How To Manage Pain After A Root Canal?

pain after a root canal

Pain after a root canal treatment (RCT) is widespread among the treated patients. According to an estimate, 40% of the patients suffer from some degree of pain. Fortunately, most of you experience mild pain that barely affects your daily routine, however, 6% experience more intense pain.

You may feel more intense pain in the first 48 hours. The pain then progressively decreases over the next few days. The pain goes away completely in more than 90% of the patients in less than 7 days.

Pain after a root canal is mild and can be managed with over-the-counter (OTC) painkillers. On the contrary, any complications or surgical intervention during the treatment may require heavy painkillers.

Non-steroidal anti-inflammatory drugs for pain after a root canal

Ibuprofen (Advil, Motrin IB).
These are the most widely used painkiller for post-operative pain. As the name indicates they work by reducing the inflammation. Therefore, they are well suited for lowering the inflammation of tissues surrounding the tooth that occurs either as a result of infectious pulp or root canal treatment.

Side effects or drug interactions

Inform your dentist if you have a medical condition or taking any drug. NSAIDs interact with other medicines or cause other side effects if prescribed for more than four days.

  • Another side effect of NSAIDs is mild to a very severe allergic reaction. Anaphylactoid reaction is a severe form of allergic reaction where you may experience narrowing of breathing airways making your breathing difficult.
  • Be cautious if you are a diabetic because NSAIDs if taken with the glucose-lowering medicines may cause fainting by lowering your blood sugar level.

NSAIDs are safe to take in short courses i.e, four days or less, however, treatment of longer duration may put you at risk of drug interactions and possible side effects.

Acetaminophen for pain after a root canal

Paracetamol or Tylenol. This is another commonly OTC painkiller available to relieve mild to moderate pain. This class of painkiller is highly safe and can be given to the children, elderly and pregnant women where NSAIDs can not be given.

side effects

Acetaminophen overdose is related to acute liver failure, if consumed in higher doses. Make sure not to consume more than 4,000 mg of acetaminophen within 24 hours.

Inform your dentist if you have any liver disease or a history of alcohol abuse. Acetaminophen is 95% broken down in the liver and then expelled out of the body through urine.

In patients with impaired liver function, a large amount of a toxic chemical compound (NAPQI) builds up as a result of acetaminophen breakdown which can lead to irreversible liver damage.

Opioids for pain after a root canal

Codine or oxycodone (Percocet or Percodan). This category of drugs acts centrally by interrupting the nerve impulse or nerve signal between the brain and periphery (affected organ away from center). They are given to manage pain of moderate to severe intensity.

Although opioids are a very powerful and useful tool in treating pain, but they are reserved as a last resort to deal with pain after a root canal.

It is important to note that moderate to severe postoperative pain following a root canal treatment is rare, and that’s why they are unlikely to be prescribed for root canal after pain.

Side effects

Opioids may depress your respiration, and the nervous system. Depression of nervous system leads to drowsiness and its long term use may cause drug dependence.

Tell your dentist if you have or have ever had breathing problems, asthma, lung diseases such as chronic obstructive pulmonary disease (COPD – a group of diseases that affect the lungs and airways), a head injury or brain tumour. Your dentist will prescribe you drugs accordingly.

If you experience any breathing issues or any unusual symptoms such as slow breathing or shortness of breath after the opioid intake, call your dentist immediately or get emergency medical treatment.

Dosage for Mild Pain

The most commonly prescribed analgesics are ibuprofen and Paracetamol. If ibuprofen is not contraindicated, you can take 200–400 mg every 4–6 hours.

If ibuprofen is contraindicated for any reason described above, paracetamol is indicated and you can take it at a dose of 500–1000 mg every 4–6 hrs.

Dosage for moderate pain

Moderate pain is expected in surgical endodontics (root canal treatment that involves any surgical procedure).

If NSAIDs are not contraindicated, the dentist prescribes an initial dose of 400-600mg of ibuprofen every 6 hours for the first 24 hours followed by 400mg every 6 hours.

If NSAIDs cannot be prescribed, Percocet (a combination of oxycodone and paracetamol) is given for 6 hours during the first 24 hours, followed by 500-1000mg of paracetamol every 6 hours.

Another regimen that dentists prescribe to deal with the pain is the combination of NSAIDs and paracetamol. A dosage of 400-600mg of ibuprofen and 500-1000mg of paracetamol every 6 hours is given on day 1 after the treatment, followed by 400mg of ibuprofen or 500mg of paracetamol for the next 3 -5 days.

Dosage of severe pain

As discussed earlier, you will rarely experience severe pain after a root canal. However, you may experience it if you have gone through a complicated surgical root canal treatment.

In the case of severe pain after a root canal, your dentist may add an opioid painkiller with a non-opioid pain relief medicine. Codeine and oxycodone are two of the most commonly prescribed opioids and are combined with acetaminophen or ibuprofen.

Percocet® and Percodan® are the two formulations of opioids given by the dentists. Percocet® mostly prescribed for the dental pain contains 325 mg of acetaminophen and 5 mg of oxycodone and is given every 6 hours for the first 24–48 hours after the procedure. Following this period, you should continue with an appropriate non-opioid painkiller as instructed.

Take the opioids as prescribed and make sure not to take them for more than 48 hours. You can continue with non-opioid painkillers thereafter.

summary

Pain after a root canal is common and affects nearly 40% of patients. Pain is more intense in the first 48 hours and then gradually declines over the next few days.

Mild pain from a root canal can be managed with over-the-counter painkillers such as acetaminophen or non-steroidal anti-inflammatory drugs (NSAIDs). On the contrary, any complications or surgical intervention during the treatment may require heavy painkillers.

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