Expert: Tony Appleton BDS DPDS - 8/3/2007

Question
3 hours after a root canal treatment on a bottom molar i experienced severe pain and facial swelling. Some hours later I had numbness around the left side of my chin.I returned to the dentist the following day to have the tooth drained. An x-ray was done as I felt pain during this procedure and it was found that I had a distal perforation in the root between the gum and bone.  I was then referred to an endodontist. Although I had an infection in this tooth and was being treated with antibiotics, the endodontist explained that the continued pain,swelling and numbness was most likely caused by an irritation to the irrigation solution used in the inital procedure. The endo was able to repair the perforation. Again I experienced severe pain and the numbness spread to the left side of my lower lip. I heard the dentist at my original visit ask the dental nurse for peroxide irrigation. At the second visit I noticed a syringe with MILTONS written on it and i'm almost certain that the endo used only saline. It has now been one week since my dilema and while the pain has eased and I am still taking antibiotics, my face around the area is still swollen and my chin and lip are still numb.  What do you make of my diagnosis and prognosis as I am really concerned that I have been left with permanent soft tissue damage and numbness caused by the irrigation solution.

Answer
Hi Caroline

These symptoms can be caused by a number of things. The infection around the tooth; the actual physical perforation; or the irrigation solution causing irritation to the tissues.

Miltons is basically a sodium hypochlorite solution - this is bleach, and is what we use to disinfect the root canals. It is quite normal to use this solution, however, obviously the solution is intended to remain within the root canal system and not to pass through to the tissues.

The endodontist probably used saline in this instance because he knew he was dealing with a perforation.

It seems likely that the dentist would have irrigated through the perforation, thinking he was still inside the tooth, and that the sodium hypochlorite (Miltons) has caused tissue damage and possibly damage to the nerve. However, another possibility is that the swelling from the infection has put pressure on the nerve, giving these symptoms.

There is a very good chance that everything will return to normal given some time, although you may be left with a residual area of altered sensation, and as a worst case scenario the numbness could be permanent.

Just give it some time, and try not to worry - chances are everything will return to normal.

Regards

Tony Appleton