Get your Health question answered in 3 easy steps
A Doctor will be with you shortly
Ask a Doctor Now
152 Doctors are Online
Ask a Dentist   »  

Getting pain in gum after a root canal treatment. What should I do to get relief?

User rating for this question
Answered by
Practicing since : 2011
Answered : 183 Questions
I had ongoing, intermitent tenderness and pain in my gum after a root canal treatment on my left, back lower molar in September last year (due to a tooth infection). After the treatment my gum remained fairly tender and it just didn't feel like things cleared up. It felt similar to having a sore throat ( but in the gum ) and my gum and side of my tongue felt a little numb at times. I was given antibiotics but eventually had my tooth extracted in March this year. Within a couple of days of the extraction there was an infection in the socket so I was given 2 types of antibiotics (amoxicillin and metronidazole). This seemed to clear it for a while but then the discomfort started building up again. Sometimes I even felt a similar sensitivity on the other side of my lower jaw.

The feeling I often have is like a burning in the gum on the left but I have also had ear pain and a general feeling of warmth and inflammation in the area where the tooth was extracted. Things often get worse after I have chewed harder food, after exercise or sometimes after a hot drink. I had my ears checked and there were no concerns from the GP. Sometimes it feels like the muscles in my neck or glands are sore. There have been times when it feels like there is a rawness moving across my lower gum towards my throat. I have felt nauseas at times which may be due to the pain or just something else. I have been fairly tired over the last 2 months. Not sure if it's relevant but in XXXXXXX this year I also had a small filling replaced on another bottom tooth (right hand side) and developed tiny bumps, pain and the some oozing from the gum around that area soon afterwards.

I have seen an oral surgeon who asked questions about my pain and took a 2d x-ray. He couldn't see anything in my mouth or on the x-ray so his theory was that it's neurological and prescribed nortriptyline. I'm not comfortable about taking this because of the type of drug it is but also because I am not convinced by the diagnosis due to some of the symptoms I have experienced. I have not yet taken the drug as a result. I don't like to question a professional opinion but the most frustrating thing for me is that these symptoms come and go and I find it difficult to explain all this to a doctor when I am not experiencing the pain at the time. Can you offer any advice, ideas or direction for me as to cause and steps I should follow?

Thank you
Posted Tue, 20 Nov 2012 in Dental Health
Answered by Dr. Geoffrey Ward 15 hours later
Hello and thank you for your question.

I greatly appreciate all of the information you have provided to me and giving me a background to everything that has gone on in your mouth. Based on what has been said, it sounds like you had a root canal that was performed and it failed or the tooth fractured requiring it to be extracted because the dentist determined that to be the best treatment option instead of retreating the root canal.

After the root canal was completed did you have tingling or numbness experienced in your lower lip on the same side as the root canal?

My immediate thought to everything is that the numbness in the jaw could have been related to the anaesthetics used to numb your mouth. Sometimes nerves are touched by the needle and cause inflammation in the sheath around the nerve. This takes time to heal and can react by the sensation of burning, tingling or numbness.

When the dentist does a root canal they should place a rubber dam over the tooth and a tooth clamp. The clamp sometimes is placed on the soft tissue instead of the tooth (ouch!). This can cause prolonged pain in the tissue and what is called pressure necrosis, where the tissue dies back and heals through epithelialization. During this process it can have the sensation of burning, pain and a sore tenderness. This could also cause the oozing in the tooth on the other side of your mouth. Or there could have been an irritation from the procedure that caused inflammation of the gums and a small minor periodontal abscess that cleared up over a while. What colour was this oozing material? white? green? yellow? clear?

If an oral surgeon looked at your radiographs, chances are he took a panoramic which is the one that rotates around your whole head and gives you 1 solid photo of your jaw and teeth. If there was an infection in the bone he would have seen it in these radiographs (x-rays).

Based on everything said, I feel like what the oral surgeon has prescribed you is reasonable. You have muscles of mastication which run along you neck, on your temples, in your cheeks, in the back of your neck and inside your mouth in front of where your tonsils sit. Being tired for a few months and sleep disturbances can cause swelling of your lymph nodes under your jaw and lead you to bruxism or grinding/clenching your teeth during the day or at night. This causes inflammation in your muscles and results in the sensation of pressure in your head, stiffness of the jaw, and fullness sensation in your ears.

You may also be experiencing inflammation of the nerve causing a fibromyalgia or neuropathy of sorts. Based on this, your burning sensations could be explained. I am however not diagnosing you, just merely giving you suggestions of what it might be.

I agree with the oral surgeon that you may have a neurological imbalance leading to discomfort, pain, burning and swelling. Nortriptyline is an anti-depressant medication in the group of tricyclic anti-depressants or TCAs. Nortriptyline is also sometimes used to treat post-herpetic neuralgia (the burning, stabbing pains, or aches that may last for months or years after a shingles infection) and also for muscles of mastication (chewing muscles) and nerves of facial sensation.

In several articles I have read, sometimes patients suffer from idiopathic dental or facial pain (pain that has no real understanding, cause or physical evidence). In all the research I have read, Nortriptyline along with a combination of clonazepam (anti-anxiety benzodiazepine), and relaxation procedures that had successfully controlled the patient's facial pain symptoms.

