Post Root Canal Pain – Extract or Wait?

A recent question from Darlene, who has had some post root canal pain:

Q: I had a root canal about 9 months ago had severe pain and swelling after… Then a few flair ups.. My dentist wants to pull the tooth.. My question is I have been pain free for about 4 months .. Tooth seems fine now.. Do you think I still need it pulled or is it possible for the tooth to be fine now.

Hi Darlene and thanks for your question. It’s not uncommon to have some problems post root canal, but in the majority of cases it will resolve within a week or two. Having pain and swelling for up to 5 months after the treatment is not a great sign for the long-term outlook of the tooth. However, being free of symptoms for four months is a positive sign.

To answer your question, first up, let’s look at why you may get pain after a root canal.

Lady with toothache


Causes of post root canal pain

Here is are some of the causes of pain and swelling after the treatment:

  • Initial pain after the procedure, lasting up to a week or two, is common. This can be due to any infection resolving or the effects of the treatment wearing off.
  • Failed root canal, the causes of which include incomplete filling of the root system, a complicated anatomy of the tooth or cracks in the tooth. See this post for more info.

Like any treatment, there can be no guarantee with root canals!


Why Might Your Dentist Want to Pull the Tooth?

The main reason for your dentist advising extraction is that s/he believes that the tooth:

  • Will continue to give you problems and/or
  • Poses a long-term risk, if there is an infection underneath the tooth. If present, this may lead to an abscess or just lead to a long-term drain on your immune system

On top of these, your dentist is likely to have decided that the tooth is not suitable for re-root treatment (ie removing the rubber material that makes up the root filling and redoing the process, in the hope of a better outcome). If your dentist does not expect this to be an appropriate option then s/he will tell you so.


Extract or Leave?

It is not possible for me to fully answer your question, “Do you think I still need it pulled or is it possible for the tooth to be fine now.” To do so, one would need to see your tooth and X-rays. 

I would say, however, that the decision is ultimately yours as to what to do. So long as you are in full possession of the facts, including any downsides and risks of not extracting the tooth, then you can decide appropriately. Ask your dentist if there are any immediate dangers present, such as an infection or cyst on the latest X-rays of the tooth. If not, then your dentist may be fine with your adopting a ‘wait and see’ approach, so long as you attend for regular check-ups on the tooth, even if not in pain.

I hope this helps, Darlene. Let us know how you get on with your post root canal pain.


For further info, you may wish to refer to these articles:

Root canal treatment guide

Pain after a root treatment and complications


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