What to expect after your root canal appointment.

What happens after root canal visits?

Whether you’re between appointments or your dentist has completely finished your tooth’s root canal work, you’ll no doubt want to know what to expect and what you should do during the hours and days that follow.

In our coverage of these issues, we’ve divided this page into the following subsections:

a) Post-root canal visit pain – What can happen, what to do.

It’s a disappointing fact but some percentage of people will experience some level of discomfort (and possibly even swelling) after their scheduled root canal visit.

For those who do, the first half of this page provides information about possible causes and remedies.

b) Root canal aftercare – What you must do.

Even though your tooth’s root canal therapy is now finished, you’ll need to keep in mind that all of the other dental work it needs still hasn’t been completed.

The care and precautions that you take over the days and weeks until it has been, can have a significant effect on the ultimate outcome of both it and its just completed root canal work.

a) Will you have any pain after your root canal appointment?

Quite possibly yes. It’s generally reported in dental literature that somewhere between 40% to almost 60% of patients will experience some level of discomfort after having had endodontic treatment.

It’s important to keep in mind however that these numbers include all cases lumped together, ranging from those where the level of discomfort experienced ranged from just slight to the most severe.

How much pain can you expect?

Study #1 –

The findings of a study by Sadaf give an idea of what might be expected.

• This study monitored 140 patients during the day (24 hours post-op) following the completion of their (two-visit) root canal therapy.
• 57% reported no discomfort after their work. For those who did, 22% reported mild, 19% moderate, 1% intense, and 1.4% unbearable pain.

▲ Section references – Sadaf

Study #2 –

A second study we’ll mention was performed by ElMubarak. It monitored patients completing their endodontic treatment (requiring either 1 or 2 visits) at points 12 and 24 hours post-op.

The findings were somewhat different than those reported by Sadaf. With this study, both time intervals shared similar numbers:

• At 24 hours – 89% developed no discomfort. 2% experienced mild, 1% moderate and 9% severe postoperative pain.

▲ Section references – ElMubarak

Study #3 –

A study by Ali followed 270 patients who underwent one-appointment endodontic therapy for up to 72 hours following their treatment. Of these patients:

• 55% experienced some level of postoperative pain.
• Broken down into groups: 26% of patients experienced slight pain (no analgesic needed), 21% moderate (pain relievers were required) and 7% severe discomfort.

▲ Section references – Ali

Endodontic flare-up.

The studies above evaluated patients after the completion of their work. But some root canal visits are intermediary ones, where just a certain stage of the process is performed.

To address this difference we’ll cite a literature review by Tsesis. This paper evaluated published research involving “endodontic flare-up.”

• Flare-up was defined as pain or swelling that developed after any type of scheduled root canal appointment that necessitated the need for an unscheduled dental visit to address it.
• (For this review, the flare-up had to occur within 48 hours following the patient’s procedure.)

The paper determined that the incidence rate for flare-up lay on the order of about 8%.

Comment – This number isn’t exactly inconsequential. However, this paper also reveals that for the vast majority of people (92%), if problems do develop they are generally relatively easy to manage (most likely via the use of OTC or prescription products, if needed). But that doesn’t mean that the members of this group didn’t suffer at all or weren’t inconvenienced.

▲ Section references – Tsesis

What to expect over longer time frames.

• At two days post-op: 80% of patients had no pain, 8% had slight pain, and 12% had moderate to severe pain.
• At day 7: 93% of patients had no pain, 4% had slight pain, 3% had moderate pain and one was experiencing severe pain.

▲ Section references – Al-Negrish

What type of pain can you expect following root canal work?

What’s common –

• The discomfort typically starts within a few hours after your root canal appointment.

  (Premedicating with an OTC pain reliever may help to minimize the level of pain you experience. Discussed here.)

• The pain may persist for several hours up to several days.
• The severity of the discomfort gradually decreases over time.

▲ Section references – Makhtari, Sadaf

While you should always feel free to contact your dentist whenever you have concerns, experiencing any of the following issues should definitely prompt you to do so.

Reasons to contact your dentist –

• Severe pain or a sense of pressure that lasts for more than a few days.
• The development of swelling inside or outside your mouth.
• Symptoms return that are similar to what you experienced prior to your treatment.

Additional reasons to contact your dentist –

• Your bite on the treated tooth feels uneven (see below).
• The temporary crown or filling that’s been placed on your tooth has dislodged.
• Experiencing an allergic reaction to medications you’ve been given or have taken is possible. Watch for signs such as itching or the formation of a rash or hives.

What causes after-root canal treatment pain?

Overinstrumentation is a common cause of post-treatment pain.

a) The discomfort you notice is probably due to inflammation.

• Root canal files that have poked beyond the end of the root. This is referred to as “overinstrumentation” (see animation).

