Root Canal Pain

Root canal pain is considered by many as the most dreadful toothache you may experience. The reason for this impression is the fact that most people confuse the pain caused by the dental problems that make necessary a root canal therapy with the pain of the treatment itself. It is true that conditions, like a severe pulpitis or a tooth abscess, that require root canal treatment may cause severe toothaches. But in most cases, the pain directly associated with the root canal procedure is only mild to moderate.

One of the most painful oral conditions is usually referred as root canal pain. Although the actual cause of this toothache is a tooth infection, it is called so because the treatment for it is usually a root canal therapy.

When the pulp tissue in the center of the tooth gets infected by bacteria, either due to tooth decay or a tooth fracture, the result is a severe throbbing toothache. The pulp contains the blood vessels that nourish the tooth and also the tooth nerves that connect it to the main trigeminal nerve of the mouth through the root canals.

Infection causes inflammation of the pulp tissue and increased blood flow which puts pressure on the nerves sending signals of severe toothache to the brain. The soft tissues inside the tooth eventually die forming an abscess and if they are not removed the infection can spread outside the tooth. Endodontic therapy that removes the dead tissue from the tooth is the only option to save the tooth and stop the infection and the root canal pain. If the endodontic treatment fails to eliminate the infection, tooth extraction is necessary.

Tooth decay pain, tooth abscess pain and fractured tooth pain are many times referred as root canal pain based on the required treatment (for treatments look into the related pages). The most proper meaning of the term is the one referring to the pain during or after a root canal treatment and not the pain due to the causative factors that the treatment is performed for.

The procedure of root canal is considered to be relatively painless, with the expected level of discomfort close to that of filling a tooth. However, under certain circumstances, the patient may experience some pain during treatment, or between the dental appointments required for the endodontic therapy, due to several conditions described in the next sections.

Root canal therapy is not a simple dental procedure. It involves the removal of tooth structure to allow access to the pulp chamber, the removal of the infected pulp tissue and tooth nerves, the drainage of the tooth abscess and finally the restoration of the tooth with a dental filling or crown. Several dental visits may be needed for the completion of a root canal therapy. Some dental pain is normal during or after the treatment.

A root canal treatment procedure is not expected to be more painful than a dental filling. The dentist will use anesthesia to numb the treated area so that you do not feel any discomfort. It is common that when you will need a root canal the tooth nerves will already be dead due to the infection. In this case drilling through the tooth may be done with much less anesthesia than if you needed a simple filling of a live tooth.

• Badly inflamed teeth - If a tooth infection has caused severe inflammation of the pulp tissue, this creates an acidic environment that can decrease the effectiveness of the anesthesia. If the tooth nerves are still alive, you may feel some root canal pain when the dentist treats the tooth. Increasing the dose of anesthesia with administering another shot can resolve the problem and stop the pain.
• Cleaning the root canals - While, the dentist will use anesthesia so that you do not feel pain during the treatment, the root canal procedure can cause some degree of discomfort to the patient during the cleaning and filing of the root canals mostly due to the duration of the procedure. Root canal therapy is not considered anymore as a painful treatment as it used to be before modern related techniques and equipment were developed. In any case, it is a treatment that is the only solution to save a badly infected tooth and it is much less painful than a tooth extraction which is the only alternative.

An experienced dentist with good knowledge of modern endodontic techniques can play a significant role in reducing the root canal pain during treatment and reduce the risk of complications and pain after the procedure.

The root canal therapy may require several appointments until it is completed. The tooth can not be filled before the infection is fully eliminated. Under certain conditions you may have to deal with some amount of root canal pain between the dental appointments:

• Gas build-up. If you have a tooth abscess the pain can be very intense. At the first treatment session the dentist opens the tooth and allows the abscess to drain, which immediately reduces the pressure in the tooth and relieves the tooth pain. The dentist places a medication inside the tooth to kill the bacteria and fight the infection. The tooth is then sealed with a temporary filling to isolate the tooth interior until the next visit. The decomposing of any dead bacteria remaining in the root canals or around the root tip end produces gases that may gradually increase the pressure inside the tooth causing root canal pain. This type of root canal pain will stop when all bacteria are eliminated and the tooth and root canals are carefully cleaned from any dead tissues. A mild analgesic is enough for temporary pain relief. Removing the temporary filling will provide a more drastic solution if analgesics have no result.
• Air travel. Dentists recommend that you avoid air travel before treatment is completed. The low pressure inside a plane’s cabin causes the expansion of any gas trapped inside the tooth, and the toothache can be excruciating.
• Loss of temporary filling. After every treatment session the dentist will place a temporary filling to protect the tooth until it is permanently restored. If the filling is lost the tooth becomes exposed to the external environment and may feel extremely sensitive, especially if the removal of the tooth nerves is not completed. The tooth is also exposed to mouth bacteria that can cause re-infection of the tooth and more root canal pain.