PAIN AFTER ROOT FILLING

introduction

The root filling is the final step of a root canal treatment and seals the canals of the tooth against bacteria. The affected tooth can be painful, especially in the first few days after the root filling, as the procedure causes a certain degree of irritation to the tooth. But where does this pain come from and how long does it last? Do I have to worry that the discomfort is a sign that the root filling has failed?

Causes of pain after root filling

First and foremost, a slight pain in the first few days after a root filling should not be a cause for concern, because the procedure itself is always associated with a certain degree of irritation to the tooth. The insertion of the root filling and the subsequent squeezing and squeezing can create this pain. The practitioner informs the patient that the tooth can cause discomfort in the first few days after the treatment and that this is not a sign of a failed therapy.

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However, these complaints usually disappear completely after one to two weeks. If the symptoms persist, this could indicate that bacteria have remained in the canal system. Inadequate rinsing or massive inflammation at the tip of the root can cause painful inflammatory cells and bacteria to persist even after filling. The bacteria form antigens and toxins, which can only escape downwards through the closed root filling and thus trigger an inflammatory reaction.

Why is there pain?

The pain after a completed root filling can be caused by various factors.

The definitive root filling was placed at the wrong time:
An inflammation below the root tip, an apical periodontitis, requires a longer healing time. First, a temporary medication insert is placed in the root canals, which has an antibacterial and pain-relieving effect. This medication will be changed by the dentist several times until the inflammation subsides. Only then is the root canals finally filled.
If the process is interrupted prematurely, so that a definitive root filling is placed, although the tissue around the root tip has not healed, the bacteria are trapped in the canal, so to speak. As a result, the inflammation can widen after the root filling has been placed and infiltrate further tissue, so that the symptoms worsen.
The root filling is too short, blistered, not wall-tight:
Bacteria can still enter the root canal and cause inflammation and pain.
The root filling is too long:
If the root filling material protrudes beyond the tip of the root, the surrounding tissue is irritated and possibly reacts with inflammation in order to break down the exogenous material. This is particularly dangerous in the upper jaw, because the close relationship to the maxillary sinus means that too long a root filling can protrude into the maxillary sinus and cause inflammation there.
The tooth breaks or is split:
A longitudinal or transverse fracture after a root filling is always a possible complication that causes bacteria to enter the canal system through the fracture gap and the patient is in severe pain.
The consequence of a fractured tooth in the case of a longitudinal fracture or a very deep transverse fracture is always an extraction of the tooth. In the case of transverse fractures in the area of the tooth crown above the gums, the tooth can still be stabilized with a pin and a crown in individual cases.
The filling is too high:
The opening of the tooth during the root filling is closed either with temporary or permanent filling material, depending on whether it is a medication or the definitive root filling. If this filling is too high, the increased chewing pressure on the tooth creates a further stimulus to the tip of the root and pain occurs.

What is an overstuffed root filling?

An overstuffed root filling describes the phenomenon that with a root filling, the sealer, which seals the part between the filling material and the canal walls, overpresses. If too much sealer is introduced into the canal at an elevated level, it is pressed beyond the tip of the root and thus gets into the surrounding tissue.
In the USA this is considered desirable by dentists because it ensures that the filling is tight and reaches the root tip. In Europe, the treatment goal is defined in such a way that the filling should end exactly with the tip of the root.

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This can be seen radiologically through the control image after the root filling. Therapeutically, one waits to see whether the tooth is still free of symptoms despite the overpressed material. This is because the sealer can be broken down by the body's immune cells. If this is the case, the state can be left as it is.

However, if the symptoms persist or worsen after the root filling, the overpressed material must be removed from the tissue by a root resection.

What helps with pain after the root filling?

Since the problem lies inside the tooth, the person affected cannot reach the pain center. If the pain is severe, you can take pain killers. Ibuprofen is recommended because, in addition to its pain-relieving effect, it is also anti-inflammatory (but only from a dose of 600-800mg). Novalgin drops can also be taken for severe symptoms.
Please consult the attending dentist.

