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Getting a root canal treatment can come as a huge relief, especially if you had severe pain and discomfort. The infection is finally gone, and with it, the pain should also stop. While some discomfort is normal, ongoing or worsening tooth pain might be a sign that something else is going on. This can understandably be confusing and distressing.
Although it is rare, there could be some untoward complications such as a missed tooth canal, persistent infection, a hidden crack on the tooth, or inadequate healing. In such instances, additional dental care may be needed to truly resolve the problem and protect your tooth. Let's explore why pain might persist days after treatment and what solutions may be offered by your dental professional.
What is a root canal treatment?
A root canal treatment is a dental procedure used to treat an infected or damaged tooth without removing it. It involves removing the infected pulp (the soft tissue inside the tooth), cleaning and disinfecting the inner chambers (called root canals), and then sealing the space with biocompatible material to prevent future infection.
When a tooth becomes infected, a dentist or endodontist may recommend root canal treatment to save the natural tooth. The procedure involves removing infected tissue, including blood vessels and nerves, from the pulp chamber and root canals.
Why do I need a root canal treatment?
A root canal procedure is often necessary when the pulp tissue inside a tooth become inflamed or infected, usually due to deep decay, tooth fracture, or cracks in the tooth structure. A common early sign of pulp damage is lingering sensitivity to cold food or drinks, which shouldn't be ignored.
During your initial consultation, your dental surgeon will assess your symptoms and take dental X-rays to evaluate the extent of the pulp inflammation and determine if root canal is a suitable treatment option. After thoroughly cleaning the root canal system, the space is filled with a material called gutta percha to prevent future root canal infections. The treated tooth is then sealed and often covered with a crown to restore strength and function.
In some cases, if the infected tooth is too damaged, it may need to be extracted. However, preserving the affected tooth is usually preferred. With local anaesthesia, the procedure is typically comfortable, and with proper care of your teeth, the tooth root and crown of the tooth can remain healthy for many years.
With this dental procedure, a decayed tooth or a badly fractured tooth can be saved from tooth loss. It’s an effective way to relieve pain, stop dental infection, and preserve your natural smile. To ensure long-term success, the root canal-treated tooth is typically finished with a permanent restoration, such as a dental crown, to protect it from further damage and restore form and function.
Why do I still have pain after my root canal treatment?
Some discomfort after a root canal is an expected part of normal healing. Your body has just undergone a procedure to overcome a root canal infection, and the surrounding soft tissues may still be tender or inflamed. For most people, this initial discomfort fades within a week and is often eased with simple over-the-counter pain relievers. If you have persistent pain or pain that seems to be getting worse, here are some other possible reasons:
1. Infection that wasn’t fully cleared
Sometimes, bacteria remain inside tiny canals or have already spread into the bone. This can cause ongoing pain, swelling, or even a bad taste in your mouth. Other than pain relief options, you may need additional treatment, such as retreatment or antibiotics.
2. Bite is too high
After the root canal, a permanent filling or dental crown is usually placed. If it's too tall, it may cause extra pressure when you bite down. This can make the tooth feel sore or painful when chewing. The fix is simple. A quick adjustment by your dentist should resolve the issue.
3. Missed root canal
Some teeth have complex root systems with extra canals that are easy to miss. If a canal isn’t cleaned and sealed, there is a risk of reinfection, which can cause severe tooth pain. A retreatment may be necessary to resolve this.
4. Cracked tooth
A hidden crack in the tooth can cause ongoing discomfort or sharp pain. Cracks are sometimes hard to detect and may require dental extraction if severe.
5. Reaction to temporary filling material
Sometimes, the medicament used in a temporary filling can irritate the tooth or surrounding vital tissue. This usually improves after permanent crown placement.
6. Cyst or abscess at the root tip
In some cases, a pocket of infection (a cyst or abscess) can develop near the tip of the root. This causes swelling and pain and may require surgical root canal treatment.
How is root canal surgery different from root canal treatment?
Surgical root canal procedures are specialised treatments used when conventional root canal therapy (non-surgical root canal) is not enough to resolve a dental problem. These complex procedures are typically performed by endodontists (root canal specialists)
A. Traditional root canal treatment (non-surgical)
A conventional root canal procedure is a non-surgical procedure used to treat infection or damage inside the tooth. The dentist removes infected or inflamed pulp from inside the tooth affected by deep decay, trauma, or infection. It is the usually the primary approach to save a tooth.
