Expert: Mark Bornfeld DDS - 12/14/2006

Question
Thank you for the easy to understand answer. All the work was done on my right side and the painful shot to the nerve was on the upper right near my upper gum. The only thing about your answer that confused me was if this is a possiblity that it can be permanent. What did you mean by "cosmetic liability"?  Will heat help? Thank you again!-------------------------------------------
The text above is a follow-up to ...

-----Question-----
I had a deep cleaning and a crown put in yesterday and received 2 - 3 novocaine shots. The first shot gave me instant nerve pain up my cheek to my eye which subsided when the shot was stopped. I rec'd the shots at 1:00pm and was still numb in my cheek, tongue & lips at 8:00pm. I noticed the swelling in my cheek w/in a hour of leaving the dentist. It is now 10PM the following day and I still have swelling in my cheek, pain when I touch my cheek or open my mouth wide and tingling in my lower lip and occasional pain in my lower jaw. I contacted the dentist yesterday and today and even today they said that it was an effect from the novocaine that might last a day. My symptoms have not improved. I have rinsed with salt water and have applied moist heat. What could be the cause of this and what is the possible prognosis?
-----Answer-----
Dear Ms. Culp,

It would be helpful to know just where the injections were administered and the teeth that were treated. However, the events as you have presented them suggest that there was internal bleeding as a result of the anesthetic injection, leading to hematoma-- a collection of blood in the tissues. Depending on the size of the hematoma, it may take several days for the swelling to go down. You may also see the development of blue, green, or yellow bruising discoloration on the skin of the cheek and neck below the swelling over the next week or two.

While these events usually heal uneventfully, they can present as a cosmetic liability; unfortunately, there is little that can be done to speed the resolution of the problem. In severe hematomas, it is sometimes necessary to surgically drain the collected blood and apply a compression bandage to prevent it from re-forming.

While the area is healing, you should be on guard for any increase in pain or swelling, which may indicate infection. Otherwise, the only thing that can be done is to allow time for nature to take its course.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY

Answer
Dear Ms. Culp,

Assuming I am correct in my assumption that the problem is due to a hematoma, it is temporary, and will heal without any residual effect.

What I meant by "cosmetic liability" is that most people would regard the swelling and bruising as visually unappealing, but this too is temporary.

Good luck!

Mark Bornfeld DDS