Post root canal pain

Why Old Root Canal Infection Symptoms Return and What to Do Next

According to a study in the European Journal of Dentistry, the overall success rate of endodontic treatment, such as a root canal, ranges between 86% to 98%. While the vast majority of treatments go smoothly, these statistics indicate that a small percentage of patients who receive an endodontic treatment develop further problems months or years later when old root canal infection symptoms return. Read on to learn why a previously treated tooth might become problematic, what symptoms you may experience and how an endodontist can help you through endodontic retreatment.

Why You May Need Retreatment After a Root Canal

Even when every step of the procedure goes smoothly, a tooth that is treated with a root canal may experience prolonged sensitivity or reinfection. According to the American Association of Endodontists (AAE), certain circumstances may prevent a tooth treated with a root canal from healing properly:

  • If the dental professional misses tiny, hidden canals or curved canals during the first treatment, the bacteria inside them may not be entirely removed and can cause infection.
  • Immediately after the root canal, the dental professional often places a temporary filling to provide a short-term seal for the root canal before placing the permanent restoration (such as a crown or filling). If there is a delay in placing the permanent restoration, there is a greater chance that the root canal can get reinfected.
  • If bacteria in the saliva get under the filling material before the filling is placed, the canal can become reinfected.
  • If the patient doesn’t maintain proper oral hygiene, new cavities can form on the same tooth that already received a root canal.
  • A filling or crown placed on the tooth that received the root canal can crack, loosen or break, allowing a new infection to start.

Symptoms of Lingering Endodontic Problems

When any of the previous circumstances occurs with your root canal tooth, you may experience a range of symptoms. Here are some signs that indicate it may be time to make an appointment with your dental professional, according to the AAE:

  • Sensitivity to hot and cold, or lingering pain after consuming hot or cold food
  • Sharp pain when biting down or when tapping the teeth together
  • Constant pain and pressure
  • Swelling of the gums, with or without the presence of a pimple-like bump near the tooth on the gums
  • A dull ache experienced consistently in the same area

These symptoms indicate there may be an issue with the pulp of the tooth, which is the interior portion of the tooth treated by a root canal procedure.

How a Dental Professional Can Help

Your general dentist or endodontist will usually take X-rays to assess the condition of the tooth in question. The AAE notes that endodontists are specialized dental professionals who have received two to three additional years of education to diagnose and treat infections inside the tooth.

When you experience issues with a previously treated tooth, it may be necessary for an endodontist to reopen the tooth, explains the AAE. This process, called endodontic retreatment, allows the dentist to remove the original root canal filling material and reclean and reseal the canals. Following this procedure, they will place a temporary filling and you will receive your permanent restoration at a later appointment.

If you have a severe toothache or other old root canal infection symptoms, don’t hesitate to book an appointment with your dentist. When these conditions are addressed early, your dental professional can successfully retreat teeth and maintain your smile.

So, why do I need a root canal on a crowned tooth?

The problem with teeth is that they were not designed to deal with a lot of the stress we put on them or the things we ask them to chew on. Root canals are necessary when the pulp inside your tooth becomes infected. This can be caused by decay, a chip or crack in the tooth, or an old or poorly placed crown. If infection of the pulp is left untreated it can cause inflammation and serious pain. During a root canal, the infected pulp is removed from the tooth and the inside of the tooth is cleaned and disinfected. It is then filled and sealed with a material called gutta-percha. After the procedure, the top of the tooth is restored either with a new crown or filling, or by repairing your existing one.

Sometimes, it can become necessary to perform a root canal on a tooth that already had a crown put in. Crowns are typically installed to repair teeth that are cracked or damaged and in need of repair. They are different from fillings, because fillings are usually used to repair very small areas of damage. Crowns are used if the damaged area is larger and needs a different solution. Sometimes the pulp inside a tooth that had a crown installed will eventually become infected and a root canal will become necessary. This could be any length of time after the crown is installed, 5, 10, 20 years later. When initially examining the tooth before installing a crown, your dentist should check to see if the problem would be better addressed by a root canal. If you need a root canal immediately after you receive a crown, it could be simply that not all teeth are created equally, and unfortunately your tooth became infected after receiving a crown.

Have questions? Come see one of our Lane and Associates dentists!

