Have you just had a tooth root canal treatment, and you are wondering when your pain, numbness and swelling will subside.
or are you still feeling discomfort after a week of post root canal treatment, and wondering if your pain is normal?
How long do post -root canal pain and discomfort last after having a tooth root canal? This is a common question I hear all the time.
As a diagnostic radiographer, I answer these questions based on my knowledge and international medical literature.
I have also just gone through a tooth root canal and my pain and discomfort persisted for a week.so am writing this out of experience.
Happy reading!😀
Any questions? remarks? Let’s meet in the comments section at the end of this article.🙏
Last updated: Nov 2024. Written by Juliet Semakula, a diagnostic radiographer.
Disclaimer: no affiliate links.
Summary: Even with a perfectly performed root canal, there can be pain that is considered normal for 3 to 5 days after treatment. Some common discomforts will be swelling, sharp, intense pain or pressure when you bite on the tooth.
▶️What is a root canal treatment?
Before we delve deep into the subject matter let’s understand what a tooth root canal is.
When your tooth pulp is infected or damaged the dentist will suggest a root canal treatment.
Here the infected pulp and nerve from the tooth’s root will be removed and then cleaned, shaped then the space will be filled and sealed.
The blue arrows show an infection down the root canal
A root-filled maxillary canine with a large excess of sealer and persistent apical periodontitis. (B) Completed surgery, including root-end filling and c shows an outcome assessed as ‘healed.’
The goal of a root canal is to save the tooth and prevent reinfection and stop tooth pain.
▶️Pain after a tooth root canal is a common and normal phenomenon.
Firstly, it is important to know that pain after a tooth root canal surgery is well recognised and studied.
There are numerous studies aimed at better understanding and alleviating post operation pain after a tooth root canal treatment
Here are some numbers of different PubMed studies that explain this pain.
How common is tooth pain after a root canal treatment?
You may be wondering why you are feeling more pain after a root canal, yet the purpose was to alleviate pain in the first place.
Tooth pain and sensitivity after a tooth root canal is a very common issue and very normal for at least 5 days following treatment.
Some people complain of pain which comes spontaneously or provoked by biting, palpation or tapping for at least a week after treatment.
▶️How long does the pain last after a root canal?
Pain may arise only after the procedure, but it is a natural tissue recovery process called inflammation.
🟠Pain and sensitivity after a root canal are expected to be mild and temporary after a few days of treatment.
🟠Pain should then subside between 3 to 5 days.
🟠Day 5 to 7 pain should have disappeared in most people, you may feel a slight discomfort when chewing on the affected side.
🟠Some people’s numbness will linger around for a 2 to 4 hours depending on the type of anaesthesia that was used to numb the place.
Some people have extra long-lasting numbness for up to 8 hours or more which is still normal for some people.
This is due to Individual reactions to medications which influence the duration of numbness or Numbness can be a sign of nerve damage or a failed root canal.
🟠Discomfort should subside within 7 days. The treatment will progress well if the pain does not intensify during the recovery period.
You should be able to even go back to work on the same day after your root canal treatment.
Some studies done by Ali et al 2012, reported incidents of post- root canal treatment pain with the 12 hour,24 hour and 48 hour period on a group of patients who had undergone treatment after a follow up
The table below shows the level of pain in relation to the preoperative pain at 12th,24th and 48 hours.
Pain after a root canal is expected due to infection trauma, retreatment, intracanal medications, and physical and chemical damage to periapical tissue during the process of treatment (Ali ,2012)
However, pain reduction was reported to range from 0% at 30 days to 65% at I day. You expect pain to decline over time for example in 9% after 12 hours, which was reduced to 8.6% after 24 hour and drastically 4% after 48 hours (Ali ,2012)
What do we learn from this: Pain is expected to be more frequent during the first 24 hours of the treatment period and it is likely to reduce as time passes.
▶️What causes pain, swelling, throbbing and discomfort after a tooth root canal.
1️⃣Inflammation which is a normal part of the body’s response to infection or injury
Inflammation of periapical tissues pain is one common short-term complications after root canal treatment (Gupta 2021)
After the infected pulp is removed. Sometimes the residual infection surrounding the tooth can cause inflammation which will cause mild pain.
However, inflammation is a good thing because the body releases chemicals that trigger an immune response to heal the damaged tissues.
2️⃣Trauma to the tissues surrounding the tooth.
The process of cleaning out the infection pulp may inadvertently lead to some damage or irritation to these tissues resulting in discomfort and pain
3️⃣Pre-existing conditions such as gum disease or cracked teeth can sometimes contribute to ongoing discomfort after a tooth root canal.
