Post Treatment Advice

THE USUAL SCENARIO

Typically when treatment has been completed it is normal to expect some discomfort/soreness from the tooth and the general area.

The reasons for this discomfort are easy to understand. There will be some pain from the injection sites. In addition there will be some localized tissue trauma from the rubber dam clamp and screen. The tooth itself will often be tender to touch or to bite on for several days after the procedure.

These relatively minor problems can be easily counteracted by taking some over the counter pain killers. The best pain killers to take are those that one would take in the event of a bad headache.

There are some important points to remember when taking any medication:

1. It is important to establish before taking any tablet or drug that you are not allergic to the drugs contained within the tablet. If you are unsure then you should not take the tablet and consult your medical doctor.

2. It is important to establish before you take any tablets that it is safe to do so and that there are no other medical contraindications to taking the tablet. For example during pregnancy (not all pain killers are safe to use during pregnancy), during lactation (for feeding mothers).

3. It is important that when taking any tablets the safe or recommended dose is not exceeded. This will be clearly written on the back of the packet. Always remember that there may be interactions with other tablets that you are taking. Again if you are unsure you should consult your medical doctor.

4. In order to get the maximum benefit from the pain killers they need to be taken regularly. Do not wait for the pain to return again, dose regularly. In that way, the pain killer will stay at the optimum level within the body.

5. It is often recommended to take the tablets with food.

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THE UNUSUAL SCENARIO

In rare occasions following the root treatment, there can be a lot of pain. This is often termed ‘an acute flare up’.

The causes of ‘Flare ups’ are numerous and multifactorial.

These can largely be broken down into key areas:

1. Procedure related: during root canal treatment, different instruments are used to clean, shape and fill the pulp space. There are three key areas that may contribute to post treatment pain:

   1. During this process small amounts of debris may be pushed through the end of the root into the surrounding tissues.

   2. The tissues surrounding the end of the root may be traumatized due to over instrumentation despite accurate length determination, or

   3. There may be some overfilling during the placement of the actual filling itself. All of these will impact on the tissues to some extent causing pain.

   These tissues may already be hyper sensitized as a result of the on going irritation from the pulp and so the normal response to tissue injury is very exaggerated

2. Pre-operative status of the tooth: There are two obvious scenarios which tend to be associated with a higher incidence of post operative pain or flare ups.

   1. Teeth with radiographic evidence of significant periapical disease (large area of infection seen on x-ray) have more bacterial strains and are more complicated have a higher incidence of ‘flare ups’ as a result.

   2. Retreatment cases (re doing a root treatment for a second time) are also associated with a higher incidence of ‘flare-ups’. This can be attributed to the difficulty with retreatments and the need to use solvents to remove the old root filling materials, the different micro-organisms that infect these teeth, and the higher chance of iatrogenic problems with these teeth.

3. Host factors: No two people are the same and their reactions to challenges will be different. The intensity of pre operative pain and the amount of patient apprehension are correlated to the degree of post operative pain. Age, gender, tooth position and presence of allergies are also shown to have a correlation with flare ups. It is impossible to determine in advance who will have the problems following treatment.

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THE MANAGEMENT AND PREVENTION OF THE FLARE UP

The management and prevention of a flare up is very varied:

1. If the root treatment has been started but not completed it may benefit from further cleaning and the placement of a dressing.

2. It certain circumstances the tooth may be extruded (pushed up out of its socket) from the inflammation underneath and a reduction on the temporary filling or tooth may be hugely beneficial easing considerably the associated tenderness on biting.

3. If there is an associated facial swelling looking to obtain drainage may provide the necessary relief.

4. Taking pain killers.

5. Taking antibiotics and pain killers. Antibiotics are really only indicated where there is an overwhelming infection.

In order to get sufficient pain relief a combination of pain killers is often recommended:

THE FOLLOWING REGIMEN IS ONLY RECOMMENDED FOR FIT AND HEALTHY ADULTS WHERE THERE ARE:

1. NO ALLERGIES TO PARACETAMOL AND ASPIRIN/ANTI INFLAMMATORY (NSAID) RELATED TABLETS.

2. NO DRUG INTERACTIONS WITH OTHER MEDICATION.

3. NO ACTIVE PEPTIC ULCER

4. ASTHMA

5. PREGNANCY

6. LACTATION

Typical Dosage

Paracetamol (500mg) One or two tablets
Ibuprofen (200mg) One or two tablets or three tablets.