I feel that it would be advisable to try the medication, even on a short term basis to see if it helps with the pain.

I hope this helped answer your question and you are satisfied with my input. If you have any further questions or concerns, please feel free to write back and we can discuss this more.


Dr. Ward
Above answer was peer-reviewed by
Follow-up: Getting pain in gum after a root canal treatment. What should I do to get relief? 11 hours later
Dear Dr Ward,

Thank you for taking time to think this over for me and for allowing me to talk this through further. Your more detailed answers are helpful.

In answer to some of the questions you asked: In terms of the root canal, the dentist did try the procedure twice because I still had tenderness and some pain after the first time. He then felt that extracting the tooth was the only answer as the discomfort did not clear up over time. I don't remember feeling numbness in my lip after the root canal. What I do remember is having sore glands, a pain in my gum as well as a strange feeling along the inside of my gum towards my tongue which I still get (can't really describe it, it's almost like a numbness). I also had a cold or virus about a month after the first root canal, which intensified the pain, especially at night.

Yes, it is possible that the clamp used by the dentist hurt my gum. This does provide some explanation to me, although would this still affect me after a year? There are also a few other things that occurred that make me unsure. The oozing on the opposite side, after the filling replacement (3 months after the tooth extraction), was accompanied with quite a lot of pain and more than usual bruised feeling that went on for about 5 days after the injection. The material that came out of the area at the time was whitish in colour and there were tiny bumps on my gum. At first I thought they were blisters but then I noticed that my gum was oozing from the sides of 2 teeth. This wasn't the first time I had bumps in my mouth though. I went through a stage where it felt like I kept getting blisters on my gums, both lower sides and I felt a similar pain on both sides too. This was very strange and I couldn't understand what was going on. I thought that there was something spreading around my mouth, but only along the lower jaw.

One of the feelings I now keep experiencing is like a reaction and inflammation on the side of the extracted tooth. For example, sometimes it feels like foods or warm drinks get into my gum and sting me like when you get hot water onto a wound. This feeling of stinging feels like it moves right into my ear and can last for an extended time (it seems to settle when I sleep). The outside of my gum is also sensitive at these times and I have to be careful when I brush because it's tender. This feels like there is some kind of swelling in my mouth at the time because my front teeth knock together when I chew. The dentist did test my bite and said the alignment was right. With my finger I can sometimes feel some swelling on my gum, near the bone. The dentist felt this once when I told him and at first he said that it was my bone and then said, yes, it was a little more raised than the other side.

In terms of the x-ray, neither my dentist nor the oral surgeon did a panoramic view but a localised 2d x-ray of the area of the extraction and the tooth next-door. They both said that it looked like the bone was growing back well.

I have tried to explain my symptoms to my dentist and to the oral surgeon but I think I haven't done a good job because of fear of sounding like I am exaggerating or imagining things. I do feel like there is some kind of infection in my system as a whole because over the last few months I have had a lot of fever blisters around my mouth and nose and a general feeling of not being completely well. I also remember how quickly I developed an infection in the socket of my gum after the tooth extraction as well as the oozing after my last dental work. These things have never happened to me before. I had teeth extracted when I had braces and nothing like this happened. I am willing to try Nortriptyline if it's the right drug but I am aware of the side-effects of those types of drugs. In addition I don't want to take something which is not going to address the cause of my problems. I just need to feel confident about that course of action.

Thank you again for taking the time to help me in this. Your response will help me to make my decision but I do understand that you are not diagnosing me.

Kind Wishes
Answered by Dr. Geoffrey Ward 11 hours later
Hello and thank you for your information.

The white material coming from the tooth indicates that you had an infection either in the gums or in the root.

I recommend taking the nortriptyline and see how you feel in a few weeks.

Based on what you said, I think you should still get a panoramic, get your teeth tested to see if you have a high filling which can cause your bite to get off and cause you to hit hard on your front teeth.

You can have normal outgrowths of bone in your jaw. Towards the tongue they are called lingual XXXXXXX and towards the cheeks they are called exostosis.

The tooth you had pulled had an infection and that is why it was different than the ones you had when you had braces because those were healthy teeth and healed at a better rate without complications.

Stating that you have had fever blisters, don't feel well and have improvement in the discomfort with good sleep makes me think that you might have herpes and the nortriptyline can help with the inflammation on the nerves caused by this. You should also get evaluated for herpes infection when they outbreak because they can cause this sort of pain as well.

Remember to brush your teeth twice a day in gentle circles 45 degrees towards the gums with the bristles. Floss once a day holding the floss against the tooth and rubbing up and down NOT back and forth.

Try the methods of applying warm compress like I talked about as well. You should also go to a dentist for a second opinion; especially one that has advanced training such as FAGD or MAGD certification.

Hope this helps; if you have any further questions or concerns I'll gladly help you.


