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Dentistry/Upper incisor pain worse after root canal treatment


Dear Sir,
I'm working away from home in Tanzania and have medicare insurance provided by my employers. I have to use the clinic(s) nominated by the insurance company, so there's very little choice. I'm going home on leave in 10 days, but the insurers state that if I use another dentist whilst I'm away, it will invalidate their cover - it states this in their small print, unfortunately.
Anyway, a couple of months ago I started to feel tenderness just below my nose, in the region of the root of one of my two front incisors. If I tried to blow my nose or touch the area it was tender and it kept getting worse, to the extent that if I tried to bite into an apple (for example) it was very sore.
I went to the dentist approved by the insurers and they x-rayed the tooth. The dentist said there was nothing apparent on the x-ray, but that they'd do a root canal anyway. This was started on 21st June and I went back yesterday for them to open it up again and clean it out again with the reamer. I am due to go back for the final time next Thursday, which is presumably when they'll pop the permanent filling in. The Tanzanian dentist only has penicillin which I am allergic to, so I plan to visit my workplace doctor tomorrow to ask if he can prescibe a different antibiotic. In the meantime, the dentist says to use a mothwash when I clean my teeth - I've been using one regularly for 20+ years.
The thing is, despite them having removed the nerve and re-x-rayed the tooth, there's no sign of infection on the x ray and my tooth is hurting worse than ever. I'm taking tylenol (paracetamol and codeine) and it's hardly touching the pain, which is now a constant throbbing. If I try to eat or even accidentally touch the tooth with my tongue, it's agony!
Please, do you think it's caused by something else and would I be better just having the darn thing removed and be done with it. It's driving me to distraction as it is.
Hope you can help.
Thank you.

Hello Liz,

I am happy you contacted me because there is really no reason I can see to put in the final filling in this tooth. Has it been left open to drain? Do you feel or see any swelling? Is there any fever you've had? Is this tooth loose at all?  What you are describing could be caused by a number of things. It could be that the tooth has a cracked root, possibly there is a second canal in this tooth even though that is rare in this one it is possible. It might be that there is simply recurrent infection that needs to be resolved before it's been opened. You need absolutely  to be on some kind of antibiotic and this must not be restored until you're pretty much pain free. I really suggest you have this opened back up, be put on an antibiotic, resolve the infection and then have it restored. The pain could be from pressure caused by the bacteria that's coming from the infected tooth and it is also possible the ligament holding the tooth in the bone is swollen. So this has to be resolved as soon as possible. Do this first before you have the tooth removed because it seems to me it's possible to save it.  As a last resort one can have an apicoectomy done on this if there is no crack in the root. An apicoectomy is actually a minor surgical procedure that cleans the tip of the root of the tooth and seals it from underneath.  Sounds terrible but it's really not a big deal. Hope this helps you and good luck Liz.  If you have more questions don't hesitate to contact me again.

Dr. Karmen


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Thomas Karmen


All general dentistry questions, especially those related to fixed prosthetics. Endodontics, Periodontics, and implants, minor oral surgery I can't answer much about othodontics nor advanced treatment of carcinoma nor deep tissue surgery nor osseous surgery such as jaw reduction or advancement.


DDS In general practice and consulting with having done some lecturing for local dental societies.

ADA and Florida Dental Association and Iowa Dental association

DDS degree

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