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Old 06-21-2015, 11:57 AM #1
indiansummer indiansummer is offline
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Default Hard lump post extraction

Hello

I have posted my question on some other forums but unfortunately received no answers, so I am really hoping to find help here. I have visited my dentist 4 times in the last fortnight so I'd like to get some other opinions before booking another appointment.

Several years ago I had a root canal treatment done (bottom right premolar). About 2 weeks ago I started feeling some mild throbbing pain. Made an appointment, Xray showed infection. Dentist removed the feeling (I notice hairline crack in it before so I suspect this is how bacteria got in), cleaned the canal (honestly it took about one minute) redressed it and told me it would settle soon. It was a Friday. It did not settle, it fact it hurt so much I thought I was going to loose my mind. I went back on Monday, was told the previous cleaning process "stirred" the infection, was given antibiotics (15x 250mg of amoxicilin). The pain was very strong, my cheek and gums swollen.
Additionally, my front tooth (top) suddenly became VERY sensitive to touch, really raw, as if nerve got exposed. Does anyone know why?

After a few days antibiotics finally kicked in, the pain almost gone away, the area was just tender. When the swelling gone down it revealed hard lump in my jaw, like a marble. Underneath that affected tooth, but not in the gum, it felt like in my bone. It didn't move. I went back to see my dentist. He told me it was still an infection, to continue taking antibiotics. I finished taking them and went back in because the lump was still there, didn't change size or position.

I asked the dentist to take this tooth out. I lost days of work, I am a single mum to two children and the pain and complications were really affecting our lives. The tooth was extracted on Tuesday afternoon, so 5 days ago. I was told the root was long, to expected soreness etc. I was in terrible pain for 2 days, then it calmed down and today is the first day without painkillers. It's a bit sore still but I think it's healing fine. The sweeling is still present but nothing major. However, the hard, marble-like lump is still there. Still same size.

Please help, what it is? Should I go back again? He has seen it several times now and didn't seem concerned. What would you do?

Thank you so much for any input you can offer!!!
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Old 06-21-2015, 03:34 PM #2
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Hi indiansummer,

The swelling you have described can be associated with a few things. But typically it is seen with root canaled teeth because the bacteria living inside of infected teeth proliferates beyond the tooth and into the bone. Frequently the result of that bacterial infection is the formation of a Radicular cyst that forms at the apex (end) of the root. When the infected tooth is extracted, it is imperative to remove the periodontal ligament, all diseased tissue and bone AND the cyst. If any of those things are not removed, the bacteria will continue to thrive in spite of antibiotic therapy. The medication may temporarily subside the symptoms and the swelling, but the bacteria will still be present and continue to spread.

Most general dentists are not extensively trained in oral surgery. So anything other than simple straight forward extractions of non infected teeth is not an area that they are well versed or extensively experienced in. So it would be wise to consult with an oral surgeon to evaluate the surgical site and the lump. It would be very helpful for the OS to have your pre op xrays of that quadrant of your mouth so he can see the history of that tooth prior to its extraction. He would also need to take his own xrays of that area to help determine the extent of the pathology that may be present in the bone.

Hope this info is helpful. Please check in and let us know how you're doing.
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 06-23-2015, 01:18 PM #3
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Default FAO Bryanna

Thank you so much Bryanna!
Is it ok if i ask a few more questions?

I am now one week post extraction and as far as I am aware it's not been longer than about 2-3 weeks since that hard lump developed inside my jaw. Is it possible that during such a short time the damage is so extensive and further surgery needed?

Are there any other plausible explanations for that hard lump underneath the extraction site?

I have visited my dentist several times in the last 2 weeks and he mentioned nothing that would suggest further issues. Is it negligence? Ignorance? I know you can't answer these questions, but my mind just boggles that I was sent away without any explanation or referral. He only told me to book another check-up in 6 months!!

How long do you think I need for the extraction site to heal fully considering the infection and the long root (that's all I know)? Shall I wait another week before contacting the surgery regarding referral? They seem to be fobbing me off all the time saying "it should settle soon".

Finally, what can you tell me about the procedure I might require? Will it require general anaesthetic? Long healing time? What about success rate?

Thank you ever so much!!! I appreciate your help.

