Expert: Steven Litwin DDS - 7/2/2009

Question
QUESTION:
  I had a root canal and it still hurt. My dentist said I have swollen gums and such, so it's making my tooth ache. I was already prescribed 2 courses of amoxicillin. So now he wants to prescribe this drug called Augmentin. If I took 2 courses of amoxcillin and that did not get rid of the pain, then would augmentin be stronger? Is it better at killing off pain and infection? thank you!

ANSWER: Hi Nate,

Thanks for the question. Nate, its not uncommon for there to be some discomfort after a root canal is completed. However, this discomfort should last no more than several days to a week and certainly have no swelling or fever. If there is swelling, fever, of it has been longer than a week with no relief and both courses of amoxicillin has not worked then I would suggest that there is a possibility that the root canal is not working i.e. failing. Before beginning a third round of antibiotics which might cause more harm than good I would consult with an endodontist (root canal specialist) to see if the root canal is failing or if there are other issues present such as a fractured root or periodontal disease. Hope this helps and best of luck.

Steve Litwin DDS

---------- FOLLOW-UP ----------

QUESTION: I went for a check-up and they saw on the x-rays that the root canal is doing beautifully and is filled up all good. So how would a dentist know if a root canal is failing?

Answer
Hi Nate,

The fact that the radiograph shows the root canal to be filled properly is a good thing. What I am saying is is that there might be other things going on here such as a possible cracked root or even periodontal disease (gum disease) if your dentist said your gums were swollen rather than just the area where the tooth is. If that is the case then you may indeed need some other type of antibiotic but if it is gum disease related and the amoxicillin did not take care of it then the other type of antibiotic commonly used for severe gum infections is doxycycline and flagyl. Both of these are potent antibiotics and should only be used if the diagnosis is certain. Which brings me to the other main point I was making before and that is before any additional antibiotic is prescribed the diagnosis has to be made as to the cause of the issues and not just assumed based on the success or failure of an antibiotic. Determining if a root canal is failing sometimes is made through a process of elimination meaning that if all other possibilities for the cause of the problems have been eliminated then it can then be assumed that the root canal could be the cause. Again, a thorough evaluation and diagnosis must be made before starting a third strong antibiotic such as Augmentin (which is amoxixillin plus another ingredient and is very strong) when you have just completed two rounds of amoxicillin already.  Hope  this helps.


Steve Litwin DDS