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Why do Root Canals Hurt SO MUCH???

When a person has a toothache, whether it be a cracked tooth, a deep cavity, or a dental abscess, if it is determined that the tooth is restorable and saveable, a root canal treatment can be performed.

A root canal treatment removes the pulp tissue in the pulp chamber and canals, disinfects the canal space, and fills and seals the space.

Pain can arise before, during, and after the root canal procedure.

Before the root canal, pain typically arises from either an irreversible pulpitis, or an abscess. The irreversible pulpitis is inflammation of the pulp tissue. The dental abscess is the infection of the pulp tissue, and can spread to the bone surrounding the tooth.

During the root canal procedure, pain can arise for different reasons:

1) Insufficient anesthesia – anatomical differences in some individuals can make it challenging for some dentists to freeze the patient. Some teeth that are highly inflamed or infected can also be difficult to freeze. The solution is usually to increase the local anesthetic dosage, and to try different techniques, such as nerve blocks, PDL injections, intra-osseous injections, or intra-pulpal injections. There are many ways to achieve sufficient anesthesia. A skilled and experienced general dentist or endodontic specialist should be able to do this consistently.
2) Instrumentation and/or irrigation past the apex of the tooth. Sometimes, the dentist will inadvertently push an instrument or irrigating solution past the apex or end of the root. This can trigger pain and inflammation during or after the root canal procedure. However, the long term success of the treatment may not be affected by this depending on the situation.

After the root canal procedure, pain can also arise for different reasons:

1) Failed root canal treatment due to incomplete instrumentation, disinfection, and/or sealing of the canals. This can lead to re-infection.
2) Missed nerve canal, or missed nerve tissue. This can lead to pain and/or infection.
3) Over-instrumentation and over-obturation (filling). This can lead to inflammation and pain, especially if it is close to nerves in the bone surrounding the tooth.
4) Cracked tooth. The root canaled tooth is sometimes prone to cracking, or may already have a crack that continues to propagate. This can lead to pain and the eventual loss of the tooth.

Today you are going to see how a root canal procedure should go: with proper anesthesia, correct instrumentation and disinfection, correct obturation, and the procedure done without pain. Also, in this video, the patient is yours truly, and the doctor is Dr. Ben Jinn. I hope you enjoy the video!