I had a root canal treatment which seemed fine at first, but then I started to have tooth pain several weeks later. I went to see the endodontist, who then prescribed me a course of antibiotics. That helped and she said I’d be fine now. However, a few weeks later the pain returned. She’s since placed me on a course of steroids, but I’ve gotten worse instead of better. I’m not sure what to do.

Adrian

Dear Adrian,

While we do sometimes prescribe steroids with a root canal treatment, it seems like your endodontist doesn’t understand the science behind it. Steroids are an anti-inflammatory. There are times this is an appropriate treatment. Generally, with a root canal treatment, there can be some irritation at the end of the tooth root. This can happen for several reasons. The file could poke through the end of the root or some materials, such as the infected pulp, the disinfection solution, or the filling material itself can make their way out. This causes a vicious cycle of pain and inflammation, but there is not necessarily an infection.

The inflammation causes swelling of the tissues around the end of the tooth, This, in turn, pushes the tooth up causing traumatic occlusion (how the teeth meet together). That then aggravates the inflammation, causing more swelling, starting the cycle over again. Prescribing steroids, in this case, can help stabilize the body’s response.

Because sometimes there could be infected tissue being pushed through, a brief course of antibiotics is generally prescribed along with the steroids.

However, this isn’t your problem. The best dentists will find the cause before prescribing a treatment. In your case, it was the wrong treatment. We were dealing with an obvious infection here. In that case, prescribing steroids is the WRONG treatment. Steroids are an anti-inflammatory. However, that inflammatory response is necessary in the case of infection. It brings necessary white blood cells and antibodies necessary to fight the infection. By prescribing steroids your dentist actually hindered your ability to heal.

Root Canal Treatment Failure

Your situation sounds more a case of root canal treatment failure. This doesn’t mean your endodontist did the root canal incorrectly. While I’ve been harsh on her diagnostic and follow up treatment skills, you can do everything right in a root canal and it will still fail.

The canal system inside a tooth is complex. It is easy to miss a small canal. Plus, some shoot off at a 90-degree angle and there is no way for the tool to reach everything. When a tooth flares up weeks after the treatment, it means there is an infection present and the root canal didn’t succeed. This is why your antibiotic treatment she gave you after the first flare-up made your tooth feel better. It brought the infection under control.

However, without getting in there and ridding the tooth of the infection completely it will rear its ugly head again. This is what you’re experiencing now. In this case, steroids are a hindrance rather than a help. You have some options here. The first is to have another root canal treatment done to try to completely get the infection. You should be aware the risk of failure increases with each root canal re-treatment. That doesn’t mean it is a waste of time to try, just be aware of the statistics. Two other options are root canal surgery or having the tooth extracted.

If you do end up extracting the tooth, don’t wait too long to replace it. There are more than esthetics to factor in. Your other teeth will begin to shift into the empty space. You can ask your dentist about tooth replacement options, including dental implants. Then decide which is best for your situation.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.