Expert: Joseph Zelig, DDS, D.ABP www.smileinthecity.com - 7/29/2006

Question
My dentist is a wonderful man, voted 'Best in the City' by a certain magazine. So I have every confidence in his work. Eight days ago I had a temporary crown placed and yesterday I went in for the permanent crown seating as well as a semi-annual cleaning.

My gums were tender for the whole week in between the two procedures and I had to be numbed up for the removal of the temporary crown and the subsequent scraping of the cement off of my tooth - it was very sensitive, down in the root of the tooth. After the permanent crown was seated and cemented in I went for my cleaning, which was not exceedingly long or difficult. At the end of my appointment I was given a mouthwash called Peridex to use twice a day for a week.

Today I woke up and my entire right cheek is swollen to include the right half of my lips. I ca barely move my mouth to smile. I also have a couple of red bumps in the right corner of my mouth that I would normally call fever blisters. I look like half a chipmunk!

I called the dentist and he prescribed amoxicillin over the phone, which I have started to take, and I also have filled his prescription for 800mg of Motrin, which I have also been taking.

I checked my gums and there is a very deep-red/purpleish spot on the inside of my mouth, next to the tooth that looks like the source of the infection.

Does it sound as if I have had some sort of a reaction to the -caine drug used to numb me up? How long will it take the -cillin to clear up this infection? What are the bumps in the corners of my mouth? How can I prevent this from happening again?

Answer
Hi,
It is difficult to give you a definitive diagnosis without seeing you. It is unlikely that the pain and sensitivity in the tooth is a reaction from the anesthetic. It is possible that the tooth was prepped very deep and MAY have become a root canal problem. Antibiotics might give you some temporary relief, but if it is a root canal problem, antibiotics would not cure it. The bumps in the corner of your mouth might just be from trauma during the procedure from keeping your mouth open for an extended period of time. I have seen this happen. A little vaseline before the procedure might have prevented this.
In any event, you should NOT be needing to take antibiotics after a crown. Something is not right. You should go see an "endodontist" (a root canal specialist) who can rule in or rule out the need for a root canal.
Incidentally, I am not at all impressed by magazines naming the "best Dentists". What it often means is that this dentist has hired a good public relations firm to make sure they get public exposure. Some of the "best dentists" are actually some of the worst. What you need to look at in choosing a good dentist is level of training and skill. If he/she advertises as a "specialist" you should check and make sure that they are actual specialists recognized by the American Dental Association.
Go find a good endodontist. If you let me know where you are, I would be happy to recommend someone.

Sincerely,
Joseph Zelig, DDS
www.smileinthecity.com