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Incision made to drain the abscess after repeated root canal treatments, swelling reduced, but jaw hurts. Any treatment again ?

Hello. I m a 26 year old female who is, overall, in very good health. I had a root canal done on tooth number 29 about ten years ago after an injury to the tooth. All seemed well until I noticed a swelling under this tooth a few weeks ago that hurt when pressed. I immediately called the dentist and was seen the next day. The dentist did an X-ray and I was told I had an abscess . She prescribed me 150mg Clindamycin over ten days for the infection and referred me to an endodontist. The endodontist retreated the root canal a couple weeks later and seemed happy with his work. A few hours after the retreated root canal tooth became horribly painful and I noticed some swelling. That night, swelling continued to intensify and spread to my cheek, but pain subsisted. I called my endodontist and he said that this was a flare-up of my old infection and I needed a called a 24-hour pharmacy to get me a prescription amoxicillin (500mg). The next day I went to the endodontist office and they had to make an incision to reduce some of the swelling and allow the abscess to drain. I was also given a prescription for metronidazole (500mg) to take in addition to the amoxicillin. Thankfully the swelling in my cheek subsisted gradually and now a week later my face looks normal, however I still have a fair amount of swelling and tenderness in my gum under the retreated root canal and my jaw hurts a little. Every time I call the endodontist the receptionist tells me to call back in a few days because the swelling should be gone and every few days when I call the swelling remains the same and yet I am told to call back again in a few days...very frustrating and worrisome. My questions are as follows, how long should it realistically take for the swelling and tenderness in my gum under my tooth to go away? Is there any chance of this infection spreading to my cheek again as I am now finished with my antibiotics? Should the tooth be treated again or possibly extracted? When they open the area again to permanently seal the root canal or do any other work is there a possibility of the infection spreading again? Thanks!
Asked On : Sat, 9 Mar 2013
Answers:  3 Views:  249
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Dentist 's  Response
Hello and welcome to hcm forum,

Since you got the re-rct for a traumatically injured tooth,chance of root fracture/spread of infection into adjacent tissue spaces has to be ruled out.
Usually the pain and swelling after access opening and pulp extirpation lasts for 2 weeks.

As the pain remains, in your case the tooth has to be checked for any fracture or infected pulp remaining within the pulp canal.

If required,adjacent teeth also has to be root canal treated.
If the symptoms persists,get it extracted.
Hope this helps.
Answered: Thu, 21 Mar 2013
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Dentist Dr. Qazi Ammara's  Response

Thanks for posting the query,

Pain and swelling indicates infection of the tooth that had spread to the adjoining tissue leading to formation of periodontal abscess .
Pain can be because of re-infection of the tooth , incompletely done treatment , perforation of the canal at the time of canal preparation .

Drainage of abscess is must , it can cause nausea , vomitting , halitosis , stomach infections.

I suggest you to take an x-ray of the tooth, depending upon which the treatment will be decided. it will be either extraction of the tooth or re-RCT .

Take tab flemiclav 625 TDS , tab flagyl 400 TDS, tab brufen TDS for three days.
Maintain a good oral hygiene , gargle with saline water 3-4 times a day .
Use chlorhexidine mouthwash twice daily.

Antibiotic and analgesic will give temporary relief.
Unless you go for drainage of abscess and retreatment of tooth you may exparience pain and infection.

Hope this helps out.

Answered: Thu, 21 Mar 2013
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Dentist Dr. Farah Hussain's  Response
hello and welcome to HCM,

Root canal treatment is the procedure which removes the infected and inflammed nerve tissue from the tooth , the process disinfects the tooth and devitalises it completely so there is no chance of reccurence of infection or pain in the same tooth.

Infection may spread through the periapical areas or adjacent periodontal structures to the adjoining teeth and jaw bone.

as you have mentioned root canal treatment was repeated for your tooth , then the remnant infection in the tooth is the cause of abscess formation.

i suspect antibiotic therapy has lead formation of a lumpy swelling called ANTIBIOMA which takes a little longer time to subside and needs to be examined by an oral surgeon.

i would suggest you to get an OPG RADIOGRAPH done which shows the exact nature of the swelling and the structures involved accordingly treatment can be carried out .

i hope this helps ,

take care.
Answered: Thu, 21 Mar 2013
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