For Patients: Pain in an Old Root Canal? Don’t Panic and Consider a Retreatment!

If you’ve been dealing with sudden pain in an old root canal, it can be alarming. The first thought that might cross your mind is the possibility of having the tooth extracted, which is the last thing most patients want.

Fortunately, getting your tooth extracted often isn’t the only option, especially if you make an appointment with your dentist or endodontist at the first sign of discomfort. Getting your tooth retreated with a brand-new root canal can be a cost-effective, time-saving, and confidence-boosting alternative that will keep your smile bright and beautiful for years to come.

In this article, I’ll show you why experiencing new pain in an old root canal doesn’t necessarily mean extraction and why a retreatment is often a preferable alternative. With this knowledge, you’ll hopefully feel more empowered to make decisions about your dental care should this situation ever come up in the future. As I always say, #GiveTeethAChance!

Why You Could Have Pain in an Old Root Canal

Tooth pain in a previously treated root canal doesn’t happen often. That’s because a large majority of root canals are successful on the first try! But when pain does occur, it can be due to a variety of reasons, and that pain can spring up anywhere from months to years after the initial treatment. 

Some of the most common causes include:

• Remaining bacteria that wasn’t completely removed during the first treatment
• Re-entry of bacteria before the permanent restoration (i.e. the crown) is put into place
• Formation of new cavities or cracks in the same tooth
• Issues with the permanent restoration, such as cracking, loosening, or breaking

While none of these situations is ideal, they can usually be resolved with a retreatment. So if you’re experiencing pain in an old root canal, don’t assume that your tooth can’t be fixed and has to be extracted. On the contrary, your pain is almost always treatable, and your endodontist or dentist will be happy to help you feel better as soon as possible.

Exploring Retreatment for Pain in an Old Root Canal

Not only is extraction usually not the only option—it’s often not even the best option, either! In many cases, your dentist or endodontist can retreat your tooth, which involves reopening the previous root canal, addressing any issues that may have arisen since the initial treatment, and sealing the tooth again. 

There are many reasons why a retreatment is a preferable alternative to an extraction:

• Preserving your natural tooth: Keep those beautiful pearly whites your mama gave you! Retreatment allows you to keep your natural tooth, which is WAY better than having a gaping hole where your tooth used to be. Plus, extracting a tooth can lead to additional challenges, such as the need for a dental implant or bridge.
• Maintaining your jawbone health: Keeping your natural tooth also helps preserve the surrounding jawbone, which may be compromised with tooth extraction. Maintaining a healthy jawbone is super important for maintaining your overall oral health and facial esthetics, because your jaw’s function is to support and hold your teeth. If you lose enough teeth, you can lose jawbone mass over time.
• Keeping the integrity of your dental structure: With retreatment, you’re able to maintain the integrity of your dental structure, helping you avoid the issues that can arise from extraction, like having a harder time chewing, talking, and breathing.
• Lowering costs: In many cases, a retreatment is a far more cost-effective solution compared to extraction and replacement options like an implant or bridge. That’s because a root canal is a one-and-done procedure, whereas if you go the other route, you’ll need to pay for a costly implant or bridge after the extraction, since they often aren’t covered by insurance.
• Protecting your self-confidence: By maintaining your dental structure and preserving your natural tooth, a retreatment can keep you feeling confident in your smile. You deserve to have a glowing smile! This is how we feel like a boss when it comes to finding success in our careers, relationships, and so much more.

Consulting Your Dentist

If you’re experiencing new pain in an old root canal, schedule an appointment with your endodontist as soon as possible. During the consultation, discuss your symptoms and concerns. You’re in charge of your own health here, and don’t forget just how empowered you are! 

Your dentist will evaluate your case, conduct necessary diagnostic tests, and recommend a treatment plan. If for whatever reason they don’t take your concerns seriously or try to push for a treatment option without explaining why, don’t be afraid to advocate for yourself by asking informed questions, discussing the possibility of retreatment, and seeking a second opinion.

Tooth Story: How I Discovered the Cause of a Patient’s Pain

As an endodontist, there are times when patients come to my office with pain in an old root canal performed by another provider, and I have to figure out what’s going on. But my job is made easier when I make an effort to listen to their experience.

For example, one time I had a patient who came in complaining of an uncomfortable sensation on the upper left side of her face, in the same area where she had a previously treated root canal. Her pain was difficult to pinpoint or explain, but she was adamant that something didn’t feel right. Of course, I totally believed her! She knows her body best.

After listening to her describe how she had been feeling and doing some initial diagnostic tests, I wanted to take a look at her x-rays to evaluate her previous root canal. This is what I saw:

As you can see, the roots visible on this x-ray look pretty well filled in, meaning that her previous provider did a good job. That said, I did see some areas where there could be issues, so I didn’t want to completely rule out the initial root canal as the source of her pain.

Next, I looked at what’s called a CBCT, or cone beam imaging. This type of special 3-D imaging allows me to take a closer look at what’s going on inside the tooth from any angle. Sure enough, when I looked at the axial view (which shows us what the tooth looks like in cross section), I discovered the culprit: an untreated canal! Specifically, it was what we call the MB2, which is a canal that’s notoriously easy to miss during a root canal.

You can see it on the coronal view as well….

And just so you have it, here is the sagittal view of the CBCT…

A tiny canal in this tooth wasn’t cleaned out and filled in the first root canal—and it’s extremely important that every single canal is free of bacteria and sealed. Otherwise, the patient may continue to experience pain and need a retreatment, just like in this instance!

Once I found the source of the problem, it was an easy fix. All I had to do was go back into the tooth, clean it out all over again (but treat it all this time), fill the canals, and seal it back up.

Takeaways: Trust Your Gut and Consider Retreatment

The main thing I want you to take away from this article is that pain in an old root canal doesn’t automatically mean your tooth is destined for extraction. If you’re experiencing any discomfort in a previously treated tooth, make an appointment to see your endodontist or dentist. They’ll be able to determine what’s going on and help you figure out whether retreatment is the right option for you.

I also want this article to empower you to advocate for your dental health in general! Whenever something doesn’t feel right with your teeth, trust your gut and consult with your dentist or endodontist. A good provider will listen to your concerns, answer your questions, and explain what’s going on in an accessible, easily-understandable way. And if they don’t, know that you have every right to seek a second opinion elsewhere.

By being proactive, you can play a major role in keeping your teeth healthy! 

– Sonia