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Pain after root canal and crown

F

freestyle10

Junior member
Joined
Aug 16, 2020
Messages
2
Location
Greater New York City Area
A tooth broke in Feb, root canal and a crown were done. Now 6 months later, there is pain when I run my finger over the surface of crown. How can there be pain in a tooth that's dead? I dread losing the tooth. The tooth broke 1mm below the gumline. When the dentist applied the crown it was painfully tight, I had to take ibuprofen for 3 days afterwards because of the pain, I thought the dentist had made crown extra tight since there might not be a lot to which the crown could be secured. Six weeks later the pain was back, the endodontist took an xray, said the root canal was fine, said the gum above the tooth was very red and that it was an issue with the fitting of the crown. Due to the pandemic, it was 3 months before my dentist could see me again, last week. She is very good, but her response was disconcerting, she said it's a dental mystery and all we can do is wait. Could the tightness of the crown have cracked the tooth or affected the post? Would it be better to remove the crown and see what's going on? I feel the pain when the crown is touched or rubbed, but not when biting
 
Niall Neeson

Niall Neeson

Well-known member
Verified dentist
Joined
Apr 18, 2019
Messages
152
Location
Ireland
Hi Freestyle10,

I completely understand that it’s very frustrating when you’ve gone to the bother (and expense) of having a root canal and crown completed but problems continue.

The nerve that’s removed with root canal treatment is the nerve inside the tooth called the pulp. This is the one that feels hot and cold.

The second type of nerve is in the ligament that surrounds the tooth. This is the one that tends to cause problems on pressure. It’s still present after RC treatment and is the most common source of continued discomfort.

The specific source of why it’s sore in your case is difficult to answer but I would be a little bit concerned to be honest. There could be a number of different explanations. Sometimes small cracks in the remaining can arise for example. Sometimes clenching or grinding on the tooth can be enough to disturb or bruise the ligament and nerve. Sometimes the gum can become angry from the crown margin being under the gum. And sometimes, although everything looks spot on, issues can still continue and, despite the dentists best efforts, healing is still unable to occur. This may be relate to tiny channels in the root canal system or narrow fracture lines that can harbour bacteria. These can be virtually undetectable at times, even with a 3D scan.

If there’s a chance you could be clenching or grinding at night I’d consider getting a guard to wear at night from your dentist. Unfortunately the other options often result in having to remove the tooth so in my opinion, it’s usually worth trying the simple options first as, depending on what’s going on, there’s a chance it may be enough to promote healing.

I hope it all works out ok for you.

All the best,

Niall
 
F

freestyle10

Junior member
Joined
Aug 16, 2020
Messages
2
Location
Greater New York City Area
Hi Freestyle10,

I completely understand that it’s very frustrating when you’ve gone to the bother (and expense) of having a root canal and crown completed but problems continue.

The nerve that’s removed with root canal treatment is the nerve inside the tooth called the pulp. This is the one that feels hot and cold.

The second type of nerve is in the ligament that surrounds the tooth. This is the one that tends to cause problems on pressure. It’s still present after RC treatment and is the most common source of continued discomfort.

The specific source of why it’s sore in your case is difficult to answer but I would be a little bit concerned to be honest. There could be a number of different explanations. Sometimes small cracks in the remaining can arise for example. Sometimes clenching or grinding on the tooth can be enough to disturb or bruise the ligament and nerve. Sometimes the gum can become angry from the crown margin being under the gum. And sometimes, although everything looks spot on, issues can still continue and, despite the dentists best efforts, healing is still unable to occur. This may be relate to tiny channels in the root canal system or narrow fracture lines that can harbour bacteria. These can be virtually undetectable at times, even with a 3D scan.

If there’s a chance you could be clenching or grinding at night I’d consider getting a guard to wear at night from your dentist. Unfortunately the other options often result in having to remove the tooth so in my opinion, it’s usually worth trying the simple options first as, depending on what’s going on, there’s a chance it may be enough to promote healing.

I hope it all works out ok for you.

All the best,

Niall
Thanks so much for your reply!
 
O

Ottosmomma

Member
Joined
Aug 12, 2018
Messages
40
Hi Freestyle10,

I completely understand that it’s very frustrating when you’ve gone to the bother (and expense) of having a root canal and crown completed but problems continue.

The nerve that’s removed with root canal treatment is the nerve inside the tooth called the pulp. This is the one that feels hot and cold.

The second type of nerve is in the ligament that surrounds the tooth. This is the one that tends to cause problems on pressure. It’s still present after RC treatment and is the most common source of continued discomfort.

The specific source of why it’s sore in your case is difficult to answer but I would be a little bit concerned to be honest. There could be a number of different explanations. Sometimes small cracks in the remaining can arise for example. Sometimes clenching or grinding on the tooth can be enough to disturb or bruise the ligament and nerve. Sometimes the gum can become angry from the crown margin being under the gum. And sometimes, although everything looks spot on, issues can still continue and, despite the dentists best efforts, healing is still unable to occur. This may be relate to tiny channels in the root canal system or narrow fracture lines that can harbour bacteria. These can be virtually undetectable at times, even with a 3D scan.