If you have tooth pain and think you may be in need of a root canal or crown, come see one of our Durham dentists or dental teams in Raleigh, Chapel Hill, or around the Triangle and Piedmont of North Carolina. In addition, if you think you may need a root canal on a crowned tooth, come see our dental team and get our expert opinion on your best options. We are here to help, and love to make you smile! Call our team at 1-877-LANE-DDS or request an appointment online and let us make you smile today!

 “Why does it hurt if it’s had a root canal?” 

“What’s a Dental Implant and How Much Does it Cost?”

A dental implant is a man-made tooth root. It later is topped off with a special connector (abutment) and crown. This is typically done in phases after diagnostic x-rays are taken. The dental implant looks like a screw placed into the bone of your jaw. Once your bone or a bone graft integrates with the threads of the screw, it is stable and ready for the “tooth” to be attached. The total cost to replace a tooth with an implant is $3500-$6000+ depending on what type of x-rays and implant is needed or if you require a bone graft.

“Do Dental Implants Hurt?”

I hear this question every day! Most of my patients say it is less painful than getting a filling. Many patients notice pressure as the implant is being placed but no pain. Typically, we can place an implant in a short appointment and people return to their day comfortably.

“Is a Dental Implant My Only Option?”

Often a dental implant is the best option for replacing a failed root canal tooth. However, there are 2 other options. A partial denture, which is fake teeth that snap on to your other teeth and come in and out or a fixed bridge, which is a fake tooth suspended between two crowns cemented on the neighboring teeth. A third option, might be to do nothing, however, long term consequences of a missing tooth are shifting of surrounding teeth and loss of bone. These can create long term, bigger problems contributing to gum disease, crooked teeth and tooth loss.

For my wife, she was on and off again complaining of tooth pain from a crown and root canal done years earlier. We had numerous times taken a standard x-ray only to not see anything conclusive. When we finally took the CT 3D x-ray we could see the root had gotten re-infected. We met with the endodontist and he agreed it was able to be retreated andthe best plan was an implant.

At Madison Smile Solutions, we strive to help our patients keep their teeth. If this happens to you or you are continually aware of “on again/off again” sensitivity – please call us at 608-227-7000 for an exam to help you get in the right direction.

Root canal patients may experience pain while biting. Auburn Hills area dentist can help.

Much to your dismay, a tooth has become painful due to decay, infection, or both. Your dentist recommended and has completed a root canal to save the affected tooth. However, you are still experiencing pain in the area when biting. You may be asking yourself how this is possible. After all, the dentist explained that a root canal removes the inner pulp and nerve of the tooth. Isn’t that tooth dead? How can I feel pain if there is no longer a nerve in the tooth?
First, it is important to understand that a root canal does not kill the tooth. The outer enamel and dentin are still alive and healthy. The innermost layer of the tooth, the pulp chamber, and the root are the areas affected by a root canal. The nerve, located in the root, and pulp chamber are not vital to a tooth’s overall health and function. As a tooth begins to decay, bacteria can build up in the pulp chamber and irritate the nerve in the root of the tooth. The resulting infection from accumulated bacteria is what causes pain. Cleaning out the pulp chamber and root canal alleviates the source of the tooth pain.
Unfortunately, even after the root canal is completed, a patient may continue to experience pain when biting or chewing. There are a variety of reasons this may occur:

  • The tooth may still be experiencing some inflammation as a result of the prior infection or from the root canal treatment itself.
  • You may have a temporary filling, which is not ideal for chewing and may irritate the tooth.
  • A permanent filling or crown may not have the proper bite alignment.
  • An infection

The best course of action when experiencing pain or discomfort after a root canal procedure is to contact your dentist for an assessment. Under most circumstances, any discomfort or pain when biting or chewing is easily remedied with over-the-counter pain relievers like Ibuprofen. However, if the pain after initial root canal treatment is a result of a recurrent infection, your dentist will prescribe a course of antibiotics. If the pain is a result of an improper bite alignment, your dentist can complete the adjustment quickly and easily, usually during the assessment.
In the Auburn Hills area, if you or your loved one has had a root canal procedure and are experiencing pain while biting, contact the experienced dental professionals of Metropolitan Dental Center at (248) 365-7737.

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What To Do When a Root Canal Fails

What is Root Canal Failure?

