I spent ten years assisting an endodontist (root canal specialist) and can tell you that, while some people may be lucky enough not to have pain after a root canal, it is very common for others to be in the kind of excruciating pain you're describing. It can last days for some people, weeks for others (although after the first 7-10 days you should notice a definite reduction in pain). Don't worry about bob b's statement - most root canals are done in two visits (to keep pain low and avoid infection) and it is not true that they leave nerves "exposed" in between; the nerves are removed within the first few minutes at the initial appointment, and a sterile barrier dressing is placed. What you are feeling is not nerve pain, it is trauma pain in the surrounding live tissue - bone, ligaments, and gum tissue (often worse than nerve pain itself!)!
First off: How much advil are you taking? If you're only taking 200 to 400mg (one or two tablets) at a time, it's not going to work. Granted, that's the over-the-counter bottle dosage, but it's rarely an effective one. The "gold standard" for treating tooth pain is to take MINIMUM of 600mg (3 over the counter tablets) at one time, no less than every 4 hours around the clock for 7 days after root canal. If 600mg is not effective, 800mg (4 of the over the counter tablets) can be used. These are incredibly safe, prescription strength dosages used by almost every root canal specialist in the U.S.; many will give you a prescription for the higher doses (you can get Advil pills that are 600 or 800mg each behind the pharmacy counter). In fact, the prescription dose goes up to 1000mg every four hours (5 tablets!!) although this is rarely recommended anymore; the safer doses are 600mg or 800mg. Check with your dentist or pharmacist if you're unsure you can take a higher dose of advil, but if you're already able to take one or two tablets, you should be fine with a higher dose. It's fine to take up to 1000mg of Tylenol with it as well.
Also, I can't emphasize this enough: ICE, ICE, ICE! Keep ice on the outside of your face as much as you can. Use a bag full of ice cubes, an ice pack, whatever - just keep the area outside the tooth cold. After a few hours, you will notice a huge reduction in pain. This will also speed healing, and help reduce the duration of the post-op pain.
Another great thing to know after root canal is NEVER lay down flat after a root canal! This rule should be followed for as long as you still have any discomfort - whenever you lay down (even to sleep) keep your head as high above heart level as possible - elevate it on two, three, or even four pillows if you can. This is because the blood will rush to the affected tooth if your head is laid flat (at heart level) and will cause intense throbbing and pain.
Sometimes, root canal teeth build up an excess of "pressure" inside the canals. This can happen due to an extensive infection, or due to hyperemic canals (excess bleeding) or other factors. When your dentist does a root canal, he/she places a filling into the canals that doesn't allow the pressure to escape. It can become intensely painful, sometimes even causing swelling. It isn't dangerous, as the body will take care of the drainage and/or pressure on its own eventually, but the symptoms can be simply unbearable for some!! This may be the case with you, and if it is, any good root canal specialist (or dentist) will want to know. There are things your dentist can do to alleviate the pain and pressure - it's very typical for someone who is in between the start and finish appointments to need to have a "change of dressing" which is where they open the tooth and clean it out once again, allowing the pressure to subside, sometimes even leaving the tooth open to drain overnight or over a few days. This pain and pressure can also be alleviated by antibiotics (if the pain is due to the drainage of an infection) although don't expect antibiotics to work right away - they take a good 48-72 hours to give any pain relief.
If none of the above recommendations are working for you, you need to call your dentist. Any dentist worth his salt will want you to come back in, at least for a checkup, and possibly to change the dressing, check for swelling, and prescribe antibiotics that may now be necessary. If you call, saying you're in massive amounts of pain not controlled by OTC meds, and your dentist does not ask you to come back in, does not prescribe any painkillers or antibiotics, and/or insists on telling you to wait it out, then he/she is either highly unskilled and not at all knowledgeable about the root canal process (in which case I'd try to have it finished by someone else - namely an endodontist) or he/she is simply lazy (another good reason to find a new dentist). Any good dentist will want a post-root canal patient to come in ASAP if they are having uncontrollable pain, or will at least call in antibiotics and pain meds. It's important to monitor root canal patients for signs of infection and excess pressure. Don't let the receptionist or assistant give you final advice when you call; you have the right to insist on a checkup appointment or to speak directly to the doctor. Dentists typically WANT to speak to or check on patients in pain, because failing to do so can result in a lawsuit.
I don't recommend going to the hospital, unless your dentist refuses to treat your pain; hospitals can be largely incompetent when it comes to dental issues, and I've seen a lot of mis-prescribing going on there. But if your dentist won't help you, it may be necessary as a last resort.
Also, if you do end up with a prescription for pain meds - Ultram, Vicodin, Darvocet, or Percocet - it's fine to take Advil at the higher doses along with it; in fact, it will probably be necessary (narcotic pain meds aren't actually terribly effective for tooth pain).
Good luck; feel better!
Dental Assistant, endodontics (root canals) for over 10 years
· 9 years ago