Expert: Mark Bornfeld DDS - 6/10/2005

Question
Hi one more time Mark,

Thank you for responding. I have a quick follow up that I forgot to ask you concerning anitbiotics and healing.

I've had 4 visits with my dentist (DDS, MAGD). The last and final visit is for next week. The molar where the abcess ocurred has a gold crown (which I'm keeping) and it was done a long time ago. It was quite painful and he was very thorough, taking X-rays throughout to make sure he completely got everything. The canals (3 of them, one that was somewhat curved) were filled and he prescribed the anitbiotic again, although he didn't think I would need it. The base of the molar was uncomfortable the first 2 days but better today. All I did was take aspirin to help with pain.

My follow up: Is it normal after an involved RC for there to be some discomfort for a few days after the canals are filled? And, for precautions, should I be taking the antibiotic?

I just don't like to take antibiotics if not necessary. I thought they were useless because, once the canals are sealed, they can't get to any remaining bacteria anyway. Again, your subjective feedback is very helpful-thank you.

Answer
Dear Dan,

Some postoperative discomfort is the norm following a root canal treatment, usually due to the physical irritation from the procedure rather than active infection. Certainly, some discomfort only a few days after completion of root canal treatment is not in itself a cause for concern.

As for the postoperative use of antibiotics, this is generally decided based on the nature of any residual infection being treated, the nature and severity of the treatment itself, and the treatment philosophy of the dentist. While root canal therapy does theoretically remove pathogenic organisms from within a tooth, it cannot directly access any bacteria beyond the tip of the tooth root, where sepsis may persist despite completion of treatment. As a matter of policy, I do not administer antibiotics postoperatively, but that does not make it wrong. When appropriate, I prefer to use antibiotics preoperatively and peri-operatively to reduce the severity of infection prior to and during root canal treatment; other dentists will do as your dentist has. The general constitutional health of the patient will influence judgement when deciding whether to use antibiotics. For example, the consequences of an acute infection in a person who is taking immunosuppressive drugs for a kidney transplant would be grave, and such a patient would more likely be prescribed antibiotics than another patient who was not similarly compromised.

If this issue is a concern, you should discuss your dentist's rationale for prescribing antibiotics with him, since he is more aware of the specific conditions that prompted him to do so. I would be off-base to advise you to do otherwise based on the very limited information I have at my disposal.

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY