A root canal is a common dental procedure designed to save a tooth by removing the infected or damaged pulp tissue. The goal is to eliminate the source of pain and prevent the spread of infection, allowing the tooth to remain functional. While the procedure addresses the original issue, pain, particularly when biting, often persists or develops afterward. This discomfort arises because the procedure involves extensive manipulation of sensitive surrounding tissues.
Expected Sensitivity During Recovery
Some level of discomfort after a root canal procedure is a predictable part of the healing process. The tooth and surrounding structures have undergone an operation, which naturally causes an inflammatory response. This mild, temporary pain is typically felt when pressure is applied, such as when chewing or touching the tooth.
This sensitivity is often caused by periapical inflammation, which is trauma to the tissues surrounding the root tip. Although the infected pulp is removed, the cleaning and shaping instruments used during the procedure can irritate this delicate area.
Another factor is soreness in the periodontal ligament, the fibrous tissue that anchors the tooth to the jawbone. The ligament is stressed during treatment, resulting in tenderness felt most acutely under the force of biting. This pain should be dull and manageable with over-the-counter anti-inflammatory medications like ibuprofen. This normal discomfort should steadily decrease, typically subsiding within a few days to a week.
Specific Causes of Lingering Biting Pain
When biting pain persists or intensifies beyond the initial recovery period, it indicates a specific complication requiring professional attention. One common cause is a high restoration, such as a temporary filling or permanent crown that is slightly taller than the natural bite surface. This height difference causes the treated tooth to absorb excessive force when the jaws close, leading to occlusal trauma and pain.
A more concerning biological cause involves re-infection or residual bacteria within the root canal system. Despite thorough cleaning, the complex anatomy of some teeth can include tiny, missed accessory canals that harbor bacteria. If these bacteria remain, the infection can flare up, creating pressure and persistent pain when chewing.
This situation can also occur if the seal of the temporary or permanent restoration is compromised. This allows bacteria to re-enter the cleaned space, a process known as microleakage.
A structural problem causing severe, sharp biting pain is a vertical root fracture, a crack that runs down the length of the tooth’s root. This fracture often opens slightly when pressure is applied during biting, causing a sudden, intense jolt of pain. Since the fracture line allows bacteria to enter the surrounding bone, this complication typically requires extraction.
In rare instances, the pain might not originate from the treated tooth but instead be referred pain. This could stem from issues like temporomandibular joint (TMJ) dysfunction that manifests as discomfort in the general area.
Immediate Steps and Professional Consultation
Patients experiencing persistent biting pain should adopt a soft diet and avoid chewing on the affected side to prevent further irritation. Using over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help manage inflammation and discomfort. It is important to monitor the nature of the pain, noting if it is dull and improving or sharp and getting worse.
An immediate call to the dentist is warranted if the pain is severe, escalating, or accompanied by signs of active infection, such as swelling, fever, or pus discharge. The dental professional will conduct a diagnostic evaluation to pinpoint the exact cause of the pain. This process often begins with adjusting the bite using articulating paper to check for a high restoration causing excessive pressure.
The dentist will also take new X-rays to look for signs of persistent infection or evidence of a fracture. They may perform percussion tests, gently tapping on the tooth, and cold or heat tests on adjacent teeth to ensure the pain is not referred. Based on the findings, the dentist will recommend the appropriate intervention, ranging from a simple bite adjustment to a retreatment or, in the case of a vertical root fracture, extraction.