  (This is why one of the first steps of root canal treatment involves measuring each canal’s length. How that’s done. The dentist’s goal will then be to stay within the confines of these measurements Using markings found on each file. as they perform the tooth’s work.)

• The escape (extrusion) of bacteria and debris from the root’s tip.
• Leakage of solutions and medicaments used during the root canal process from the tooth into the tissues surrounding its root.

These events aren’t necessarily preventable.

It’s important to point out that despite a dentist’s best efforts to minimize the chances of each of the above from occurring, being able to absolutely prevent them is something that lies far beyond their control.

b) Infection may play a role.

It’s possible that the process of performing a tooth’s root canal therapy has triggered the activation of bacteria living in association with it. If so, an acute infection may develop.

But in the majority of cases, the discomfort a person notices after their appointment is primarily due to tissue inflammation without the complication of active infection.

What might trigger post-op infection?

The general scenario involved is one where during the cleaning and shaping process How this is done. the action of the dentist’s files within the tooth’s root canal(s) results in the escape of bacteria into the tissues that surround its root(s).

Studies have shown that despite their best efforts, the extrusion of debris from a tooth during cleaning and shaping tends to occur regardless of the technique the dentist uses (Sipaviciute). We’ll also mention that it would be impossible for the dentist to know if, or to what extent, this event had taken place.

Whether or not what has occurred will trigger a significant event is quite variable. Factors such as the virulence of the microorganisms involved, their numbers deposited in the root’s surrounding tissues and the effectiveness of the person’s immune system in response to them will all play a role.

c) Additional possibilities.

▲ Section references – Ingle, Sipaviciute

Does post-op pain indicate that your root canal treatment has failed?

There’s no reason to expect that what you experience immediately after having your endodontic treatment performed is an indicator of its long-term success.

• The development of pain immediately after receiving treatment correlates with the intensity of the tissue irritation that took place during the work.
• Root canal treatment failure Signs, symptoms, reasons. occurs when a source of tissue injury still persists over the long-term.

  This generally relates to deficiencies associated with the work and therefore its inability to provide its intended purposes. What root canal accomplishes.

Predictors of pain after root canal work.

There are some risk factors that tend to correlate with which patients will or won’t experience discomfort after their root canal appointment.

Preoperative pain = Postoperative pain.

A study by Sadaf (linked above) determined that the biggest risk factor for postoperative discomfort is having preoperative pain. 83% of patients whose tooth hurt prior to their root canal appointment experienced pain afterward. In comparison, only 17% of those without symptoms did.

As lesser factors, this study also determined that:

• Females are more likely to experience discomfort (65% vs. 35% for males). (Other studies have reported similar findings.)
• Possibly the type of tooth receiving treatment is a factor. With this study, 50% of patients experienced moderate pain when a lower molar was treated vs. 35% for upper ones. Lower numbers were associated with other types of teeth. (Not all studies have found tooth type to be a relevant factor.)

Other studies have reported similar findings.

• 69% of patients that had no preoperative pain remained pain-free following their tooth’s procedure.

  Of the group that did have preoperative pain, 100% also experienced postoperative discomfort.

• Only 4% of the no pre-op pain group experienced severe post-op pain.

  73% of the group that had pre-op pain had severe post-op pain.

• This study also determined that the treatment of premolar and molar teeth was more likely to be associated with postoperative pain than front ones. And that treating lower teeth resulted in post-op pain more so than uppers.

Managing post-root canal pain.

Since the most likely cause of discomfort after a root canal appointment is periradicular (around the root) tissue inflammation (see above), a dentist’s initial treatment is typically focused toward managing it. A paper by Jayakodi discusses the following treatment approaches.

Note.

Whenever a medication is selected for use, the patient must evaluate the product’s labeling so to make sure it’s use is appropriate for them. The product’s dosing recommendations should not be exceeded.

NSAID analgesics.

Dentists frequently use over-the-counter (OTC) “nonsteroidal anti-inflammatory drugs” (NSAID’s) as their first choice in treating tissue inflammation triggered by root canal work.

Dosing.

For healthy full-sized adults (with no complicating factors and under the guidance of their dentist), a common regimen is: 200 to 400 mg orally every 4 to 6 hours as needed for pain relief.

Acetaminophen.

In cases where the use of an NSAID cannot be tolerated by the patient (known sensitivity to NSAIDs or aspirin, gastrointestinal ulcerations, NSAID complicated hypertension), a dentist will typically turn to the use of acetaminophen (Tylenol).

Dosing.

For healthy full-sized adults (with no complicating factors and under the guidance of their dentist), a common regimen is: 325 to 650 mg every 4 to 6 hours as needed for pain relief.

Prescription medications.

If the patient’s pain can’t be controlled by one of the above drugs, a narcotic analgesic (prescription pain reliever) may be required. It’s sometimes given in combination with an NSAID.

