[PMartin]

I apologize for the lengthy post but want the details included. I began to have tooth pain in the molar immediately in front of the wisdom tooth on the lower left side last Thursday morning. This tooth had a root canal one year earlier. I was on Augmentin for a stye for 6 days at this time and am also taking Humira ( immune suppressant) for an autoimmune disorder. By noon it was painful and by 3pm the pain was serve. No dentist could get me in but after telling a dentist the details (being on Augmentin and Humira) he said go to an urgent care and have it looked at. Dr said there was some swelling and prescribed prednisone and 60mg of codeine. That helped the pain slightly.
The dentist said there was a bad infection in the tooth and sent me to an endodontist that afternoon. She said the original crown was poor fitting and created a gap between the crown and gum. The endodontist recommended and performed a retreatment, which was the most painful procedure/accident I have ever had, more so than crushing my 5th metatarsal, tearing both peroneal tendons and breaking my heal bone or cutting the tip of my middle finger off.
They trouble numbing the tooth at all. Taking the old crown off required a lot of effort and force, the fact the area was inflamed and irritated didn’t not help. I took two Percocet’s and waiting 30 minutes before she proceeded. They could not get the ring for the dental dam to fit because the tooth had been ground low. After four or five attempts and a lot of forceful pushing on stuck only to pop off. She injected more lidocaine deeply into the area between the tooth and gum. After the procedure she replaced the old crown on the tooth, gave me a new antbiotic and said come back next week to fit for a new crown. The tooth and jaw was very sore until Saturday afternoon but Percocet made it bearable. Saturday after noon the Percocet became less effective and was not lasting as long. By Sunday it was not effective at all and the pain began to run from the jaw hinge to my chin both along the gum and inner jaw line, along the upper jaw the front tooth, down my throat, the roof of my mouth on that side bone badly, up my jaw near my eye and up my check bone.
I want to the ER to make sure the infection had not spread concerned with the pain and the fact I was on Humira. The Dr noted some white thick gunk was all around the tooth that had the retreatment and obviously I was in severe pain over the left side from my throat to eye area. He gave me a dilaudid injection that was semi effective and then a second that completely relieved the pain and ordered a CT scan. The result showed an infection but it had not spread. He discharged me with dilaudid for pain and Percocet to take in addition if the dilaudid did work on its own. It was fairly effective Sunday however Monday not as effective. Today the crown came off on its own. I called the dentist that I first saw who thought it was strange the endo removed the crown and replaced it rather than drill through it. He was also concerned with the level of pain and expanding area. He cannot get me in until Thursday at 9am, and gave me yet more Percocet incase I run out as I have enough dilaudid.
The ER doctor suggested an oral surgeon look at the area to see if he can find the source. It has been a nightmare, I haven’t eaten since Thursday morning as every time I try to eat even crewing soft food on the opposite side it guarantees a flare up, and even drinking will cause a minor flare up. Has anyone experience this after root canal or other dental work?

[Bryanna]

Hi PMartin,

I'm sorry you are having so much pain. You have certainly been prescribed A LOT of medications!

The problem you are having is very common and is the result of a severely infected tooth. Root canal therapy does not cure an infected tooth as there is no access to the hundreds of microscopic canals. I will add a diagram of the anatomy of a tooth to show you just how many of these tiny canals are in every tooth. Because there is no access to them, they will always contain infected nerve tissue. So to clarify, this tooth has been infected since the original root canal.

The only way to attempt to cure the infection is to remove the source of the infection. The source of the infection is the tooth. Keeping this tooth means to keep the infection and the infection will spread to the adjacent teeth and your jaw bone. The infection can also become systemic, meaning it can easily travel to another area of your body. Especially since you are immune suppressant drugs.

The healthiest option is to have the tooth extracted and as soon as possible. Only see a dentist who is an oral surgeon for this extraction as it is likely to be a bit complicated.

Look at the diagram of the tooth. The microscopic canals are called and marked dentin tubules and they are all of the tiny brown lines in the photo.

Please check in and let us know how you are doing.

[PMartin]

Thank you Bryanna
I was thinking the same thing. The denist that performed the root canal called today to set an appointment to make a crown completely disregarded the problems and pain saying its just pressure. Needless to say i did not do it. The ER doc said i am no dentist but i would have removed it, there are to many places for bacteria to hide that antibiotics can not reach. I thought it was odd as did the dentist that the endo removed a very solidly attached crown and agrivate the tooth and nerves rather than drill through it. The only upside is I went from 9 pm last night to 11am this morning without taking pain medication. i will see the oral surgeon tomorrow morning. I am still amazed at the amount of med it has taken to make this bearable. Lesson learned, anything that may require that level of med other than ortho surgery is not a procedure to opt for.

