Pain after fresh root canal treatment? Is it possible?
First I will briefly talk about what a root canal is. The dentist will explore the root of the tooth and clean out the root canals. However, a tooth can have more than one root and a root can have more than one canal. Not just one, but all the canals need to be opened up, cleaned and root-filled to prevent bacteria from entering. The root canal must be sealed to the tip of the tooth root – again, to prevent bacteria from re-infecting and causing inflammation. From then on, there is no nerve in the tooth, so the tooth cannot hurt classically. It follows from the precise root canal workflow that there are several reasons for tooth sensitivity after root canal treatment.

• During root canal cleaning, the root canal needle may reach the tip of the root and cause sensitivity for a few days.
• If you have had root canal therapy after an older infection, the old infection should clear up around the root tip.
• In teeth with more complex anatomy, the dentist may not find all the roots and their canals at first – or at all, meaning there may be bacteria left somewhere, which are maintaining the inflammation and causing pain with their toxins.

There is no pain during the painless root canal because of the anesthesia. Afterwards, however, temporary or more permanent pain is possible for several reasons. We have to be patient in the first few days and if the pain is significantly reduced, it is only caused by the sensitivity of the root tip. However, if the pain does not decrease, you should see the dentist again.

What if a tooth that has had a root canal treatment in the past hurts again?
If a tooth with a root canal that has been treated in the past becomes sensitive to pressure, likely, there is still inflammation at the root apex. It is always necessary to take a minimum of x-rays, but for the most definitive diagnosis, an excellent alternative is a CBCT scan, which allows the dentist to view the tooth in 3 dimensions! It is possible that bacteria may still be present in one of the root canals and that their toxins may still reach the root apex over a longer period, causing further irritation of the tissues and root canal mucosa by inflammation. Naturally, the immune system steps in and tries to destroy the toxins, thinking they are the enemy, and inflammation ensues. The primary purpose of inflammation is to prevent bacteria and their toxins from entering the large bloodstream. Although this is a defence mechanism, at a local level it is inflammation, causing the bone to slowly break down. This bone loss is usually clearly visible on X-rays. Importantly, bone loss due to such inflammation does not start to show up on X-rays until 6 weeks later, as the X-ray shadow does not show fresh inflammation. Unfortunately, some bone has to be destroyed for this to show up on the X-ray. This is why, in a freshly dead tooth, the problem is already there, but the X-ray does not show it. Pressure sensitivity may be a sign of root-end inflammation, i.e. suspicion of dental gum disease – it is recommended to see a dentist as soon as possible to clarify the suspicion of gum disease! To clarify the suspicion of a pulp, an oral examination and a panoramic X-ray are necessary in the first instance, followed by further examination of the teeth in question with intraoral X-rays and 3-dimensional CBCT X-rays! Do not settle for a conventional film panoramic X-ray or a blurred, lower quality panoramic X-ray, as in many cases important details may not be visible or may be blurred!

What should I do if my root canal tooth hurts?
1. Don’t panic! In most cases, the pain will go away after a fresh root canal. What you should notice is that the pain gets stronger or weaker every hour. Observe how you feel the next morning, don’t go by what you feel in the evening after a fresh root canal, because that can fool you. Watch the process, not the time. So if the pain decreases, but it can take days, that’s fine. 2. If your pain doesn’t decrease the next day, and even increases, see your dentist again! 3. If it’s an old root canal tooth, don’t trivialise it by saying it can’t hurt because it’s not alive. See a dentist as soon as possible! Look for a dentist with good quality panoramic x-rays, intraoral x-rays and 3-D CBCT. If you need to screen a gumy tooth, you should look for a team that has all the technical facilities and professional knowledge to do it.