Antibiotics.

As stated above, tissue irritation as opposed to active bacterial infection is the most common cause of a patient’s pain after root canal therapy. And for that reason, the initial treatment of what a dentist interprets as a routine case typically won’t include the use of an antibiotic.

If at any time they have reason to suspect that infection does play a role, an antibiotic will be prescribed.

Keep in touch with your dentist.

▲ Section references – Jayakodi

Preventing anticipated post-root canal treatment pain.

Before your appointment.

“Premedicating” with an NSAID before root canal work may help to limit or prevent the amount of postoperative discomfort a patient experiences. Ibuprofen (Motrin, Advil) is frequently used. Ask your dentist what makes an appropriate choice and plan for your case.

▲ Section references – Mokhtari

Following your appointment.

In cases where premedication with an NSAID before your appointment was not considered, per your dentist’s recommendation taking a dose before the local anesthetic used for your procedure has worn off can be effective in helping to prevent or limit post-endodontic treatment pain.

While the time frame involved is shorter than with premedication and therefore likely to provide a less pronounced benefit, the idea is that the NSAID can start to have an effect prior to that point when any pain can be felt.

Other possible sources of pain after root canal.

a) Gum tissue trauma.

A rubber dam clamp.

• The tenderness you notice should just be minor and can be expected to disappear in a day or so.
• The use of a salt-water rinse may help to speed up healing. (1/2 teaspoon of salt to a cup of warm water. Rinse every three to four hours. Spit the rinse out.)

b) A high temporary filling.

If the “bite” of the filling that your dentist placed at the completion of your dental visit is too “high” (too tall, in the sense that when you close down you strike the filling first), your tooth may become traumatized and begin to hurt.

• The needed solution is that you return to your dentist’s office so they can buff the filling down until its bite is correct.
• Since this trauma causes inflammation of the tissues that surround the tooth, even after the filling has been trimmed the pain may continue for some time.

  The inflammation management techniques discussed above would be appropriate for this problem too.

b) Root canal aftercare: What precautions should you take?

After an appointment, don’t look for trouble. It’s usually best to exercise caution with a tooth that’s either having endodontic therapy or has just had it completed.

Favor your tooth.

Until your dentist tells you otherwise, you generally avoid using your tooth too extensively. Here are some reasons why:

Take it easy on your tooth’s temporary filling.

1) The filling may break.

This is a very serious complication and one that can lead to root canal treatment failure. This is why upon the completion of your tooth’s endodontic work its permanent (final) restoration should be placed as soon as can reasonably be arranged.

2) The tooth may break.

Since the way their tooth feels is now back to normal, a person is often eager to make use of it again.

Until your dentist has had a chance to finish rebuilding your tooth What will be needed?, it should be considered fragile. What a disappointment it would be to spend the time, effort, and money to have root canal treatment performed, only to have the tooth irreparably break or crack before it was fully restored.

3) Foods to watch out for.

In light of the above, avoid using a root canal tooth to bite into or chew hard or crunchy foods. Notably, this might include items like raw vegetables (carrots, celery), nuts and hard candies. But really, due to a tooth’s potentially fragile state, any number of other kinds of foods might be able to cause damage too.

Maintain proper oral home care.

1) Flossing.

This type of restoration often isn’t as finely crafted as “permanent” ones are. For example (as illustrated in our graphic).

• Restoration “B” represents a “permanent” filling placed in a tooth following its root canal treatment. Notice how its contours match that of its tooth.
• Restoration “A” represents a temporary restoration, and notice how its contours extend past the side of its tooth. These ledges are referred to as “overhangs.”

Precautions. What to watch out for when you’re flossing.

The potential problem that exists is that when you floss you may snag on a temporary filling’s overhang.

• If your floss feels like it’s starting to wedge, back off. Forcing your way may end up with getting your floss stuck or breaking your filling.
• If you get into trouble or are close to it, let go of one end of your floss and then pull it out to the side.
• Despite the temporary nature of this restoration, report the difficulties you’ve noticed to your dentist so they can trim away the excess filling material.

  (If you can’t clean your gums around your tooth properly they will become tender and sore. Poor gum health will also make the process of creating the final restoration for your root canalled tooth more difficult.)

2) Tooth brushing.

All teeth require regular brushing and a tooth that is receiving, or has received, root canal treatment is no exception. In the case where your gums or tooth are sensitive, simply do the best that you can.

Rebuilding your tooth after its work has been completed.

All teeth that have received root canal therapy will need some type of final (“permanent”) restoration.

The kind that’s chosen, as well as the time frame in which it’s placed, can greatly influence the long-term success of a tooth’s treatment. Use this link for a discussion about the different types of restorations that might be placed When? | Why? following root canal treatment.

Comments.

This section contains comments submitted in previous years. Many have been edited so to limit their scope to subjects discussed on this page.