A root canal fails when a tooth that has been previously treated with a root canal procedure becomes infected at the root. If this infection is allowed to continue to develop without proper treatment, the infection can potentially spread to other teeth in the area or cause illness in other parts of the body.

What Causes a Root Canal to Fail?

  • Undetected canal branches: Depending on the circumstances and the patient, a root canal procedure can be an intricate process. Sometimes, a patient’s tooth (such as a lower incisor, for example) may have more canals within it than are expected. Molars that have three roots may have as many as four canals, some of them hidden behind others. If one of these canals is missed and not treated, an infection will ultimately develop and can potentially form a painful abscess.
  • Obstruction: An obstruction (such as another tooth, filling material, etc.) may make it impossible for the dentist to reach and thoroughly clean the entirety of the canal affected.
  • Cracks in the root: The root of the affected tooth may develop a fissure or fracture deep beneath the gum, making it impossible to fully seal the canal. This allows for the possibility of an infection that leads to increased sensitivity, pain and the need for retreatment.

What are the Treatment Options for Failed Root Canals?

There are a number of options available for dental patients affected by a failing root canal. These include:

  • Retreatment
  • Apicoectomy (or surgery at the apex of the tooth)
  • Extraction of the affected tooth

Retreatment is the most common option and has the highest rate of success. It involves removing the original filling, disinfecting the canal and then resealing it to prevent further irritation and exposure to bacteria.

Apioectomy is the procedure most often chosen when a blockage of some sort prevents access to the canal or if the original procedure included a post and crown restoration. The process includes the creation of a small flap in the gum through which the root is accessed. The infected portion of the root may be completely or partially removed and a new seal is placed.

Extraction is the option chosen if retreatment is not effective or if the affected tooth cannot be successfully restored in any other way. If there exists sufficient bone at the site of the extraction, an implant may be used to fill the empty space.

Depending on the nature and the severity of the root canal failure, the dentist will consider all options available in order to make a decision regarding treatment and further surgery.

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Failure of Root Canal Treatment Misdiagnosed as Neuropathic Pain: Case Report


A patient presented with long-standing symptoms of neuropathic pain in the upper jaw. There were no signs of infection, and the patient had been told by several dentists and physicians that there was no evidence of any pathology. Investigations eventually revealed the source of the problem as failure of root canal treatment. Diagnosis of neuropathic pain (and other orofacial neurogenic disorders) is often a process of exclusion, and this case underscores the need for clinicians to eliminate all possible causes before reaching that conclusion.

Dentists see people in pain every day. Fortunately, in most cases the cause of the pain is relatively easy to diagnose, with periodontal disease, pulpitis (reversible or irreversible), infection and myalgia being the most common causes.1 Cracked tooth syndrome, vertical root fractures, myofascial pain and temporomandibular joint disorders may present with greater complexity, but can, with patience, be accurately diagnosed.2-4 However, atypical odontalgia, trigeminal neuralgia and neuropathic pain often present difficult diagnostic challenges.5 Accurately determining the source of a patient’s pain and selecting the most appropriate management technique should always be the goal.

Case Report

A 30-year-old woman presented with pain in the upper right jaw. She reported that she had been experiencing constant, throbbing pain for over 5 years. She noted that it began after she underwent root canal therapy on tooth 16 and that since then, she had never been completely pain-free.

In the years between the initial treatment and the current presentation, she had seen 2 general dentists, both of whom reported no sign of infection or failure of root canal therapy, and 2 endodontists, who similarly advised that no endodontic treatment was necessary. She had also had a consultation with an ear, nose and throat surgeon, who confirmed no identifiable pathology. In Russia, her country of origin, she saw another physician, who took a brain scan to eliminate any pathology of the central nervous system. The patient did not know whether the mode of imaging had been computed tomography or magnetic resonance imaging,6 but she reported that it too had yielded negative results.

The patient reported that she had recently completed 3 courses of an antibiotic (amoxicillin), which had provided no relief. In response to questioning, she reported that she had tried nonsteroidal anti-inflammatory drugs (ibuprofen, ketorolac), acetaminophen and acetaminophen with codeine, but nothing relieved the pain. She was frustrated and desperate for help.

