My Root Canal Tooth Still Hurts Despite Steroids

My dentist did a root canal and crown in late November 2021, but in about three weeks, the tooth started to hurt. My dentist took x-rays, and she said the tooth looked sound without cracks. In January, my dentist referred me to an endodontist who prescribed antibiotics. I returned to the endodontist in two weeks, and by that time, most of the pain was gone. The endodontist said that the pain would gradually disappear, and most of it did. But last Thursday, I woke up with a severe toothache. I scheduled an appointment with the endodontist, saw him this past Monday, and he prescribed steroids. The pain is still intense, throbbing, and pulsing. Should I feel relief by now? Jacob from Delaware

Jacob,

Thank you for submitting your inquiry to our office.

Although dentists commonly prescribe steroids for root canal pain, they are ineffective in some cases. It seems that, in some situations, doctors lack diagnostic skills and an understanding of pharmacology.

Steroids for Root Canal Pain

Although some doctors subscribe steroids for root canal pain, it is essential to determine if the tooth is infected, irritated, or both. Steroids are anti-inflammatory drugs, but steroids can block the body’s response to infection.

Irritation after root canal treatment – Irritation around the root tips after root canal treatment is typical. During root canal treatment, some of the infected tooth pulp can get pushed through the root tips, or the root canal files can poke through the end of the tooth. Irritation can cause a cycle of post-operative pain as inflammation swells the tissue at the root tip, pushes the tooth up, causes occlusion issues, and increases pain. Although steroids can provide therapy for this situation, they are often combined with a brief course of antibiotics because there is a risk of infection at the end of the tooth. Both irritation and infection must be treated.

Flare-up weeks after root canal treatment – Infection is usually the cause of a pain surge weeks after root canal treatment. Your delayed pain suggests that it is not connected to irritation from root canal treatment. That is why your endodontist prescribed antibiotics, which worked. But your pain is not entirely resolved, so you need another round of antibiotics and repeat root canal treatment.

Repeat Root Canal Treatment

Repeat root canal treatment is necessary when a dentist does not entirely remove the infection from the tooth. The root canal system inside some teeth can have angles that are easy to miss. If the entire system is not fully cleaned out, infection lingers and will eventually flare-up.

And it is not that your dentist is at fault. Some root canal systems require an endodontist’s instruments and skill level (a root canal specialist). We do not understand why your endodontist did not recognize the cause of your pain but instead told you that it would disappear. It will not disappear without repeat root canal treatment at a minimum.

Prematurely Crowning a Root Canal Tooth

If a dentist places a crown before ensuring root canal treatment is successful, then retreatment will be more difficult. Either your endodontist must drill a hole in your crown to access the roots or remove the crown for clear visibility.

We Recommend a Second Opinion

Because your endodontist seems uncertain about how to treat your tooth, we recommend getting a second opinion. After examining your tooth and assessing its condition, the second-opinion endodontist will recommend treatment. Your treatment options may include:

1. Repeat root canal treatment – The endodontist will remove the root canal filler material, clean and disinfect your tooth, and refill it.
2. Root canal surgery (apicoectomy) – During this procedure, the endodontist will access the tooth through the gum tissue and tooth root instead of from the crown, as with root canal treatment.
3. Tooth extraction – Although this is the least desirable treatment option, sometimes tooth extraction and a dental implant are necessary.

San Antonio dentist Dr. Gilberto Tostado sponsors this post.