Why is my root canal tooth hurting so much?

I actually have two questions. The first is concerning a root canal I recently had on tooth #7. It has been five days since the procedure and I am still in immense pain. I went back to my dentist yesterday, she did a visual check of the tooth, shaved down the back of the tooth some, gave me pain killers, and said it could take up to a week to feel better. Is this normal? I’ve had another root canal before (years earlier by a different Dr.) and had no pain. Plus before this treatment my tooth had no pain (the dentist saw something on an x-ray that indicated a need for the root canal). I have never had such intense and CONSTANT tooth pain before and was looking for a second opinion as to if this sounds normal. My second question is in regards to having crowns put on the teeth that had root canal treatments. My dentist said I would need a crown put on tooth 7 and tooth 11, but I am weary of having crowns if I don’t need them. I had a root canal on tooth 11 15 years ago and it has not bother me at all. Are crowns on front teeth safe? Will it change the appearance of my smile? Are there other options? Thank you in advance for you help and advice.
Sincerely, Carrie

Carrie,
You can have an infected tooth and it doesn’t hurt. If the pulp of the tooth is dead, it can be infected, but since the nerve is dead, you won’t feel it. And you will have infection spilling out into the bone (which is probably what your dentist saw on the x-ray), but your body walls it off, and it really doesn’t hurt. But then when the dentist goes in to clean that out and seal the tooth, that can upset the equilibrium and cause a temporary flare-up like you are experiencing. Usually the flare-up heals within a few days. Reducing the occlusion so you don’t hit the tooth when you bite together is a helpful move. So the fact that this tooth hurt so badly after your root canal treatment doesn’t mean the dentist did something wrong. I’m guessing it will probably settle down in a few days. Then, when you go back in 6 months for a regular checkup, you should have this tooth x-rayed. If the bone has healed in that time, that indicates that the root canal treatment was a success.

As far as whether or not it needs a crown afterwards, your tooth #7 is your upper right lateral incisor, which is one of your four front teeth. For a front tooth it isn’t always that necessary to get a crown, unless there was a large cavity in the tooth. There is an interesting blog post about front teeth, root canals, and crowns. On that post, it says that if you don’t get a crown, you want to be sure that the dentist cleans out all the root canal filling materials from the crown of the tooth, which is the part that shows that isn’t the root. Old gutta percha and sealer cement will cause the tooth to quickly darken and be ugly, so that needs to be cleaned out. A lot of dentists don’t realize that. And then a flexible fiber post placed inside the tooth could be helpful to strengthen the tooth against breaking off.

Dr. Hall

Five-year-old needs extensive dental work.

My five-year-old daughter has large cavities in all of her upper molars. For some of them, about 1/3 of the tooth is gone. I have taken her to several dentists, and she hasn’t let any of them work on her teeth. What can I do?
Collette

Colette,
If you see 1/3 of a tooth gone, the decay is usually considerably more extensive than that.

When children that young have that many large cavities, it can be because of their eating patterns. Does she have frequent snacks all day long? Extensive tooth decay requires frequent feeding. Food passes through the mouth, and a meal will cause the activity of tooth decay bacteria for about twenty minutes. For that much decay, it requires feeding all day long.

For right now, you need to get her the dental care she needs. Your daughter may end up requiring sedation to get this work done. But get it done. If she loses these baby molars and nothing is done, her permanent molars will drift forward and block out her other permanent teeth, and her mouth will end up being a mess with teeth pointed in all directions because of the crowding that will happen.

Then, for the long term, I would try to encourage better eating patterns. These can be tough habits to break, but I would encourage you to tackle this. You may have to let her go hungry for two or three hours in order for her to build up enough appetite for a meal. Somehow you have to get her out of this pattern of constant snacking. It’s not only bad for her teeth, but snack foods are also not very nutritious, so this will help her in several ways.

Links:
Cleveland pediatric dentist.