The patient’s medical history was noncontributory. Radiographic examination showed acceptable root canal therapy of tooth 16, but no treated fourth canal on the mesiobuccal (MB) root could be visualized (Fig. 1). There was no sign of apical pathology on any teeth in the first quadrant. Palpation of the soft tissues showed profound mechanical allodynia: all of the buccal tissues were extremely tender to the lightest touch; all of the teeth from the canine to the second molar were equally sensitive to percussion; and teeth 13, 14, 15 and 17 were equally sensitive to cold, although none produced a lingering ache. All probing depths were within normal limits (as far as could be discerned, given that all tissues were exquisitely tender to any touch), and no swelling or sinus tract was visible.

The tooth had been restored with a direct composite, but no cracks on the clinical crown could be seen on microscopic examination.

Discussion of the potential diagnosis and required treatment included the possibility of neuropathic pain, such as atypical odontalgia. The patient asked that the tooth be extracted, as she could not take the pain any longer. It was explained that extraction might not resolve the pain and could actually worsen it. It was also explained that there was no overt reason to perform root canal retreatment; however, the clinician suggested that retreatment be started, with the idea of looking for vertical cracks after the old root filling material had been removed. The clinician was not optimistic about the chance of success with retreatment, but the diagnosis of neuropathic pain could be reached only by excluding all other potential pathologies, including failure of the previous root canal therapy.

Tooth 16 was anesthetized with articaine 4% with 1:200,000 epinephrine and lidocaine 2% with 1:100,000 epinephrine as a buccal infiltration. The tooth was isolated with a rubber dam, and the existing composite restoration was removed to ensure full exposure of the visual field and access to the pulp chamber. Three treated canals were observed, but the root fill (gutta-percha) had a “dirty” or “sludgy” appearance, consistent with infection. After removal of the gutta-percha, all canals were cleaned and shaped using a combination of hand and rotary files. An untreated mesiobuccal 2 (MB2) canal was located and was also negotiated to length. All canals were irrigated with 2.5% sodium hypochlorite, and the smear layer was removed after instrumentation with 17% ethylenediaminetetraacetic acid (EDTA). The canals were then dried, and final microscopic inspection under high magnification revealed no cracks whatsoever. Calcium hydroxide was injected to length in all canals, and restoration was accomplished with a cotton pellet and temporary endodontic restorative material. Although no purulent or serous drainage was observed, there was a distinct odour that is typically present when teeth with failing root canal therapy are instrumented.

The patient was given clindamycin 300 mg 1 tablet t.i.d. for 7 days and dexamethasone 2 mg 1 tablet t.i.d. for 3 days. As is typical with clindamycin therapy, the patient was advised to take a probiotic (e.g., yogurt and Lactobacillus acidophilus) in conjunction with the antibiotic, and to discontinue the drug therapy immediately if any significant adverse effects developed, such as diarrhea or a rash.

At the scheduled follow-up appointment, 4 weeks later, the patient reported that she had experienced immediate relief from her pain. Before administration of anesthetic, the patient’s teeth and tissues were examined, but no tenderness to palpation or percussion was found in the first quadrant . The root canal retreatment was completed without complication (Fig. 2).

Figure 1: Preoperative radiograph showing adequate root fill and no apical pathology.

Figure 2: Postoperative radiograph showing the final root fill.


Diagnosis of neuropathic pain is a process of exclusion. It involves methodically ruling out localized pathology in the form of odontogenic infection, periodontal disease, cracked teeth, caries or failed root canal therapy. This case underscores the responsibility of the attending clinician to be as thorough as possible when evaluating a patient who is experiencing pain. The patient may present with a variety of symptoms, rather than classical signs, and a comprehensive approach may be required to parse out the underlying etiology.7 In the case presented here, all of the dentists and physicians who examined the patient, including the current author, were certain that there was a neurogenic basis for her pain; nonetheless, it seemed worthwhile to investigate whether the tooth was cracked or the root canal therapy was failing. Retreatment was undertaken primarily because of the patient’s insistence and was ultimately successful. After years of frustration, this patient became her own greatest advocate. This case emphasizes the importance of the initial interview with any patient.


Dr. Shackleton is a general dentist in Calgary, Alberta, with a practice limited to endodontics. He is currently working on a 3-year master’s degree in orofacial pain and oral medicine through the University of Southern California.