Furthermore, the patient should leave the affected area in the mouth alone and, if possible, not chew hard foods so that the tooth is not additionally irritated. The person affected should keep their heads high at home so that the blood flow in the affected area does not increase and thus promote inflammation.

Targeted cooling can also help against this. It is advisable to cool the affected area with a cold pack or cooling pad wrapped in a towel for 5 to 10 minutes at a time. Longer cooling is counterproductive, as it signals hypothermia to the body and counteracts it with increased blood flow. However, this is exactly what promotes inflammation. After the cooling phase, you should wait about half an hour to three quarters of an hour before starting a new cooling process.

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Home remedies such as chewing on cloves or rinsing with sage tea can only help to a limited extent, as the pain center cannot be reached.

Homeopathic globules are recommended as a support to strengthen the immune system and to alleviate pain symptoms. Arnica, Belladonna or Calendula are used in potency D12 for these symptoms. Consultation with the treating naturopath should be made for the globules that best suit your individual needs.

Which pain relievers work particularly well?

In the case of complaints after a root filling, painkillers have limited effect, as the pain center is in the canal system and is difficult or hardly accessible. Ibuprofen is particularly recommended, as it has both pain-relieving and (with a suitable dose) anti-inflammatory effects.
If the pain is particularly severe, Novalgin® drops can also be taken, but these require a prescription.

The disadvantage is that ibuprofen attacks the gastric mucous membrane and should therefore only be taken together with Pantozol, a stomach protector, for sensitive patients with stomach problems. Paracetamol is the drug of choice for people with intolerance to ibuprofen.

The active ingredient acetylsalicylic acid in aspirin or tomapirin, on the other hand, is counterproductive due to its blood-thinning effect.

What can the dentist do against pain after root filling?

The therapy for pain after a root filling depends on the cause of the pain. First and foremost, one waits to see whether the symptoms have receded and after a few days have minimized. Therapy is only initiated when the persistent pain quality and intensity does not change and remains permanent or remains stronger.

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Pain due to a root filling that is too short or too long is treated with a revision. During the revision, the existing root filling is completely removed and the canal system is again treated with medication and disinfected. When the tooth calms down, a new root filling is put into the tooth.
Read on under: Revision of a root canal treatment
A root filling that is too long is often treated with an apicectomy, the surgical removal of part of the apex. When separating the root tip, a check is made to ensure that the root filling is tight from the shortened point. If this is not the case, the root filling is sealed and filled retrograde, from below from the tip of the root.
If the inflammation below the root tip increases, the revision is also initiated and attempts are made to minimize the inflammation below the root tip by means of a medicinal insert. An accompanying systemic administration of antibiotics can also help to remove the inflammatory cells from the body more quickly.

The pain from the persistent inflammation below the root tip can also be caused by a fistula that forms from the root tip, the focus of inflammation, outwards, either into the oral cavity or outside the oral cavity. Pus is constantly drained through the fistula duct, which also causes pain. Therapeutically, the fistula duct can be surgically removed.
As a result, complaints due to a longitudinal or transverse fracture below the gums always mean that the tooth is not worth preserving. The tooth must be removed by the attending dentist.
If the pain occurs mainly when chewing, then the cause is probably that the filling is too high. This can easily be remedied by grinding in.

Duration of pain after root filling

The variability of the causes of complaints after a root filling causes a large variance in the duration of pain. While mild pain after root filling disappears completely after one to two weeks in about 80% of cases, other causes are responsible for the pain remaining for months.

Without a subsequent treatment by revision, root resection or tooth removal, the complaints will persist, which is why complaints after a root filling are usually protracted.
The healing of inflammation through subsequent treatment also depends on the individual immune system and the ability to regenerate. Wound healing disorders caused by medication or diseases such as diabetes mellitus have a negative effect on healing and thus prolong the duration of pain.

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The prognosis for pain depends on the cause. The slight complaints, which are almost always present after a root filling and which quickly subside, do not reduce the prognosis of the tooth. In cases of persistent complaints, the tooth can also be saved with a good prognosis with a revision or a root tip resection. Only in the case of a fracture is the prognosis poor and it is necessary to remove the tooth in order to maintain a symptom-free situation.

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