Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Dealing With A Lingering Infection After An Extraction

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I had a root canal performed over a year and a half ago, and my endodontist said there were C-shaped roots and that she was hoping it worked. She gave me the standard antibiotic regimen and told me to follow up with my regular dentist. I followed her directions, and when I had my routine cleaning 6 weeks later, I mentioned to the hygienist that I was still dealing with some pain. They took an x-ray, but since my dentist wasn’t there that day, they said they would have him take a look and give me a call.

My dentist never called back, so I thought that meant everything was fine, but when I went back for the next routine cleaning, I told them that I still had pain. They took an x-ray and said it showed there was an infection, and I was told to call my endodontist for a follow-up. It was a holiday, so my dentist prescribed penicillin pills and scheduled an appointment for me later in the month.

About one month later, I ended up having the tooth pulled by an oral-maxillofacial surgeon, and I have since had improvements. However, I do still have pain in my jaw directly under where the tooth was extracted. The tooth socket has healed, and several symptoms have improved, but I am still concerned there may still be an infection in the jaw bone.

My faith and trust in my dentist have been shaken, and the dentist that pulled the tooth never even scheduled a follow-up with me. Is it possible that I still have an infection in my jaw? In your opinion, how should I proceed with this? I greatly appreciate your time. Thank you.

-Rylee from Arizona

Rylee,

A failed root canal can often be fixed with re-treatment or root canal surgery. However, extraction is sometimes necessary, as you have experienced.

It’s too bad that your dentist wasn’t more on top of this, but I wouldn’t fault the oral surgeon for not scheduling a follow-up after what he or she probably saw as a routine extraction. It is rare for there to be a lingering infection in the bone after a simple extraction of a tooth because the open socket leaves a clear path for drainage, so your body has no trouble getting rid of the infection. Occasionally, you can get a post-operative infection if the tooth is fully impacted and the tissue is sutured closed over the extraction site. From what you have explained, it sounds like your jaw healed normally.

But the lingering pain is a concern, so I would have it checked out. There are some cases where an infection can linger after an infected tooth is removed. Such a situation would require a strong dose of antibiotics. I would recommend that you go back to the oral surgeon and get evaluated. If you do still have an infection, I would imagine your surgeon would stay clear of penicillin since you already were on that. If you do happen to have a lingering infection, it is probably penicillin-resistant. I would try a strong antibiotic like clindamycin or some other antibiotic that isn’t penicillin.

 

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Root Canal Caused Days of Pain

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I had a root canal treatment done five months ago, and it was very traumatic for me. My dentist wanted to put a crown on the tooth, but decided that it would be best to wait, since the tooth was still painful. When it never got better, my dentist referred me to an endodontist. He thought maybe he had missed a canal, and the root canal specialist would be able to find it.

Well, the endodontist re-did the root canal. He told me there were no missed canals and advised me that there would be some discomfort for a few days. However, it’s been four days and I still have pain in the tooth. I don’t want to lose this tooth.

How long do you think I should wait to see if it gets better before I assume something is wrong? It’s been five months since we started this and I’m not sure what to do. I do know that I don’t want anyone else to mess with my tooth.

Your advice would be greatly appreciated.

Regards,

Kari from Colorado

 

Kari,

The key to knowing if the root canal was successful is not so much the discomfort itself, but if it’s improving at all. If it is improving, even just in the slightest, I would be optimistic. Your endodontist said that you would be in discomfort for a few days. I don’t think four days is too long, provided that it isn’t getting worse. Especially if you’re biting on the tooth, it can take it a while to get better. If the pain is coming from biting on the tooth, one remedy could be to grind the tooth down so that you don’t hit it at all when you bite. Since you’re planning on getting a crown on it, taking it out of occlusion shouldn’t hurt anything.

You didn’t say anything about swelling, so hopefully there isn’t any. Increased swelling would be a problem—a sign that the tooth isn’t going to get better.

For our readers, I’d like to add that this kind of trouble with a root canal treatment isn’t typical. Most of them these days are fairly uneventful. But a certain number of root canal treatments will fail, and to be fair, we can’t rule out that possibility with your tooth. But you need to give it more time to know that.

The root canal failure that happened with your general dentist may have been an inadequate seal at the end of the root since it wasn’t the result of a missed canal.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.