Dear Bryanna:

I have been searching all over the web trying to understand my issue better and I truly found your responses the most logical, detailed and thorough. Thank you so much for extending your support to everyone here. I am very concerned about a dental issue I have here, I am really seeking your experienced advise and I apologize in advance for being very detailed about it.

I had a root canal treatment on tooth#19 very long ago, I am 31 years now and I only remember it was done when I was back in the grades when I was in school possibly 20 years ago! The tooth had a crown on it and I never really complained of an issue till 3 years ago. I was 6 months pregnant that time and a sudden unbearable pain started on the tooth. I saw a general dentist who thought it was not a good idea to try to have procedures on the tooth while I was pregnant so he decided to give me a course of antibiotic and see if the pain will subside, and it did. I was fine again and forgot about it completely. 2 years later (May 2015) the pain came back again. I went to a dentist, they kept me on antibiotic and pain killers, took x rays the doctor said there was an infection underneath and suggested a tooth canal retreatment. I lost the crown in the retreatment and the doctor kept flushing medicines inside she said these were calcium based medication to fight the infection and make the tooth stronger, these medicines were clear to me in the subsequent x rays as white lines and spots. She initially said it will take around 2 to 3 sessions and she kept monitoring through x rays and the every time the infection was still present. After every session I would have an inflammation in the area and pain as well which was bearable. Doctor kept telling me if it swells too much or pain becomes unbearable to go to her and she would open the filling for the infection to drain.

Around the 2nd or 3rd session a bony hard bump appeared under the tooth, the doctor seemed concerned about it and she said its unusual! She said she won’t give up on the tooth though as the front tooth showed progress but the back root infection was still persistent. I would usually just have the pain on the day of the session and sometimes the day after but not otherwise. I went for around 7 sessions - a session every 3 weeks or a month – The area underneath got really inflamed after the last session and my cheek got really swollen and I was done trying by then and figured out after 7 months the dentist was not able to contain it so decided to seek a second opinion. I went to the best dental center in here, first time doctor peeked inside my mouth looked very concerned with the bump, he took an x ray and suggested an extraction. The doctor prescribed an antibiotic (Augmentin 650 mg) and flygl 3 times a day for a week from the day of the extraction. He said with the source of the bacteria gone (the tooth) and the antibiotic the swelling / bump should go as well.

I extracted the tooth with a dental surgeon in the same center on 13/1/2016. I was extremely worried about the bump at this stage. The surgeon comforted me not to worry and upon extraction he said there was a liaison around the roots of the teeth which caused the infection. He said the bump will reduce but it will take many weeks. I didn’t have pain after the extraction, very light which was perfectly handled with a pain killer. The surgeon asked me to come and see him after a month.

I had other dental issues on the other side so I could not bite, had very light / liquid / soft diet on that week. Felt very week with the tension, change in diet and antibiotic and I was extremely concerned with the bump. I kept touching it all over that week to see if it reduced in size, I barely had any sleep and I was very worried if it could be cancer or a serious problem. I asked the doctor for a quick fix so I can at least bite on this side till I fix the issues on the other side which I did not want to start till this side is healed. I had a bridge fixed since a week now replacing the extracted tooth. I kept asking the doctor about the bump and he seemed less concerned about it, he said it has got smaller but when I asked him if it will ever go he said its un predictable and it might not. He said it’s a very old infection and maybe the calcium medication used in the root canal retreatment has triggered this reaction and the bone got swollen. He asked me not to worry about it now. But I feel very less informed, I really want to know more.

I am very concerned about the bump. I don’t believe it should still be there after the extraction. Yes it has reduced in size by I would say 20-30% but its still there. Its around 1.5 cm in length and about 0.5 cm in width, its oval shaped and it hard like a bone when I touch it but its not painful at all. I told the other doctor about my concern he said we could do a biopsy if I am very concerned but he said he doesn’t really think its required.

Its been a month now and I will see the surgeon (who extracted the tooth) tomorrow for a follow-up appointment. I am not sure what are the right questions to ask here. I want to get comfort. I also started getting eye twitches on the eye at the same side which are very frequent and irritating. I have seen an eye doctor who said it is most probably tension and stress related. The eye twitches started before the extraction but they have increased a lot over the last 2 weeks. Could these 2 problems ever be linked?

Seems like Bryanna didn't see this yet, and am conscious about the time difference, anyone there can advise? I have the appointment to meet that oral surgeon in 3 hours and I really want to ask the right questions and as many. felt the doctors are really not giving details which are really important to comfort me and help me understand the case better. The eye twitching is not helping either and being an over analyzer am linking both but I really really hope they are not correlated...not good times indeed!

