About Mark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present Clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Question QUESTION: Hi,I had root canal done by my dentist last Friday and it was very painful.I had an abscess for 5 days before getting root canal and my cheek was still a bit swollen. Dentist prescribed clindamycin 4X150mg a day for 7 days which I took for 3 days before root canal.(I am allergic to penicillin and sulfa and bad reaction to Zithromax and biaxin and similar family of drugs), so I am limited. It is an upper small molar -5th tooth from front. The root canal was so painful because canal could not be frozen because of infection and dentist had to put needle into the nerve. It was excruciating. It is 2 days after root canal and my cheek is still swollen and tender from gum above affected tooth to side of bottom of nose and my tooth is still sore, though not as bad as it was after root canal. I am not seeing dentist till a week this Tuesday. Shouldn't the infection be gone by now and why is my tooth still sore? its a week tomorrow when it first started. I will be finished antibiotics on Tuesday and worried that infection will still be there and I am pretty restricted to what meds I can take.Is clindamycin usually successful to clear up tooth abscesses at the dosage I was given? Thank you.
ANSWER: Dear Kate,
Although it is not possible in this forum to accurately assess whether your root canal treatment was successful, some residual pain and swelling at this point would not be inconsistent with a favorable result. It sometimes takes several weeks for all signs and symptoms of dental infection to resolve. The fact that there has been some lessening of the pain and swelling suggests that matters are progressing according to plan.
The dosage of clindamycin you received is typical. Although the root canal therapy should be primarily credited with the resolution of the infection rather than the clindamycin, the antibiotic will help to hasten the process.
Hope this helps...
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
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QUESTION: Hi Dr. Bornfeld, thank you for your reply and help.Just a couple of general comments/questions. Even though root canal is done to resolve infection,would it not be vital to take antibiotics before and after root canal in the case of infection, in order to stop the infection from spreading to the ear, sinuses, even the brain?Can infection be cleared up without any antibiotics in the case of a tooth abscess? I will be finished my 1 week supply of clindamycin tomorrow but there is still a lump(swelling) in my cheek and side of my nose (sinus area?).I will phone the dentist tomorrow and see if he thinks I should take another weeks supply of clindamycin since there is still some swelling. I would like to be free of infection before I see him next week. Another general question, not specific, is it fairly common that one course of 7 days of clindamycin at dosage I am taking, does not clear infection up completely and has to be repeated?I am a bit anxious its taking longer than I thought. Thank you.
Answer Dear Kate,
The necessity of antibiotics must be decided based on individual circumstance. Antibiotics are certainly not necessary to eliminate infection in all cases, and over-use of antibiotics introduces as much risk as under-use. Not only does inappropriate use of antibiotics present risk of side effects and allergy, but can favor the development of resistant bacterial strains. The ubiquitous use of antibiotics over the past sixty years has led to a whole host of new and virulent types of infections-- c-diff, MRSA, and a variety of other acronyms that have previously not existed. This has become such a pervasive problem that the CDC has implemented an initiative to encourage restraint on the part of prescribing doctors when considering antibiotic therapy-- see:
Clindamycin is also a medication that should be used selectively; over-use can lead to pseudo-membranous colitis and c-diff infection, which can be serious. Unless there is a compelling reason to think that your infection is not resolving, I think your dentist will discourage you from extending your antibiotic therapy.
