Pain after a root canal: can the tooth still be saved?

Which tooth hurts, and where is the problem?

A narrow canal missed during the original root canal treatment can still harbour infection. A crown that later loosens or cracks, or new decay, can also let bacteria enter from the crown side. The dentist checks for cracks in the tooth or root and whether there is enough tooth structure to support a restoration. If you have dental X-rays from before and after treatment, put them in date order so the dentist can compare the previous work with what has changed. [1]

How the two procedures reach the problem

In root canal retreatment, the dentist reopens the tooth from the crown side, removes the old root filling, looks for missed canals or new infection, and then cleans and seals the canals. An existing crown or post may affect access. Once the inside of the tooth has been treated, the dentist also needs to plan a permanent restoration that seals the crown side reliably. [1]

Root-end surgery reaches the tip of the root through the gum. The dentist removes inflamed tissue and, where necessary, a small part of the root tip and seals the end of the canal. This may be discussed if disease around the root tip persists and standard root canal treatment cannot adequately address it. If the root is cracked or the remaining tooth cannot be reliably restored, the dentist will need to assess separately whether the tooth can be kept. [1,2]

What to ask at an assessment in China

An endodontic department at a dental hospital is a place to start. Guangzhou Medical University’s published specialty profile lists treatment under a microscope and microsurgery at the root tip, an example of how to identify the appropriate department. Bring old X-rays and treatment records, and say whether a crown or post has been fitted. Ask the dentist to write down which step deals with the infection, when the permanent restoration is fitted, and which follow-up visits a dentist at home can handle. See the questions to ask before agreeing to treatment when comparing options. [1–3]