Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 12/2/2006

Question
Hi, after having a filling on my 2nd right bottom molar last Friday, by Monday I was diagnosed with an abscess and given 5 days 500mg amoxicillan 3 times a day.  On Wednesday evening the tooth was extracted.  Luckily I've had little swelling since I iced my cheek for 5 hours post op but the pain is still very intense.  Gauze packing has been placed in the socket with antiseptic but the pain is debilitating even on ibuprofen and co-codamol.  My ear hurts as well as my cheek and under my jaw and all I can do is sleep with the painkillers help to escape the constant throbbing.  No one can tell me if this is normal.  My worry is that the infection has spread to my jaw bone or that maybe it's been fractured slightly.  It wasn't a very easy extraction and the tooth had basically disintegrated above the gum line, leaving the dentist to cut the tooth in 2 to get the roots out.  Please could you give me some kind of feedback.  Is this normal?  Should I be worried?  Thanks so much for your help.  Kindest regards, Susie Royse, Oxfordshire, England

Answer
Susie - Of course it is difficult for me to be 100% accurate without directly examining you or seeing an xray, but it sounds like you have a trapped infection in the bone or the soft tissues of the face.  What I mean is that even though the cause of the infection, the tooth, was removed, the infection spread beyond the tooth into the surrounding bone and soft tissues of the face.  Placing ice on an area after an extraction prevents the body's ability to remove infection and reduce the trapped bacteria.  Bacteria can only be affected by an antibiotic like amoxicillin if the infection is exposed to blood vessels that deliver the antibiotic to the area.  With an abscess the infected area is contained and builds pressure.  Ice will not allow normal blood flow to the area. At the same time antibiotics cannot attack the bacteria producing the pain and pressure.  

One of the things that you did to help contain the infection was placing ice on your cheek.  Ice does not allow for natural drainage and the bacteria is contained.  

So what can you do help?  Stop the ice immediately.  Start a warm salt water (teaspoon of salt in glass of warm water) rinse for 5-10 minutes at least 5 times per day.  This will assist the body's attempt to eliminate the contained infection.  Continue the antibiotic.  Having had the tooth extracted a few days ago should allow the bacterial infection to drain.

If you have no improvement by Monday, definitely either see the dentist or have the dentist refer you to an oral surgeon.  I do not like infections that dwell in an area for a while so rinse and if not better call.

If you have any further question do not hesitate to contact me again.