashface]

Actually it also throbbed very slightly and hurt a tiny bit when I went for a run today too.

 

[Gordon]

Not unusual, the running will have increased the blood flow to the area a bit, which can sometimes make things a bit tender, possibly your lower teeth will have bumped on it a bit as you were running too.
Prodding at it won't cause any issues.

 

[Squashface]

Thanks Gordon! It’s hard not to panic when the pain comes and goes even if it is very mild.

 

[Gordon]

Yes I know, don't worry about asking on here anytime.

 

[Squashface]

Sorry- I have another question I hope you can help with. I forgot to mention it before- but the tooth that had the root canal used to be slightly further forward than the other front tooth. Maybe 0.5mm or so. Since the root canal it’s about 0.5mm further back than the other tooth! So I believe it moved during the procedure. Could that account for the pain when I press on it/the mild throbbing?

I think I might grasping at straws as I’m dreading that the dentist will tell me it’s failed. The pain still at no point has been worse than mild, but it’s still hurting a bit after taking my last antibiotic. I don’t know how long to wait before contacting the dentist again.

 

[Gordon]

I can't think of anything that could be done during RCT that could move a tooth back. Are you sure about this?
If the filling at the back of the tooth post RCT is a bit too thick, then this could give you a similar feeling and could contribute to a bit of tenderness.

 

[Squashface]

I'm pretty sure the tooth has moved, which I thought was strange when I first realised. The only reason I think it's moved is because I always worry about this tooth because it's always stuck out slightly further than the other (I sucked my thumb on that side when I was a child). This was partially fixed when I had the crowns done 2 years ago.

It seems to now be tilted further back than before, and only by a small amount. It also sort of clicks a little when pressed on, but it doesn't seem to move or feel unstable. I wondered if the dentist was a bit rough with the dental dam

 

[Squashface]

So I’m now 5.5 weeks post root canal, and 48 hours since I took my last Metronidazole. It sometimes hurts very slightly randomly. It’s still tender if I press on the back of the tooth (pain level about 1 out of 10), absolutely no pain whilst biting into food though. But I still get throbbing pain during exercise. Depending on the intensity this can be a pain level of up to a 3 to 4 out of 10, but this seems to vary day to day. Some days no pain, but one or 2 intense runs have been a 4/10 pain wise. Any pain seems to go within 10 mins of stopping exercise.

Any thoughts on whether I should still be concerned? Is it just healing very slowly? I would’ve thought I’d have experience very intense pain at some point through all this if the root canal had failed? But if it was a true success wouldn’t it be totally pain free by now?

I’m reluctant to pester my dentist as they backed up with much more serious cases due to not being fully open from Covid-19. But I also don’t want to leave it too long and risk a huge infection down the line. Such a tricky situation.