AboutJoel S. Teig, DMD, FABOMS Expertise I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.
Experience Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.
Organizations American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons
Education/Credentials BA
DMD
Awards and Honors National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude
Question My neighbor who speaks little English was having a root canal last week when the dentist blew air into and around the tooth. Immediately her face blew up and her eye was swollen closed. She was taken by ambulance and spent 4 days in hospital. She is on antibiotics and is to see a physician this weekend but I am concerned. Please tell me about this condition. How did the air get from the tooth to the other parts of her skull? Where does the air go now? how long does it take to recover? she has swelling, droopy eyelid, ear pain and headache that at times is worse than before, but doesn't want to bother calling the M.D. but she seems very nervous.
Answer Nancy - From your description of how your neighbor was treated, I can say that the air syringe that dentists used produce a fairly significant blast. This blast when invading the soft tissue in and around a tooth can actually dissect the soft tissue attachments and allow the air to spread. The only major question I have was how the dentist was able to infiltrate initially the soft tissue. Most soft tissue around teeth (gingiva) is firmly attached to the underlying bone and actually to a portion of the tooth itself. The only way air could penetrate that attachment is an actual attachment problem.
The possible reasons the attachment was insufficient could be: periodontal disease where the attachment is minimal or weak; the dentist if doing root canal may have placed a band around the tooth to utilized a rubber dam (a device that prevents saliva or other sources of bacteria from entering the tooth canal; and lastly, the dentist may have actually placed too much air pressure into the canal.
If the later reason was the cause of the swelling and air penetration, then the air would travel initially through the medullary bone. This bone is made of multiple spaces with the bone and would allow air to penetrate. If there was an infection at the end of the root of the tooth that was having root canal treatment then the overlying bone facing out may have been destroyed by the infection necessitating root canal treatment. If this was the access for air, the air could easily spread through the soft tissues of the face. The facial soft tissue is a loose tissue with firm components such as muscles and bone attachments, but there is also some fat in the tissue which would easily allow air to spread.
The air will dissipate with time, but the physicians are 100% correct in placing her on antibiotics, since this is an excellent location for the spread and starting of infection.
Spreading will occur due to just the air redistributing or it could come about from infection. I would definitely suggest that she contact physician as soon as possible for another evaluation. Occasionally is this situation an incision and drainage in necessary to allow air to have an easy access point.
I wish your friend the best and everything should heal, but if you have any further questions please feel free to contact me again.