Caution! Post-operative pain is higher in elderly patients than in young patients because of less pain tolerance, less blood flow, and delayed healing
There are several types of pain after a tooth root canal
Is it possible to feel very different pains after a root canal procedure?
Here are the most described ones, along with some explanations.
| Types of pain after a tooth root canal Treatment | Explanations |
| Immediate pain | Pain which is usually mild and can last 2 to 4 days. This pain is usually aggravated by chewing, biting, or applying pressure to the teeth or local anaesthetic wearing off after several hours. |
| Throbbing pain | Intermittent pain that could indicate inflammation healing or minor complications and lasts 1–3 days |
| Severe pain | Intense pain that sticks around longer than a week after a root canal indicates that the infection is still there and the root canal wasn’t successful and may warrant medication, additional cleaning of the canals, or other procedures. |
| Temperature Sensitivity to cold or hot | You might be sensitive to hot and cold temperatures in the treated tooth and the surrounding area and Mild discomfort during healing and adjustment to fillings or crowns and can last up to a week |
| Bruxism or teeth grinding pain | Sometimes it can cause pain and put stress on the jaw and teeth after a root canal. |
| Swelling of the gums | The root canal process involves cleaning out infected pulp from the tooth’s interior. This can lead to inflammation and trauma in the surrounding tissues, resulting in swelling and discomfort. It will go away after 2 days. |
| fever | Fever is a sign of infection and a common bodily response when your immune system detects a problematic microbe. The root canal may be infected again causing you pain |
▶️We know how pain evolves after a tooth root canal
Some research teams study the progression of pain following a tooth root canal procedure.
Here is the data on the subject matter.
♦The anaesthetic used during the procedure numbs the area, but it takes several hours to wear off. As the anaesthetic wears off, you may experience pain and sensitivity
♦Still following days after the procedure, the tissue and nerves around the tooth can become inflamed, causing pain and discomfort. This is called peri radicular inflammation
♦️The temporary filling applied after the procedure. If the filling is too high, it can cause soreness and pain when you bite on the tooth
What can we conclude from this: you can continue to recover and have less pain as days go by. Some people continue to have discomfort for years due to other factors.
Based on my experience pain tends to decrease rapidly within the few days following the procedure if it is a successful root canal.
▶️There are several ways to help you relieve post tooth root canal surgery
♦️Resting
After you have had a root canal treatment, it is important to rest for at least a day or two before you resume your normal activities, though you can go back to your normal activities the same day with no problem.
♦️ Pain medication.
Usually, no medication is prescribed after a root canal treatment; however painkillers such as ibuprofen in the event of pain sensation is recommended (Ferreira 2020).
But always ask your doctor before you take any medication for your pain.
♦️Avoid hard food.
Eat foods that are easy to chew, this will prevent hard pressing on the treated teeth and will help reduce sensitivity and quick recovery.
♦️Keep practising good oral hygiene
Brushing your teeth gently with a mild mouthwash, avoid hard brushing or flossing around the treated tooth for at least a few days.
♦️You can apply cold compress
Apply an ice pack on the outside of your cheek near the treated tooth, this will help to reduce swelling and numbness temporarily.
♦️Rinse with warm salt water.
Salt water has been known to be a natural disinfectant and promotes healing. You can mix half a teaspoon of salt in eight ounces of warm water and rinse your mouth several times a day, especially after meals
These guidelines should be able to help you manage post root canal pain and promote healing without any complications
▶️What to do if severe pain, sensitivity and swelling persists a week or more after a root canal treatment.
If you notice any of the following symptoms persisting or worsening it is important to pay attention and see a dentist.
🟣Severe and throbbing pain after 5 days of the root canal could be a sign of infection or a failed root canal.
🟣Having swelling after two weeks around the treated tooth or in the surrounding gums can indicate an infection.
🟣Sensitivity: which is prolonged when you take hot and cold drinks, may suggest an issue with tooth restoration.
🟣Discoloration: If you notice darkness around the tooth that underwent a root canal treatment, it might be indicative of internal bleeding or other problems within the tooth structure.
🟣Persistent bad breath or taste coming from your mouth even after maintaining good oral hygiene, could point towards lingering infection post-root canal therapy.
🟣Any numbness or loss of sensitivity after 5 days of treatment in your lips or tongue may indicate a nerve damage during the procedure.
🟣Unusual bleeding or discharge from the surgical site is a sign that something may be wrong.
🟣Also, there is the possibility of a new infection after the primary treatment leading to another wave of symptoms.
🟣Also Swelling around the treated tooth or in the surrounding gums is expected.
What is common and normal?
It is normal to have throbbing or severe pain persisting after 48 hours after a root canal.
Even with a perfectly performed root canal, there can be pain that is considered normal for 3 to 5 days after you’ve had root canal surgery.