If there’s a chance you could be clenching or grinding at night I’d consider getting a guard to wear at night from your dentist. Unfortunately the other options often result in having to remove the tooth so in my opinion, it’s usually worth trying the simple options first as, depending on what’s going on, there’s a chance it may be enough to promote healing.

I hope it all works out ok for you.

All the best,

Niall
not to hijack this posters thread but I have a similar issue and my endo and regular dentist both looked at it and seem to conclude it’s a bruised ligament and/or TMD that was made worse by having the treatments. I had 3D x rays and they do not see any cracks. So frustrating. How long after starting a soft food diet and wearing a tooth splint at night does bruised ligament pain seem to improve in your experience?
 
Niall Neeson

Niall Neeson

Well-known member
Verified dentist
Joined
Apr 18, 2019
Messages
152
Location
Ireland
Hi Ottosmomma,

If it’s a bruised ligament relating to a clenching or grinding habit then wearing a splint will usually lead to some degree of improvement pretty quickly, eg within a week or two people would usually notice a change in the right direction.

Niall
 
O

Ottosmomma

Member
Joined
Aug 12, 2018
Messages
40
Hi Ottosmomma,

If it’s a bruised ligament relating to a clenching or grinding habit then wearing a splint will usually lead to some degree of improvement pretty quickly, eg within a week or two people would usually notice a change in the right direction.

Niall
thank you! The soft food diet suggested by my endo is frustrating, good to hear that the splint can help on it’s own. It seems to be a slow healing thing is that correct? I had the splint and soft food going for a few days and when I started eating harder food the pain came back right away
 
O

Ottosmomma

Member
Joined
Aug 12, 2018
Messages
40
with my case what I find confusing is the tooth had felt pretty good for a couple months and then started to hurt with pressure. The endo thinks it’s a bruised ligament/TMD brought on by extensive dental work but what I don’t understand is why now? It did hurt for a couple weeks after the procedure too. So I just don’t know. I guess as you said it is worth trying to see if it heals since I don’t want to have it pulled. But I’m worried about why it isn’t getting better. I did have it adjusted but I worry it’s still high
 
Niall Neeson

Niall Neeson

Well-known member
Verified dentist
Joined
Apr 18, 2019
Messages
152
Location
Ireland
If it is indeed a bruised ligament from clenching or grinding it’s not uncommon for symptoms to come and go depending on the night time habits (that are essentially impossible to monitor effectively as you’re asleep and can be associated with tiny movements). The night time habits can sometimes relate to what’s going on emotionally in people’s lives. Often, but not always, correlating with stress. So if it’s a bruised ligament that’s one explanation on the behaviour.

Worth considering the not-so-good-news alternative of course. If it’s not a bruised ligament and it is infact a chronic infection or undiagnosable fracture line in the tooth then it could be explained by a low grade bacterial infection brooding under the radar before rearing it’s head. That could explain the pattern of symptoms in that case.

does that all make sense?

hopefully it’s the former issue and the splint and soft diet will settle things and encourage effective healing.

If it still feels high I’d chase it up. Sometimes it can also be the biting contacts when you move your teeth from side to side that are the unhelpful forces rather than those contacts when you bite in your normal position.
 
O

Ottosmomma

Member
Joined
Aug 12, 2018
Messages
40
If it is indeed a bruised ligament from clenching or grinding it’s not uncommon for symptoms to come and go depending on the night time habits (that are essentially impossible to monitor effectively as you’re asleep and can be associated with tiny movements). The night time habits can sometimes relate to what’s going on emotionally in people’s lives. Often, but not always, correlating with stress. So if it’s a bruised ligament that’s one explanation on the behaviour.

Worth considering the not-so-good-news alternative of course. If it’s not a bruised ligament and it is infact a chronic infection or undiagnosable fracture line in the tooth then it could be explained by a low grade bacterial infection brooding under the radar before rearing it’s head. That could explain the pattern of symptoms in that case.

does that all make sense?

hopefully it’s the former issue and the splint and soft diet will settle things and encourage effective healing.

If it still feels high I’d chase it up. Sometimes it can also be the biting contacts when you move your teeth from side to side that are the unhelpful forces rather than those contacts when you bite in your normal position.
thank you so much for your reply. So, on the regular X-ray (not the 3 d one) there was a shadow around the end of one of the roots, the dentist and endo both think it’s just “inflammation” which I suppose could be from the off bite and bruised ligament right? The endo felt very certain it was not infected. when my dentist did the rc he said no signs of infection but lots of inflammation. So I just don’t know.
 