Hi Mees,

So sorry for the delay in my reply.... I was away for a few days.

By now you have most likely seen the oral surgeon. What did he say about the lump? Did he take an xray?

The first thing to keep in mind is that the root canaled tooth was infected for the entire time it was in your mouth since the original root canal was done. The rc procedure is done in an attempt to "retain" an unhealthy tooth for an uncertain amount of time. There is no dental procedure that can cure an infected tooth and make it health again. So that infection has been brewing for how many years?

Based on your description, I am thinking that there is a possibility that the dentist who did the root canal and kept instrumenting and irrigating the tooth may have perforated the tooth and pushed the rc material and debris beyond the tooth and into the bone. This could account for the lump. Was anything like a perforation mentioned to you?

I hope the oral surgeon takes an xray today or better yet a 3D dental scan. Please check back with us when you can.

Bryanna

Dear Bryanna:

no worries at all! I hope you enjoyed your time away..

I have seen the dental surgeon yesterday evening, he examined the bump and took a panoramic xray for the full Jaw. I asked him if this bump is actually a cyst. After examining the xray he assured me its not. I asked him if it could be something worse and he assured me again its not. He said he believes the calcium based material that was used during the root canal retreatment would have caused this reaction and the bone got swollen. he said it will gradually go down but it will take few months and he said we really don't need to do anything further about it. He kept assuring me that there is nothing to be worried about and that the area looks healthy. I also told him about the increased twitching in the eye after the extraction and he said its anxiety

I now remember the first doctor (one who did the root canal retreatment) going more aggressive everytime. she used to tell me ill go a little beyond the tooth or around it, ill trigger bleeding because the blood cells can fight the infection better and she also told me there was a lot of puss and dead tissues coming out in the very first session. I had the last session with her on 31st of December 2015 so that was the last time she actually flushed these medicines inside. I feel the lump has gone down but as I said by around ~20-30%.

I now feel more comforted about it after seeing the dental surgeon yesterday. but please do let me know what you think and whether you think his explanations make sense from your point of view. I am attaching the xray that was taken in the first diagnoses in the center am treating in now. it was around 11/1/2016 2 days before the extraction ad also the panoramic x ray that was taken yesterday.

Thank you so much for your time Bryanna.

Attached Thumbnails

   

Forgot to mention that the bump was previously extremely solid when touched from the first instance. now I feel like the hardness is one or 2 layers down as if there is soft gum layer above it ... could that be a positive indicator that its shrinking?

Also, There is abit of swelling (no pain) over the entire jawline (opposite side facing inward) I have noticed it after the bridge fixture, the doctor applied pressure to fix the bridge with the cement during the procedure, could that be a reason?

I am very determined to fix all my dental issues over the next 6 months, and I have plenty as you can see did not really take care of the smaller issues till they got worse .. feeling really bad about it but I have started educating my self much more on the different choices and procedures we have out there, I just wish dentists are a bit more outspoken instead of us trying to pull the info out of them :s

Mees,

Are all of the dentists that you are seeing a part of one single practice? Is is a clinic type practice with different dentists? If not, explain to me who referred you to each specialist.

The lump that you have in your lower left jaw is inflammation and possible infection from the rc filling material. The dentist that did that rc severely perforated each root tip and grossly pushed that material into the jaw bone. That material is not meant to and should not enter the bone. The white masses that you see at the end of the roots (on the xray prior to the extraction) are the filling material and clearly show the severity of the perforations and the amount of material shoved into the bone.

The panorex xray shows that whoever did the extraction of that molar did not remove all of the rc filling material from the jaw bone. It's also likely that he did not remove the periodontal ligament or other debris from the bony socket. If you look at this panoramic xray you will see a large white mass in the root space on the left. That is that rc filling material. He should have removed all of that along with the ligament and other debris. There is a high probability that the area is infected because he basically left the socket very dirty and that material will hold onto bacteria.

The bridge that you had done to replace this molar..... looks like a plastic tooth that was either cemented or bonded to each adjacent tooth. When you bite down on this thing... you could be putting excessive force on those adjacent teeth. Do those teeth feel sore or tender? Do you feel pressure in the area where the tooth removed?

I would recommend that you see an oral surgeon who is NOT affiliated in any way with any dentist that you have seen so far. To not only evaluate this molar area and make a plan to clean out that site properly but to also deal with the other dental problems that need to be addressed surgically.

I know you felt some reassurance from the oral surgeon that you just saw but in all honesty .... this situation is not okay the way it is. I'm sorry, I wish I could have given you positive news :/

Bryanna