Correspondence to: Dr. Thomas Shackleton, 18, 3919 Richmond Road SW Calgary, AB T3E 4P2. Email: [email protected]

  1. Kim JK, Baker LA, Seirawan H, Crimmins EM. Prevalence of oral health problems in U.S. adults, NHANES 1999-2004: exploring differences by age, education, and race/ethnicity. Spec Care Dentist. 2012;32(6):234-41.
  2. Manolopoulos L, Vlastarakos PV, Georgiou L, Giotakis I, Loizos A, Nikolopoulos TP. Myofascial pain syndromes in the maxillofacial area: a common but underdiagnosed cause of head and neck pain. Int J Oral Maxillofac Surg. 2008;37(11):975-84.
  3. Mathew S, Thangavel B, Mathew CA, Kailasam S, Kumaravadivel K, Das A. Diagnosis of cracked tooth syndrome. J Pharm Bioallied Sci. 2012;4(Suppl 2):S242-4.
  4. Gonçalves DA, Camparis CM, Franco AL, Fernandes G, Speciali JG, Bigal ME. How to investigate and treat: migraine in patients with temporomandibular disorders. Curr Pain Headache Rep. 2012;16(4):359-64.
  5. Clark GT. Persistent orodental pain, atypical odontalgia, and phantom tooth pain: when are they neuropathic disorders? J Calif Dent Assoc. 2006;34(8):599-609.
  6. Ibrahim S. Trigeminal neuralgia: diagnostic criteria, clinical aspects and treatment outcomes. A retrospective study. Gerodontology. Gerodontology. 2012 Oct 3. doi: 10.1111/ger.12011.
  7. Oshima K, Ishii T, Ogura Y, Aoyama Y, Katsuumi I. Clinical investigation of patients who develop neuropathic tooth pain after endodontic procedures. J Endod. 2009;35(7):958-61.

Root Canal Infection Symptoms

A root canal infection is a serious dental condition that is caused when bacteria reach the central canals of the teeth, either as a result of tooth decay or injury. A root canal infection should be treated as soon as possible because the condition can progress rapidly once bacteria infect the soft pulp tissue in the inner chambers of the tooth. Root canal therapy is an effective procedure that can be performed to eliminate the infection and restore the tooth.

At Dental Associates of New England, Dr. John D. Meola and our team of dentists educate patients about the symptoms of root canal infections so they can contact our office as soon as they develop the signs of the condition. To learn more about root canal infection symptoms, read on, and then contact our Boston, MA practice to schedule an appointment.


Pain is the symptom that causes most patients to undergo dental care when they have a root canal infection. Root canal therapy can cause severe pain. The discomfort is also characterized as pain that is particularly high when biting down or applying pressure to the tooth. In addition, the tooth may be especially sensitive to hot and cold foods and drinks.

Swelling and Tenderness of the Gum Line

A root canal infection can cause inflammation at the gum line. This swelling can cause the gums to feel tender and look more red than usual. In most cases, the swelling and discomfort is localized, meaning it affects the area surrounding the infected tooth.

Darkening of the Tooth

The tooth that is infected may darken and look more brown or yellow in color. When the tissues in the root canals become infected, they turn dark brown, affecting the color of the tooth. During root canal therapy, the darkened tooth material will be removed and the tooth will be capped with a crown, brightening the appearance of the tooth.

Dental Abscess

A dental abscess can cause extreme discomfort and bad breath. It forms when bacteria and the dying pulp tissue create a pus-filled pocket at the tip of the root. The abscess may create a bulge or recurrent red bump or pimple on the gums. It may also begin to leak foul-smelling liquid.

During root canal therapy, the painful abscess can be drained, and bacteria and dead tissues removed to restore comfort.

Chronic Bad Breath

Patients that have a root canal infection often have chronic bad breath. If bad breath is constant, even after brushing, flossing, and using mouthwash, an infection may be present.

The bacteria that cause root canal infections emit a foul odor. As a result, patients often experience bad breath and a bad taste in the mouth. The formation of an abscess can further exacerbate this problem.

If you are experiencing any of these symptoms, you may have a serious dental condition that needs to be treated in a timely manner to avoid further problems or tooth loss. Contact Dental Associates of New England today to schedule an appointment at our practice.

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After your procedure, your endodontist will send you home with instructions for pain management and how to care for your tooth while recovering from treatment and until a follow-up visit. Following guidelines for care is especially important if a temporary filling or crown is in place.

