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Dr. Andrew Rynne

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Can complications with ongoing RCT effect scheduled cataract surgery?

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Dr. Shesh Jaiswal

Dentist, Endodontics

Practicing since :2007

Answered : 305 Questions

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Posted on Sat, 9 Aug 2014 in Dental Health
Question: Complication with on-going root-canal treatment while scheduled for cataract surgery (can the cataract surgery go ahead?)

Hello,
After two weeks of intermittent terrible toothache in the lower right jar in early May, I was checked out by my dentist via X-ray who diagnosed tooth infection (small halo around one of the roots) of my crowned molar 6 (before the last permanent molar, 7) and prescribed 400mg Amoxicillin and 200mg Metrodinazole (or so) for a week. As the pain did return and worsened by the 5th day of intake, I was told to have root canal treatment through the crown by the endodontic specialist coming to the surgery once a week who was present that day and, as an emergency appointment opened up the crown drilled down to the opening of three root canals to release a lot of blood and some puss (immediate relief). A week later, he went further down these three canals, and a week after that completed clearing them out to the root. 3 weeks later he filled the roots, which was surprisingly painful despite anesthetic (particularly the clamp to install the rubber dam) and put a temporary filling on top (cavit). Not even a week later, the pain and feeling of inflamation started again (up to the ear and all along the star) and I was given another course of those antibiotics, finishing last Sunday which brought only minimal relief. By Tuesday night the pain was back, and on Wednesday, he opened the crown further to discover a curiously positioned fourth canal opening corresponding with the one at the back-root canal which had already been filled. That filling came out and both were cleaned, left with medicinal inlays and a double temporary filling (cavit and glass inonoma) put on top. After a very sore evening, the pain improved rapidly the next day, and the next day (yesterday) was even better (not tender to touch), but this night the pain came back and, after gurgling with urine which had helped no end, I had a terrible chemical taste in my mouth (ammonia or chloride or a mixture of both), which I feared might have come out of the tooth. I checked the filling in the mirror and there is a round greyish spot right in the middle of the supper surface, but not really a cavity.
I was told over the phone (after sending a picture by email) that the glass ionomer can discolour but that this was nothing to worry about and that my pain (much closer to the inflammation than the tenderness right after the treatment) was from the nerve and would not signify reinfection that shortly after the procedure. I am wondering why it was so much better directly after.

Usually, I would go to have things checked out next week, BUT I am scheduled for very necessary cataract surgery of my right-eye this upcoming Tuesday which would be very difficult to postpone for work reasons. A nurse of the eye-hospital told me that they would not operate if there is any infection (will they check this through the blood?). As there is no certainty, that the root-canal treatment will be successful in getting this tooth under control and keeping an infection out, I would rather have at least the cataract surgery out of the way. However, I am terrified of not being able to drive to see the endodontists in his own surgery some 100 miles away in case the tooth pain gets unbearable.

Can you, please, tell me, whether this tooth condition in my lower right jar (whether infection or not), might affect the success and recovery time of the cataract surgery (complications), so I end up with a messed up tooth and eye? Or are these unrelated, though both in the head, and in my case, on the same side of it (the right side)? I so worried.

Thank you,
XXXX (46 years old)
doctor
Answered by Dr. Shesh Jaiswal 1 hour later
Brief Answer:
RCT failure

Detailed Answer:
Hello and welcome to HCM
This is dr XXXXXXX jaiswal answering your query.
I have gone thoroughly to your query and i think its a failure of RCT.
Can you upload the xray pics of your tooth undergoing RCT.
Sometimes you can get more than expected root canals in molars but that has to be identified cleaned and filled properly.
As far as your catract operation is considered you can go for it.
If i were your treating doctor i would advice you to take cefodoxime plus clavulanic acid combination twice daily for 7 days and a good pain killer like aceclofenac plus serratiopeptidase twice daily.

Find out for any missing canals or any partially filled canals thats causing you pain and refilling it.
If the pain exist you may have to go for apicectomy.

Hope this ans helps

Regards
Dr. XXXXXXX
Above answer was peer-reviewed by : Dr. Raju A.T
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