Dr. Ward
Above answer was peer-reviewed by
Follow-up: Getting pain in gum after a root canal treatment. What should I do to get relief? 15 hours later
Hi and thank you again for giving me the time and help Dr Ward,

Yes, what you say does make sense, I probably do have a virus like Herpes in my system as I have had fever blisters infrequently in the past when I have had colds or been very busy. I had thought about this but what I can't really figure out is the connection between the tooth and gum infections and the virus now.

I do feel like there is still an infection in my mouth because of the feeling that foods, etc are irritating a kind of sore in my gum ( as well as the pain that I feel in my ear). Also, I have had small fevers at times, day and night. All these things are on and off so much that it's hard to understand. Did the infection in my tooth possibly cause a virus to spread into my gum and nerve or is the virus more active now because of the fact that I have/had and infection in my gum? I'm not sure how to look at this. If I need some kind of medication to fight infection as the primary cause of the pain then I would rather do that before taking the Notriptyline to fight the symptoms.

It can be difficult to request x-rays or tests in the UK unless going privately but as I pay into the healthcare system I would like to ensure that more thought is taken on this. I suppose my last question is whether you have a suggestion as to the way I should go about this? I haven't been very successful in getting further investigations up to now. I also don't want to sound as if I am telling a Dr what I think should be done. Any advice here would be welcome and I do appreciate the suggestion to take the Notriptyline.

Just on the side; I see you practise in Arizona. My husband and I visit the States often because I have a sister living in Pittsburgh, a brother in Atlanta and an Uncle in Houston. We have seen a lot of the East side of the States and XXXXXXX but will be visiting Arizona with my family next year. We're really looking forward to it as the state looks beautiful in pictures.

Thank you very much for your patience.
God Bless.
Answered by Dr. Geoffrey Ward 35 minutes later
Good morning! Thank you for your follow up.
Typically the virus would not be the source of the dental infection. Dental infections are generally bacterial in nature and come from natural bacteria found in your mouth. It sounds like you are in a public health system and unfortunately this type of system is kind of rushed when it comes to providing appropriate care. This is why I'm an advocate against this system coming into play in the US.

Viruses can be opportunistic. They can sit dormant and wait for something in your life to cause a stressor that allows them to attack. This is why you see people get shingles infections when they are elderly or for instance, going through stressful periods like medical or dental school. The dental infection caused your immunity to get challenged and possibly allowed a virus (if you have one) to flair up. Herpes virus lays dormant along nerves and if you have it orally then the nerve it'll go to is your trigeminal which gives you feeling in your jaw face and head and part of your ear. This virus can cause nerve damage which is neuralgia. This is why I suggest taking the Nortiptyline and see how you feel after a few weeks of use.

A Panoramic would probably need to be in order. And I think you should go private for this if you can't get help in the public health sector. If this is a virus, typically we will prescribe magic mouthwash solution:
80 ml viscous lidocaine 2%
80 ml Mylanta
80 ml diphenhydramine 12.5 mg per 5 ml elixir
80 ml nystatin 100,000U suspension
80 ml prednisolone 15mg per 5ml solution
80 ml distilled water

This can help with the pain associated with radiation patients and patients with herpes virus in their mouth. I also would use the Notriptyline as it helps with pain in viral infections such as herpes, shingles etc.

As for a medication for the virus itself, typically there aren't medications to rid yourself of the virus but there are some that can help with flare ups. I am not familiar with what they have there.

This is what you should tell a dentist, and I think you should go to a fresh one for full evaluation if possible, or go private:
State your history in great detail in chronological order from the first time you experienced the pain up until now. State that another dentist felt that you have had an infection and tried treating it with a root canal and then extracted the tooth and that you had an infection, the pain did not go away. This all could still be referred pain from the TMJ joint as some people get the sensation of burning, tingling or pain from it in their jaw. Tell them you had a filling on the other side and a few days later your tooth had puss ooze from it. Tell them you have had a history of fever blisters. Tell them that you have sensation of expansion in your jaw and that it was suggested to get a Panoramic xray, and you can always tell them esp if they are a new dentist that the last dentist you saw did not have a Pan machine to provide you with the radiograph. Take the medication prescribed and see how you feel. It also may very well be a neurological thing causing discomfort. And you can always find a dentist in the US where you are going and set up an appointment, prepare them for what they are going to investigate and pay out of pocket for the exam time and evaluation. I know some doctors especially newer ones will do free exams and radiographs for new patients.

Hope this helps and I'm here to answer more questions.

Yes, Arizona is beautiful, if you visit, do it in the winter, we have summers that get up to 50 C in temp!

Best wishes God Bless you too and good health,

Dr. Ward

Above answer was peer-reviewed by
Share on Facebook
Share on Twitter
Share on Google+
Question is related to
Medical Procedures
Lab Tests

The user accepted the expert's answer

Ask a Dentist

© Ebix, Inc. All Rights Reserved.
All the information, content and live chat provided on the site is intended to be for informational purposes only, and not a substitute for professional or medical advice. You should always speak with your doctor before you follow anything that you read on this website. Any health question asked on this site will be visible to the people who browse this site. Hence, the user assumes the responsibility not to divulge any personally identifiable information in the question. Use of this site is subject to our Terms & Conditions
Already Rated.
Your rating:

Ask a Doctor