As the medication used to numb your mouth during the procedure wears off, you may feel some tenderness in the area for a few days as everything heals and some mild soreness in your jaw from keeping your mouth open for an extended period during the procedure. These temporary symptoms usually respond well to over-the-counter medication but your doctor may prescribe stronger, narcotic medication as well. It’s important to carefully follow the instructions for medications and that narcotics can make you drowsy so you should exercise caution when taking them and driving a car or operating dangerous machinery.

Though you may experience a slightly different sensation from your treated tooth than your other teeth for some time, you should contact your endodontist immediately if you experience any of the following symptoms:

  • Severe pain or pressure lasting more than a few days
  • Visible swelling inside or outside your mouth
  • An allergic reaction to medication (rash, hives or itching)
  • Your bite feels uneven
  • The temporary crown or filling, if one was put in place, comes out (losing a thin layer is normal)
  • Symptoms you experienced prior to treatment return

A root canal is a common procedure that dentists perform to treat certain types of tooth pain. During the procedure, the dentist will carefully remove dead, infected, and damaged pulp from the inside of the affected tooth (developed teeth can survive without the pulp), thereby eliminating the source of the pain.

Although this procedure is highly effective for treating pain, sometimes patients still experience tooth pain after root canal, and today we’ll tell you five of the most common reasons why.

  1. Tooth Pain After Root Canal: Post-Procedure Inflammation

One of the most common causes of post-root canal tooth pain is inflammation, which can be caused by the procedure itself or because the infection caused the tooth ligament to become swollen. In these cases, the swelling will subside in the days and weeks following the root canal, and the pain will resolve on its own.

  1. Tooth Pain After Root Canal: Infection

A root canal is often performed to remove infected pulp from inside the tooth, so it’s possible that there’s still some bacteria present after the procedure, and this can lead to infected tissue and more pain. Like with swelling, the problem should resolve itself once your immune system attacks and kills the bacteria, but if the problem persists, your doctor or dentist may recommend antibiotics.

  1. Tooth Pain After Root Canal: Fillings That Are Too Large

After your dentist removes the pulp from inside your tooth, the empty space is filled with a rubber-like material. If too much filling material is used, however, it will cause the tooth to sit higher, and this will cause pain any time you bite down. Although this problem won’t resolve on its own, your dentist can fix the issue easily by adjusting the filling.

  1. Tooth Pain After Root Canal: An Incomplete Root Canal

Some teeth, especially the molars, can have multiple canals, and it’s possible for a dentist to miss one or more of these during the procedure. In these instances, the initial cause of the pain never gets fixed, so you’ll still experience pain even after the root canal. Similarly, if the dentist happens to miss any of the damaged nerves inside the tooth that need to be removed, you may still experience pain when that tooth comes in contact with heat, cold, or something acidic.

  1. Tooth Pain After Root Canal: Damage to the Surrounding Tissue

During the root canal, tissue damage can occur if bacteria is accidentally injected into the surrounding tissue, if too much filling material is used and flows past the root tip, or if a file used to clean the inside of the tooth slips beyond the root tip and pokes into the tissue below. In these cases, the pain will disappear when the damaged tissue heals.

Root canals are an effective method for addressing problems caused by damaged or infected pulp, and this procedure is usually effective at eliminating tooth pain. However, if your tooth pain persists after the root canal, these are common issues that might explain the problem. In most cases, the tooth pain will resolve on its own, but if the pain is excessive or continues for more than five days, consult a dental professional as soon as possible.

Related Article: Brooks City Base Dentist: GPS Spotlight on Dr. Gary Skrobanek

Dr. Gary P. Skrobanek’s experienced and friendly team at GPS Dental offers family dentistry for all ages in San Antonio, TX area. Our Brooks City Base dentist office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we promote dental health awareness to our patients and provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at (210) 633-3477 to make an appointment.


Root canal treatment

When root canal treatment is needed

Root canal treatment is only required when dental X-rays show that the pulp has been damaged by a bacterial infection.

The pulp will begin to die if it’s infected by bacteria, allowing the bacteria to then multiply and spread.

The symptoms of a pulp infection include:

  • pain when eating or drinking hot or cold food and drink
  • pain when biting or chewing
  • a loose tooth

As the infection progresses, these symptoms often disappear as the pulp dies.