Monika
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Old 06-23-2015, 03:38 PM #4
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Hi Monika,

You are welcome

The hard lump needs to be evaluated more thoroughly than it appears to have been by your general dentist. He means well but it's important for you to understand that he is not extensively trained in this type of dentistry so although he is hopeful that the lump will resolve on its own, he is not giving you a diagnosis of what it is or why it is there. So ideally it should be evaluated by an oral surgeon for a proper diagnosis which will hopefully determine if intervention is necessary or not. The surgeon may also take a wait and see approach but at least he will give you a diagnosis.

The intervention, if any, for a lump such as yours depends on what it is, what the internal dimensions are and where exactly it is located in the bone or soft tissue. These are the issues that an oral surgeon will try to determine, which takes more than just a clinical look see in your mouth. Diagnostically you may need some additional radio graphs and/or possibly a multidimensional dental CT scan (not a 2D CT scan as that is not diagnostic enough).

Before you get all worked up over what may or may not happen, get it properly diagnosed as it may not need any intervention. But you won't know that until you know more about it.

Can your dentist refer you to an oral surgeon or better yet, can you go to an oral surgeon of your own choosing? Are you in the US? Are you dependent upon health insurance coverage?
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Old 06-29-2015, 02:48 PM #5
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Default FAO Bryanna

Hi again Bryanna,

Thank you so much for taking the time to message me back. It really means a lot.

I decided to wait a little before contacting my dentist again. Tomorrow will be 2 weeks from the extraction and about 3-3,5 weeks since that hard lump formed in my jaw.

At first it was solid, hard as a marble and kind of round too. Now it feels a fraction softer, it does not hurt, it feels slightly tender when I press it and I get this weird sensation too. It's difficult to describe... When I press it, I feel pressure. The area is still raised underneath the extraction site, but it's much flatter. There's no bleeding, no other discharge, everything's healing well I think.

In your opinion, are these changes a positive ones? Is there a tiny possibility that my body's dealing with it and the lump in fact will eventually go away because it's showing signs of going down? It's a VERY slow process though.

I'm really curious what you think.

With kindest regards and thanks

Monika

PS. I'm in the UK.
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Old 06-29-2015, 05:40 PM #6
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Hi Monika,

I am glad to hear that you are feeling okay.

The decrease in symptoms and appearance of the lump is positive. The tenderness though is a bit concerning. The problem with an ongoing infection in the jaw bone is that the bacteria can migrate and find a path to drain into. Sometimes as this occurs, the original site seems to get better only to develop a new site elsewhere. So if things continue to "improve" but are not completely better, it would behoove you to see the dentist at the 4-6 week mark for a clinical examination and periapical xray. The xray will not show the formation of new bone yet as it is too early for that. But it would show if their were bacterial pathology in that area.

Hope this info helps. Thanks for checking back with us!

Quote:
Originally Posted by indiansummer View Post
Hi again Bryanna,

Thank you so much for taking the time to message me back. It really means a lot.

I decided to wait a little before contacting my dentist again. Tomorrow will be 2 weeks from the extraction and about 3-3,5 weeks since that hard lump formed in my jaw.

At first it was solid, hard as a marble and kind of round too. Now it feels a fraction softer, it does not hurt, it feels slightly tender when I press it and I get this weird sensation too. It's difficult to describe... When I press it, I feel pressure. The area is still raised underneath the extraction site, but it's much flatter. There's no bleeding, no other discharge, everything's healing well I think.

In your opinion, are these changes a positive ones? Is there a tiny possibility that my body's dealing with it and the lump in fact will eventually go away because it's showing signs of going down? It's a VERY slow process though.

I'm really curious what you think.

With kindest regards and thanks

Monika

PS. I'm in the UK.
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Bryanna

***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 03-26-2020, 01:20 PM #7
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Default Update

Sorry i know this an old post but wanted to check how you managed to resolve the small lump? Im dealing with exactly the same issue.

Ay advice is much appreciated
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Old 10-12-2020, 10:07 AM #8
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Quote:
Originally Posted by davidgraham5 View Post
Sorry i know this an old post but wanted to check how you managed to resolve the small lump? Im dealing with exactly the same issue.

Ay advice is much appreciated
Same here. I just made my very first post here, which hasn't been approved yet.

In my post I forgot to add that I'm trying to find out information this way because my dental clinic does not have email or online contact - and I'm not good with using the phone to try explain a possibly complex situation and then wait for a reply through the receptionist.
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Old 10-12-2020, 01:04 PM #9
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Welcome Jenseen.

Kitt
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Old Yesterday, 06:29 AM #10
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Welcome Jenseen.

Kitt
Thank you, Kitt!
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