Niall Neeson

Niall Neeson

Well-known member
Verified dentist
Joined
Apr 18, 2019
Messages
152
Location
Ireland
thank you so much for your reply. So, on the regular X-ray (not the 3 d one) there was a shadow around the end of one of the roots, the dentist and endo both think it’s just “inflammation” which I suppose could be from the off bite and bruised ligament right? The endo felt very certain it was not infected. when my dentist did the rc he said no signs of infection but lots of inflammation. So I just don’t know.
Very possible yeah
 
Niall Neeson

Niall Neeson

Well-known member
Verified dentist
Joined
Apr 18, 2019
Messages
152
Location
Ireland
Ha! I completely agree!! Unfortunately the teeth are attached to the human body and that’s where it begins to get complicated!
 
T

the_lost_interleukin

Junior member
Joined
Sep 28, 2020
Messages
1
Location
Germany
Dear all,

Firstly, I wanted to say that I am very happy to join your community :)

I wanted to ask for some advice because I am going through some dark dental moments.

My story starts approximately one and a half year ago when a dentist while filling my second upper pre-molar, reached the pulp.
Long story short, after that filling I had acquired horrible cold sensitivity in that tooth and after numerous visits at many different dentists all of them reassured me that it will resolve at some point, so I waited it out.

At some point after one year, I felt my the tooth getting numb and I immediately went to a doctor who performed a root canal. I have to admit that the pain when the anesthesia wore off was excruciating, although I found it normal back then considering the one year were the tooth was suffering.

After some days, the debilitating pain subsided, but there was always pain upon tapping the tooth which made me a bit concerned. Before sealing the tooth with a filling, I reported to the doctor that I had pain and he said that it wasn't normal and I should consult an endododist instead. Did that, the endododist I found after recommendation completed the root canal procedure, placed a crown and got to a point where after 4 months I had intermittent pain at my gums and upon tapping the tooth the pain radiated through my face ending at my forehead. Need also to add, that the tooth was NEVER pain free, even before the placement of the crown, but still the endododist said that it will resolve through time.

Went back to my endododist, I communicated my pain concerns with her, she suspected ligament inflammation and that is why she prescribed a nightguard. During those two weeks that I am wearing the nightguard, nothing really changed and in fact yesterday I started having throbbing pain deep in my tooth and pain at my upper jaw radiating which caused a horrible headache :( Today, since my problems weren't resolved and in fact got way worse than anticipated, I visited her again for consultation, she did an X-Ray which was clean and she gave me antibiotics for one week just in case there is a minor inflammation that the X-Ray cannot pick. She also insisted that is not coming from the tooth and the area I am complaining to have pain at is close to the bone and I should visit an ENT..

Now I don't know what to do, after reading threads of other people I am considering asking having my tooth pulled out and discuss the possibilities of an implant. My symptoms in a nutshell are :

1. Pain at my gums around my tooth
2. Postponed pain (~5s) after tapping the root canaled tooth that radiates from the tooth to the forehead.
3. Upper jaw bone soreness - e.g upon touching my cheek.
4. Since yesterday, throbbing pain, especially when moving

I am getting really stressed that due to ignorance I am starting developing serious problems - e.g osteomyelitis and looking for some genuine advice from people who had a similar experience to what I am going through. Of course any other advice would be also welcome.

Thanks a lot for dedicating your time in reading my post and looking forward to your replies :)

Best,
L.
 
Niall Neeson

Niall Neeson

Well-known member
Verified dentist
Joined
Apr 18, 2019
Messages
152
Location
Ireland
Hi the_lost_interleukin,

Sorry to hear that you’ve been having so much trouble with this tooth. I understand that as well having to experience the pain, it can also be incredibly frustrating.

Firstly, absolutely no reason to consider that it’s something systemic like osteomyelitis so you can relax on that front.

I have to say that the sequence of events and choices from your dentist do not sound unreasonable. The fact is that most teeth with root canal treatment will settle over time. Unfortunately, occasionally teeth just don’t seem to play ball or follow the usual path of recovery. This is no fault to your own but may be down to a little crack or micro-canal continuing to gather bacteria that may not even even be visible to an endodontist.

Sometimes there can be some interplay between a tooth problem and a sinus issue and I expect that this is what they would like to rule out at ENT. Again, not unreasonable before making an irreversible decision to remove the tooth.

Unfortunately, it may be that despite all your efforts the tooth may still be best to be removed. This does occasionally happen and, although it’s maybe no comfort to you, it is incredibly frustrating for us dentists when this happens too. We want you to get better. We want you to be happy with our treatment. We want to make the right decisions for you and your well-being.

I hope you find a solution to the ongoing discomfort soon. I’d love to be able to wave a magic wand and fix it but at least be re-assured that: 1. you’re not on your own with this and 2. there’s no reason to think it’s something more serious.

Hope this is of some help or comfort.

Niall
 
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