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Dental and Oral Health (Adults)

Abscess after root canal

03/21/2006

Question:

Number 19 molar has been giving me trouble for about a year. My military dentist (I`m in the AF)told me it’s time for a root canal. They set me up for root canal the following week and prescribed Motrin and Vicodin for the pain. He drilled and scraped out root on 15 Mar and filled with temp filling. He set me up to complete the next week. On 18 Mar the pain was excruciating. I contacted the on call military dentist, he changed me to Tylox and motrin. I had no signes (other then pain) of an infection at that time. That evening my jaw swelled very quickly. Called Dentist back the next morning, went in and he opened the tooth scraped some more, said it looked pretty good in there. He cut inside my cheek and gum below the tooth and drained puss. He then refilled with temp filling and prescribed antibiotics. I go see him again today , not sure what he`s gonna do today. My question is; I don’t know if he is an Endodontist and it seems (from my internet searches) he should have not cut the infection open until I was on antibiotics. 1. Should I insist to be referred to an Endodontist down town? 2. Should I have more pain every time I come back from the dentist and novacane wears off? 3. How long will this pain last? this is the worse pain I have ever experianced Thank you.

Answer:

It is not uncommon to experience some discomfort after endodontic treatment. The pain you described is much more severe than normally expected.

It is not uncommon for a tooth that has an infection which is not symptomatic to develop symptoms such as pain after it is sealed by the temporary filling. This usually occurs when there has been infection, but the infection has been able to drain through a cavity in the tooth or a defective restoration in the tooth. Once this is sealed up, the infection begins to build pressure near the end of the root of the tooth which causes severe pain. This is usually relived by the treatment you received.

It is very common to drain an infection in the manner which you described. The antibiotic will then fight the infection which is still in your bone. The pain should be reduced dramatically in 48 to 72 hours. If this is not the case, it is possible that the dentist did not find all of the canals in the tooth. It will be necessary for the dentist to re-instrument the canals in order to find the extra canal. If you are still having pain after this, it is possible that you have a cracked root on the tooth. If this is the case, removal of the tooth is the only option.

Endodontic treatment of a tooth is a very common procedure done by general practitioners as well as endodontists. If your problem is not resolved, talk with your dentist and ask to be referred to an endodontist.

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Response by:

D Stanley Sharples, DDS
Clinical Assistant Professor of Primary Care Dentistry
College of Dentistry
The Ohio State University