B. Root canal surgery (surgical endodontic therapy)
It is a surgical procedure performed when a root canal fails or when retreatment isn't possible. It is usually done by a root canal specialist when a previous root canal procedure didn’t heal properly.
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What are the types of root canal surgery procedures?
Retaining natural tooth is recommended for your long-term dental health. When retreatment of a root canal is not possible or has already failed, surgical endodontic treatments may be the next step to save your tooth. Here’s a breakdown of the most common surgical types of root canal procedures:
1. Apicoectomy (root-end surgery)
This is the most common type of surgical endodontic procedure and is typically recommended when a standard root canal or retreatment doesn’t resolve the infection. During an apicoectomy, the gum tissue near the affected tooth is gently lifted to expose the root tip. The endodontist then removes any infected tissue along with a small portion of the root. Once cleaned, the root tip is sealed with a special root canal filling material (called a retrograde filling), and the area is closed with stitches to allow proper healing.
2. Root canal retreatment with surgical access
This type of root canal surgery is used when a previously treated root canal fails and the infected tooth cannot be accessed the usual way due to dental crowns, posts, or other dental fillings in the way. Similar to an apicoectomy, this approach allows your endodontist to surgically reach the canals, clean them again, and reseal the tooth to stop the infection and promote healing.
3. Root resection (hemisection)
In cases where a tooth with multiple roots (usually molars) has one root that is severely damaged or infected, root resection may be a solution. The procedure involves removing the damaged tooth root and the portion of the tooth crown attached to it, while keeping the healthy tooth structure intact. The remaining structure is then restored with a dental crown, preserving function and avoiding full tooth extraction.
4. Intentional replantation
This is a rare but sometimes necessary technique used when a tooth can’t be treated effectively in place. The tooth is carefully extracted, treated outside the mouth and then replanted into its original socket. Though it’s considered a last resort, intentional replantation can be a successful way to save a tooth when other options are not viable.
5. Surgical perforation repair
A surgical repair may be necessary when a hole or perforation occurs in the root or tooth structure from a deep cavity, trauma, decay or a previous dental procedure. The root canal specialist accesses the site surgically and uses a biocompatible material like mineral trioxide aggregate (MTA) to seal the perforation and prevent further damage or infection.
6. Bone grafting
When infection or surgery causes bone loss near the root of a tooth, bone grafting may be recommended as part of your recovery to prevent loose teeth, to support healing and for future restoration. Bone grafting preserves your jaw structure, reduces surgical complications, and promotes long-term oral health giving your smile the strength it needs to last.
Is root canal surgery covered under MediSave?
In Singapore, the cost of surgical dental treatments can be partially offset with MediSave. While standard root canal therapy isn’t claimable, surgical dental procedures such as apicoectomy, surgical retreatment, bone grafting, and cyst removal may be covered. This support helps make essential treatment more accessible, allowing patients to focus on healing rather than financial worry.
MediSave is for medical procedures that are surgical in nature. Root canal treatments may be claimable under your dental insurance plan so it is a good idea to check with your insurance provider or speak to clinic staff for assistance with coverage and claims.
What to expect after root canal surgery?
Recovery after a root canal treatment procedure is typically smooth, with most patients experiencing only mild discomfort or tenderness near the surgical site for a few days. Over-the-counter pain medications are usually enough to manage any soreness. During this healing process, take special care to consume soft foods and avoid sticky foods. Maintaining good oral hygiene is essential for your oral health. you can gently brush and floss as usual to keep the area clean, being careful around the surgical site.
Conclusion
Root canal treatment is a common procedure with a robust success rate that helps to heal a root canal infection. However, in the rare instance that there are complications, retreatment or root canal surgery may be necessary to save your natural tooth. The healing process after a surgical endodontic procedure is generally smooth-sailing especially with proper care and a good oral hygiene routine.
Schedule a dental check-up appointment with Dental Designs Clinic to understand your options and our caring and professional clinic staff are here to help restore your confident smile and achieve your dental health goals.