Some common discomforts patients complain of having in the days following a root canal that are considered normal include: Sharp, intense pain or pressure for 3-5 days
▶️How do I know if my root canal is infected, or if it has failed?
Usually if you start to develop a fever or temperature over 99.5 degrees may signal that you have a root canal infection.
Severe pain: When you have pain that persists for over 5 days after a root canal, you should return to your dentist.
Also, there is the possibility of a new infection after the primary treatment leading to another wave of symptoms, particularly after this length of time (Balto,2010)
Your dentist will take x-ray in different horizontal angles to help detect any persistent radiolucent lesion that may be superimposed upon the root.
▶️Why is my root canal tooth hurting after years
Sometimes, a tooth that has been treated doesn’t heal properly and can become painful or diseased months or even years after treatment
Here are different reasons why you may still have pain from a root canal treatment after years.
⬛Incomplete healing: The tooth may not have healed properly, or the infection may have returned. This can happen if the canals were not cleaned properly, or if some canals were missed
⬛Cracked tooth: The tooth may have cracked beneath a crown or filling, which can lead to infection and pain again.
⬛Degraded restoration: The restoration placed over the tooth may have degraded, allowing bacteria to get in and cause irritation
⬛New decay: The tooth may have developed new decay.
With proper care, even teeth that have had root canal treatment can last a lifetime. You may have a second chance. An additional procedure may be able to support healing and save your tooth. Discuss with your dentist.
▶️Why do I feel tooth pain after root canal when biting
Relax, this biting down pain after a root canal is common and can occur for several reasons, including
⬛Inflammation: The root canal procedure can cause inflammation of the surrounding tissues, which can lead to discomfort when chewing
⬛Tissue sensitivity: The removal of the nerve during a root canal can cause tissue sensitivity.
⬛Accidental damage: Dental instruments can accidentally damage the tooth structure or surrounding tissues during the procedure
⬛Reaction to medication: Some patients may react to the medication used in the procedure.
⬛The high filling: sometimes, the temporary filling placed after the root canal can be high. This can cause the tooth to bear more force than usual when you bite down, leading to pain.
⬛Incomplete cleaning: In rare cases, the canals within the tooth might not be completely cleaned of infection during the root canal leading to pain when biting.
⬛Fractured tooth: If the tooth was already cracked or fractured before the root canal treatment, the procedure itself could worsen the crack causing pain when biting.
The discomfort should gradually subside within a few days, fear not, you should see a dentist if you experience pain beyond the typical seven to ten days or worried of other symptoms.
We have come to the end of this article, any questions let’s meet in the comments section.
Wishing you a quick recovery.🙋
📚Sources:
Balto K. How common is tooth pain after root canal treatment? Evid Based Dent. 2010;11(4):114. doi: 10.1038/sj.ebd.6400758. PMID: 21170014.
Ferreira NS, Gollo EKF, Boscato N, Arias A, Silva EJNLD. Postoperative pain after root canal filling with different endodontic sealers: a randomised clinical trial. Braz Oral Res. 2020;34:e069. doi: 10.1590/1807-3107bor-2020.vol34.0069. Epub 2020 Jul 15. PMID: 32696911.
Khan J, Zusman T, Wang Q, Eliav E. Acute and Chronic Pain in Orofacial Trauma Patients. J Endod. 2019 Dec;45(12S):S28-S38. doi: 10.1016/j.joen.2019.05.010. Epub 2019 Oct 14. PMID: 31623907.
Shresha R , Shrestha D , Kayastha R . Post-Operative Pain and Associated Factors in Patients Undergoing Single Visit Root Canal Treatment on Teeth with Vital Pulp. Kathmandu Univ Med J (KUMJ). 2018 Apr-Jun;16(62):220-223. PMID: 30636751.
Gupta NK, Mantri SP, Paul B, Dube KA, Ghosh S. Incidence of postoperative pain after single-visit and multiple-visit root canal therapy: A randomised controlled trial. J Conserv Dent. 2021 Jul-Aug;24(4):348-353. doi: 10.4103/jcd.jcd_216_21. Epub 2022 Jan 13. PMID: 35282580; PMCID: PMC8896126.
Ali SG, Mulay S, Palekar A, Sejpal D, Joshi A, Gufran H. Prevalence of and factors affecting post-obturation pain following single visit root canal treatment in Indian population: A prospective, randomised clinical trial. Contemp Clin Dent. 2012 Oct;3(4):459-63. doi: 10.4103/0976-237X.107440. PMID: 23633809; PMCID: PMC3636834.
Friedman shimon. “The prognosis and expected outcome of apical surgery.” Endodontic Topics 11.1 (2005): 219-262.