Your tooth then appears to have healed, but the infection has in fact spread through the root canal system.

You eventually get further symptoms such as:

  • pain when biting or chewing returning
  • swelling of the gum near the affected tooth
  • pus oozing from the affected tooth
  • facial swelling
  • the tooth becoming a darker colour

It’s important to see your dentist if you develop toothache. If your tooth is infected, the pulp cannot heal by itself.

Leaving the infected tooth in your mouth may make it worse.

There may also be less chance of the root canal treatment working if the infection within your tooth becomes established.

Antibiotics, a medicine to treat bacterial infections, are not effective in treating root canal infections.

Cracked Tooth Syndrome

What Is It?

Unlike teeth with obvious fractures, teeth with cracked tooth syndrome usually have fractures that are too small to be seen on X-rays. Sometimes the fracture is below the gum line, making it even more difficult to identify.

Cracked tooth syndrome more often occurs in molars, usually lower molars, which absorb most of the forces of chewing.

People who grind or clench their teeth may be more susceptible to cracked tooth syndrome because of the constant forces put on their teeth. Sometimes a person’s normal bite causes certain molar cusps (the highest points of the tooth) to exert so much pressure on the opposing tooth that it cracks.

Teeth with large fillings or teeth that have undergone root canal treatment are weaker than other teeth and may be more likely to crack. People with one cracked tooth are more likely to have others, either at the same time or in the future.


You may experience pain in the tooth when you bite or chew. However, it probably will not happen all the time. The tooth may be painful only when you eat certain foods or when you bite in a specific way. You will not feel a constant ache, as you would if you had a cavity or abscess, but the tooth may be more sensitive to cold temperatures. If the crack worsens, the tooth may become loose.

Many people with cracked tooth syndrome have symptoms for months, but it’s often difficult to diagnose because the symptoms are not consistent.


Diagnosis of cracked tooth syndrome is often difficult. Your dentist will do a thorough examination of your mouth and teeth, focusing on the tooth in question. He or she may use a sharp instrument called an explorer to feel for cracks in the tooth and will inspect the gums around the tooth for irregularities. Your dentist also may take X-rays, although X-rays often do not show the crack.

Your dentist may use a special instrument to test the tooth for fractures. One instrument looks like a toothbrush without bristles that fits over one part of the tooth at a time as you bite down. If you feel pain, the cusp being tested most likely has a crack affecting it.

Your dentist may shine a fiber-optic light on the tooth or stain it with a special dye to search for a crack. If the tooth already has a filling or crown, your dentist may remove it so he or she can better inspect the tooth.

Expected Duration

How long symptoms last depends somewhat on how quickly a cracked tooth can be diagnosed. Even then, treatment may not always completely relieve the symptoms.


If you grind or clench your teeth, talk to your dentist about treatment. Grinding can increase your risk of cracked tooth syndrome.


Treatments for cracked tooth syndrome do not always completely relieve the symptoms.

Treatment depends on the location, direction and extent of the crack. Cracks vary from superficial ones in the outer layers of the tooth to deep splits in the root affecting the pulp (the center of the tooth, which contains the tooth’s nerves).

If the crack affects one or more cusps of a tooth, the tooth may be restored with a crown. If a crack affects the pulp, you probably will need root canal treatment. About 20% of teeth with cracked tooth syndrome require root canals. After a root canal, the tooth will no longer be sensitive to temperature, but it still will respond to pressure. This means that if you felt pain when you bit down before the root canal, you probably will not feel it as intensely as before, but you may feel it from time to time.

In some severe cases, the tooth may need to be extracted. Some cracks extend into the root of the tooth under the bone and there’s no way to fix the tooth. If your dentist decides the tooth needs to be extracted, you can have it replaced with an implant or a bridge.

When To Call a Professional

If you experience pain upon biting or chewing, contact your dental office.


Treatment of cracked tooth syndrome is not always successful. Your dentist should inform you about the prognosis. In some people, a restoration with a crown will relieve all symptoms. In others, root canal treatment solves the problem. Some people continue to have occasional symptoms after treatment, and may need to have the tooth extracted.

Additional Info

American Association of Endodontists
211 E. Chicago Ave.
Suite 1100
Chicago, IL 60611
Phone: (312) 266-7255

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