Bhabha College of Dental Sciences - BCDS

⚡🦷 “The RCT looks perfect… so why is the patient still in severe pain?”

One of the biggest mistakes students (and sometimes clinicians) make is assuming ALL post-root canal pain is endodontic pain.

But sometimes…
the problem is the NERVE. 🧠⚡

Neurologic pain associated with RCT is a high-yield INBDE concept because it can mimic failed endodontic treatment — leading to unnecessary retreatment or even extraction.

Here’s what you NEED to recognize 👇

🔥 RED FLAGS FOR NEUROPATHIC PAIN:
▪ Burning sensation
▪ Electric shock-like pain
▪ Tingling or “pins and needles”
▪ Lip/chin numbness
▪ Pain triggered by light touch
▪ Persistent pain despite a “good” RCT
▪ Pain that crosses multiple teeth

🚨 If the patient says:
“My lip feels numb after treatment”
…think possible inferior alveolar nerve involvement immediately.

🦷 COMMON CAUSES AFTER RCT:
⚠ Overinstrumentation beyond apex
⚠ Sealer or irrigant extrusion
⚠ Warm vertical compaction near mandibular canal
⚠ Sodium hypochlorite accidents
⚠ Local anesthetic nerve trauma

The MOST commonly involved nerve?
👉 Inferior alveolar nerve (especially mandibular molars/premolars)

💡 INBDE PEARL:
Routine post-op endodontic pain is usually:
✔ dull
✔ localized
✔ percussion-sensitive
✔ improves with time

Neuropathic pain is often:
❌ burning
❌ electric
❌ associated with altered sensation
❌ persistent despite treatment

🚫 WHAT NOT TO DO:
❌ Repeated blind retreatment
❌ Multiple occlusal adjustments without cause
❌ Unnecessary extraction
❌ Empirical antibiotics for noninfectious pain

✅ MANAGEMENT:
✔ Careful reassessment
✔ CBCT if nerve proximity suspected
✔ Urgent referral if paresthesia present
✔ Neuropathic pain medications (gabapentin/pregabalin in selected cases)
✔ Orofacial pain or OMFS referral

Remember:
🧠 “Burning + numbness + electric pain” = think NERVE, not pulp.

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📘 MCQ 1

A patient reports severe burning pain and numbness of the lower lip 24 hours after RCT on a mandibular second molar. The most likely structure involved is:

A. Lingual nerve
B. Inferior alveolar nerve
C. Buccal nerve
D. Auriculotemporal nerve

━━━━━━━━━━━━━━━
📘 MCQ 2

Which feature MOST strongly suggests neuropathic pain rather than routine post-endodontic pain?

A. Tenderness to percussion
B. Mild chewing discomfort
C. Electric shock-like pain with tingling
D. Pain relieved by NSAIDs

Post your answers in comment 👇

🦷 “Doctor… my filling is done, but why does the tooth hurt now?”

One of the MOST common patient complaints after a composite restoration is postoperative sensitivity — and for INBDE aspirants, this is a favorite clinical scenario question.

The key is understanding WHY the tooth hurts.
Not every painful composite means failed treatment.

Here’s the high-yield breakdown 👇

🔹 1. Polymerization Shrinkage
As composite sets, it shrinks slightly.
This creates stress at the tooth-restoration interface → microscopic gaps → dentinal fluid movement → sensitivity.

📌 Result:
Cold sensitivity, especially in deep restorations.

🔹 2. Bonding Errors
Composite restorations are extremely technique-sensitive.

Common mistakes:
❌ Overdrying dentin
❌ Saliva contamination
❌ Inadequate adhesive pe*******on
❌ Improper curing

📌 Result:
Poor hybrid layer formation → exposed dentinal tubules → postoperative pain.

🔹 3. High Occlusion
This is one of the MOST TESTED causes.

If the restoration is slightly “high,” the tooth receives excessive occlusal forces.

📌 Classic clue:
⚡ Pain while chewing or biting
⚡ Percussion tenderness
⚡ Relief after occlusal adjustment

🚨 INBDE Pearl:
Pain on biting after a new composite restoration = CHECK OCCLUSION FIRST.

🔹 4. Deep Cavity Preparation
When the remaining dentin thickness is minimal, the pulp becomes vulnerable to irritation.

Deep preparations increase:
▪ pulpal inflammation
▪ dentinal fluid shifts
▪ postoperative sensitivity risk

How to Prevent Post-Composite Sensitivity

✅ Rubber dam isolation
✅ Incremental composite placement
✅ Proper bonding protocol
✅ Adequate curing
✅ Avoid overdrying dentin
✅ Check occlusion carefully

Clinical Clues You MUST Know

🧊 Short cold sensitivity
→ Usually reversible pulpitis

🔥 Lingering thermal pain
→ Suspect irreversible pulpitis

🦷 Pain on biting
→ High occlusion or cracked tooth

⚠️ Sensitivity worsening with time
→ Possible pulpal pathology or leakage

MCQ 1

A 26-year-old patient reports sharp pain while chewing 2 days after placement of a Class II composite restoration on a mandibular molar. Cold sensitivity is minimal and non-lingering. Percussion tenderness is present.

What is the MOST likely cause?

A. High occlusion
B. Irreversible pulpitis
C. Recurrent caries
D. Composite undercuring

MCQ 2

A patient complains of brief cold sensitivity after placement of a deep posterior composite restoration. The pain disappears immediately after stimulus removal and there is no spontaneous pain.

What is the MOST likely pulpal diagnosis?

A. Pulp necrosis
B. Symptomatic apical periodontitis
C. Reversible pulpitis
D. Irreversible pulpitis

Post your answers in comment 👇