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Oral Surgery/post root canal pressure and swelling

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Question
I have crowns placed on my front 8 teeth on top.  In April, I had an auto accident and took a hard facial hit from the air bag.  I have had to have 6 of the crowns replaced due to chips and cracks.  After the old crowns were drilled off, and I was in the temporary crowns, I started having severe pain in my very front right tooth.  Doc's opinion was that the tooth was traumatized in the accident, causing the root to start to die.  I have had many root canals, and a couple of abscesses, so I had figured this was going on.  The tooth was root canaled on Wednesday, and the permanent crowns were placed that day.  It is now the following Monday, and have a great deal of pressure and a bit of swelling between my tooth root area and lip.  Feels like a pretty hard lump up there (right at the base of my nose).  I have never had this post root canal before, for this long.  Is this normal?  It does not have the pain of an abscess, but just a lot of pressure.  I am out of town, and unable to see my dentist until Wednesday (2 more days).  He says he will put me back on an antibiotic if I want, but I hate to go on one unnecessarily.  Do you have an opinion as to what is going on and how concerned I should be about getting through the next couple of days, and if I should go back on the antibiotic?  Thank you for your time!

Answer
Vikki -  Especially since you sustained trauma producing the death of the nerve within the tooth, necessitating root canal treatment, the dentist made a mistake cementing that crown early.  The root canal should have been done and the crowns should not have been cemented with permanent cement only temporary cement.  If temporary cement was used, the crown could be removed, the nerve canal could be exposed and pressure and or infection could have been drained.  Now if you are having a problem with that tooth, it is important not to drill off the crowns again.  The dentist should refer you to an oral and maxillofacial surgeon for a simple surgical procedure, called an apicoectomy.  Any pressure building up and infection can simply be eliminated without losing the crown or the tooth.  

For the next couple of day, immediately begin warm salt water rinses for about 2-3 minutes, at least 4-5 times a day.  You should definitely go back on antibiotics, but the cure is not either.  The problem in the bone surrounding the root tip needs to be corrected and that is why an oral and maxillofacial surgeon needs to be seen.

I wish you well and hope you are better soon.  If you haf3e additional questions, feel free to contact me again.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon 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 practicing for over 20 years. Assistant Clincal Professor at 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- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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