Dentalnews (en)

Toothache after root treatment – is this normal or is it malpractice?

The tooth aches and needs to be treated, but the ache still does not go away, is this normal?

After root treatment it is normal for the tooth to continue hurting for another 2-3 days. This is because the bone around the tip of the root is irritated by treatment, and this can cause pain. But If the pain gets worse, you should inform your dentist.

Here you can see how root treament is performed and what are the triggers to do it ...

Actually a toothache is never really the fault of the tooth, but rather the fault of the dentist or the patient!

Generally we speak of infections or cysts, and specifically infections in the bone.

Cysts in the mouth, or to be more precise, the jaw, are usually caused by infections in the bone – more on this tomorrow.

What causes infections in bones?
It starts when the dental nerve is damaged, e.g. by cavities or bad brushing habits (the patient’s fault). Or the dentist may inadvertently damage the nerve while drilling, either by drilling too deep or not providing sufficient cooling for the tooth, which leads to overheating – basically the nerve gets cooked).

Some other causes could be the chemicals used by the dentist, or white fillings – called composites – all this being the patient’s fault: more on this topic here.
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Once the nerve is damaged, you get a toothache lasting for several days!

Some of you may go to a dentist, while others do not, since the pain goes away after a while. What you may not know is that this is simply because the nerve is dead. But now the nerve begins to rot, just like meat which has been lying out in the sun. This rotting leads to an infection in the bone – and then you again have a toothache. This process can last days, weeks, months or even years. Once the infection is acute, you feel pain when you put pressure on your teeth, like when you chew. Chronic infections don’t tend to hurt, though.
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If your nerve damage has become acute, and you go to the dentist , then you still face the luck of the draw!
Root treatment – the lucky ones!
If the root is treated properly, using sterile root canal instruments, and using a coffer dam, then the damage caused by the nerve can be repaired, and you will soon be smiling again: to the left you can see a tooth after proper treatment, and to the right one which wasn’t treated properly.
The losers
Poorly performed treatment can lead to another infection days, weeks or even years later. And now we’re back to square one!

Toothache after root treatment – is this normal?

After root treatment it is normal for the tooth to continue hurting slightly for another 2-3 days. Slightly means that it can be treated using standard pain medication, that it does not increase intensity or start throbbing.

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It is important to use a cofferdam during root treatment and an optical magnifier. A coffer dam protects teeth from saliva and the tongue, which is absolutely necessary for clean work.

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The picture on the left shows a patient with a horizontal coffer dam, which isolates a tooth from the rest of the mouth and enables the dentist to concentrate on working.

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Saliva contains many hundreds of bacteria, which are prevented from invading the inside of the tooth, which should be cleaned and sealed tightly.

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If the channels on the inside of the tooth are not filled up to the root, then years later the bone can get infected, requiring root tip resection or extraction.

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An x-ray can be used to check the results of a root-tip resection, the channels should be homogeneously filled to the root. The picture below shows a tooth which has received good root treatment. Find out more about this topic from the video lexicon www.checkdent.com!

Toothache – what is there to say about it?

A pain that most people are familiar with, but what exactly causes it? And what can you do about toothache?

Starting with the tooth itself, if the neck of the tooth is exposed, this can cause toothache. The enamel does not always go over seamlessly into the root: sometimes some of the dentine is exposed. This area is usually found in the sulcus, below the visible gums.

How can the neck of the tooth be exposed? – this can be explained as follows:

You do not practice proper dental hygiene for some time, plaque forms, and leads to inflammation of the gums, the gums swell and start to bleed. Bone matter begins to recede, you start  taking better care of your teeth again, and the inflammation goes down. The inflammation of the gums also goes down, as does the swelling in the gums. But the inflammation has caused the gums to recede slightly, so the neck of the tooth is now exposed.

Using toothpaste containing fluoride helps to protect the dentine for the most part – but one day you drink too much fruit juice, the juice irritates the dentine, your teeth become sensitive to heat and cold. The pain does not stop until enough saliva accumulates in your mouth. One of many things which can lead to sensitive teeth.
Treatment:

After brushing your teeth, you can apply Elmex tooth gel and refrain from rinsing, if that doesn’t help then you can get the necks of your teeth sealed by a dentist!

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Cavities reach the nerve of the tooth, the tooth nerve slowly starts to die, you feel a dull ache, if bacteria are very aggressive and the cavity especially large then the nerve does not die slowly but quickly; you get a pulsating and intense pain which stops after a few days.
Treatment:

Go to a dentist for root treatment!

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You do not bother getting any treatment, the pain goes away and you forget about the problem. But is does not quite go away completely, the inflammation spreads to the bone, the tooth suddenly becomes sensitive to pressure and it hurts when you bite down. It may take days, weeks, months or even years for bone to become inflammed. Even faulty root treatment can cause bone to become infected.

Treatment:

Root treatment or root tip resection by a dentist!

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At some point you may notice a small bump on your gums, which bursts and releases pus. The pressure and the chewing problems decrease, the inflammation continues and bone continues to recede, but pus is able to escape through a fistule in the mouth  and the pain goes away.
Treatment:
Root tip resection by a dentist!

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One other reason for a toothache is the pain caused by parodontitis. Sometimes the gums hurt, and sometimes the teeth – if the neck of the tooth is exposed, this can cause pain. This can be a dully pulsating or a hot and cold pain.
Treatment:
Parodontitis treatment by a dentist, oral irrigator!