Q. What could be the cause of sharp pain in a root canal-treated tooth?

Answered by
Dr. Achanta Krishna Swaroop
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Mar 17, 2023

Hello doctor,

I am a 53-year-old male. I have an irregular bite where contact occurs primarily on the back teeth. The last two molars on both sides have gold crowns. I also wear a mouthguard. About a week ago, I started having pain in the left last lower molar. When I went to the dentist, an X-ray showed the tooth to be in good condition. It already had a root canal, and the crown was 13 years old. The dentist referred me to a periodontist as he still had concerns about a cracked tooth and bone loss. I experienced extremely sharp throbbing pain in that tooth area during the weekend. I had taken 8 Advil and 6 Tylenol on that day. An abscess was observed on the gum area above that last molar. Fortunately, 48 hours later, the throbbing pain had significantly gone down, and I only took two Advil. I want your opinion on this.



Welcome to

Thank you for your query.

I understand your concern. I would like first to tell you irrespective of the pain, you should not have taken so many tablets of Advil and Tylenol all at once in a day as only painkillers can worsen the infection instead of solving it. Pain killer and antibiotic prophylaxis go together. Coming to the tooth in question, the root canal would have been re-infected. This can happen after a few years also, despite having a crown in some cases. A root canal infection would make the tooth in question a very weak prognosis. You can get the tooth re-root canal treated, meaning the RCT can be repeated instead of extracted. This would be one of the options by which you can retain the tooth and the crown. The crown will be fixed after the re-root canal. If your local dentist gives you a weak prognosis or risk of more fractures with a re-root canal, then there is no option at last except extraction.

So I suggest you ask your dentist about options regarding re-root canal treatment because that is the only effective way to drain the abscess from that tooth completely. If in case it has a weak prognosis, according to the dentist, after a physical examination, then you will need to get it extracted. In that case, you can get an implant done at the molar area and a crown again. These are your options.

Also, please refrain from taking more than 2 Advil or 2 Tylenol tablets in a day. More painkillers alone can worsen the infection of the jaws. Instead, you can continue with Amoxicillin for two days twice a day. If you do not have pain for now, avoid the painkiller. The prognosis also is poor because you have been referred to the periodontist for bone loss and cracked tooth root. In that case, even a re-root canal holds a poor prognosis. Hence ideally, it needs to be extracted unless you are willing to go for a re-root canal. Talk to your dentist about this procedure so you can retain that tooth. But if it is really weak, then extraction would be the choice, and you will need to go for implantation.

I hope this has helped you. Thank you.

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