[Bryanna]

Hi PMartin,

Okay. It is very interesting and makes me very happy, that the ER doctor was honest to inform you about the many places for the bacteria to hide in the tooth whereas antibiotics are unable to reach those areas. Do you know what areas he was talking about? They are the DENTIN TUBULES!

Very glad to hear that your pain has decreased and you are getting that tooth out by the oral surgeon tomorrow )

I would suggest that you prepare yourself with some nutritious soft food meals, enough for at least a week or two as you will have to give your jaw a rest after the extraction. Chewing regular food after a tooth is removed can make the jaw work too hard after it's been manipulated. So it's best to have your menu ready just for the eatin'!

If you smoke... stop. At least until the extraction site closes up. Smoking can disrupt the formation of the blood clot which is essential for proper healing. Smoking can also dislodge a newly formed clot... either occurrence can not only cause a painful dry socket but it can also prevent the bone from growing in properly.

Please let us know how you're doing after the extraction.
Bryanna

Originally Posted by PMartin

Thank you Bryanna
I was thinking the same thing. The denist that performed the root canal called today to set an appointment to make a crown completely disregarded the problems and pain saying its just pressure. Needless to say i did not do it. The ER doc said i am no dentist but i would have removed it, there are to many places for bacteria to hide that antibiotics can not reach. I thought it was odd as did the dentist that the endo removed a very solidly attached crown and agrivate the tooth and nerves rather than drill through it. The only upside is I went from 9 pm last night to 11am this morning without taking pain medication. i will see the oral surgeon tomorrow morning. I am still amazed at the amount of med it has taken to make this bearable. Lesson learned, anything that may require that level of med other than ortho surgery is not a procedure to opt for.

[PMartin]

Thank you Bryanna
the crown had come off on its own. I called the dentist and he wanted me to come in this morning, he also said ( a sign of things to come ) keep it off or put it back on it really doesnt matter as long as you protect it. I went in and the called the endo for a surgical report and after x ray. Ironically the endo had called for me to come in for a build up and crown fitting, yesterday.
Well, the endo said she wasnt done with the root canal ( a week later and i was told the only thing left was a build up and crown).
The dentist was really puzzled and took me back to have a look. He took the crown off which was bent and misinformed. Turns out he said "she didnt do anything significant to the tooth". She had moosed the crown off drilled the top of the filling out and worked on, not completed ONE root, sealed it put the crown back on and sent me on my way. The dentist said the only reasonable thing to do is remove the tooth. He said ha would not do it because the level of work requires a surgeon that can properly remove and clean the entire area. (He was beyond confused why she would do that especially given i am on a long acting immune suppressant drug.

They sent the x rays and records to an oral surgeon that wants me in this afternoon. He said it has to come out and mention (so i wasnt shocked) I will probably have drainage tubes put in. He said they really messed up to leave a pain level that requires hydromorphone and oxycodone for 6 days.
Thanks for you help i will let you know what happens.

[Bryanna]

PMartin,

I am well aware of what you are going through as I have partaken in the treatment and after care of dental patients who have been in your situation. The tooth is so sick and there was never any question about that. You were not treated wisely or properly. I am so sorry you have been through all of this pain and all of those meds!!

Depending on how extensive the infection is, the oral surgeon may have to do an incision and drain today and then go back in next week to remove the tooth. That will be a judgement call on his part. I am hopeful that the oral surgeon will be diligent with his work and you will heal okay.

Please check in with us today when you can.
Thinking of you and sending positive thoughts your way.....

Bryanna



I am glad to hear that

Originally Posted by PMartin

Thank you Bryanna
the crown had come off on its own. I called the dentist and he wanted me to come in this morning, he also said ( a sign of things to come ) keep it off or put it back on it really doesnt matter as long as you protect it. I went in and the called the endo for a surgical report and after x ray. Ironically the endo had called for me to come in for a build up and crown fitting, yesterday.
Well, the endo said she wasnt done with the root canal ( a week later and i was told the only thing left was a build up and crown).
The dentist was really puzzled and took me back to have a look. He took the crown off which was bent and misinformed. Turns out he said "she didnt do anything significant to the tooth". She had moosed the crown off drilled the top of the filling out and worked on, not completed ONE root, sealed it put the crown back on and sent me on my way. The dentist said the only reasonable thing to do is remove the tooth. He said ha would not do it because the level of work requires a surgeon that can properly remove and clean the entire area. (He was beyond confused why she would do that especially given i am on a long acting immune suppressant drug.

They sent the x rays and records to an oral surgeon that wants me in this afternoon. He said it has to come out and mention (so i wasnt shocked) I will probably have drainage tubes put in. He said they really messed up to leave a pain level that requires hydromorphone and oxycodone for 6 days.
Thanks for you help i will let you know what happens.