Hello,
I am going through extreme pain from a hard lump that has appeared on my cheek. Initially I went to a dentist because of a throbbing pain on the tooth. The dentist took some X-ray and explained to me that the tooth needed a root canal. The first day of the root canal, he dug deep into my gums & kept complaining on how he could not locate the third canal. He then asked me to come back the next day so he can try to find the missing canal. On that next day he dug again for almost two hours. My cheek on that side of face had by Now swollen. He sent me home to wait a day & to come back for bridging of the tooth. The next day I was at the ER with excruciating pain & a hard swelling on my cheek. The ER, who failed to manage my pain sent me back to the dentist in the morning. I asked the dentist to just remove the tooth which he did. He then referred me to the oral surgeons because of the swelling (the lump) that was not going away. The oral surgeon took X-ray & told me that there was some root canal rubber left on my canals but he did not think that it was the cause of my swelling or the hard lump that had formed on my cheek. After putting me on stronger antibiotics and making an incision into my inside cheek for the pus to drain. I did not feel anything draining for a couple of days & the pain persisted. Last night I went to ER again because the pain was insane. They did a CT Scan & informed me that the lump does not seem like itÂ’s related to the root canal or the tooth extraction. Now they have sent me to an Ear, Nose & Throat oncology for a biopsy. The appointment is for the 20th February which is almost 6 days away. Meanwhike I remain in extreme pain from the lump and the pain is hardly responding to narcotic pain killers. IÂ’ve been mostly relying on Tylenol since IÂ’m allergic to NSAIDs.
After seeing other people complain about the same problem on this forum, I feel relieved that my case might not be related to cancer as I thought. One thing I noticed though, you have not advised other people with this problem to see an ENT. Why do you think that the ER is asking me to see the ENT oncology? Also the oral surgeon had recommended that I see the ENT prior to my going to the ER. IÂ’m I being misled going to the ENT? I have no insurance so I do not want to waste money going to specialists that might not be able to help me. I just want to hear your thoughts on this referral.
Thank you so much for being here for all of us!

Hi Lizhasproblem,

If the swelling had not occurred prior to the dentist attempting the root canal treatment, then based on your description, I would say that the lump is likely the result of that root canal procedure.

Here's why I think that...

1) All root canal procedures are flawed in the sense that it is not possible to remove all of the infected nerve tissue from inside of the microscopic canals which are INACCESSIBLE irrelevant of how many times the tooth is worked on. Thus leaving every root canaled tooth chronically infected.
I will post a diagram of the anatomy of a tooth so you can see just how many of these tiny canals are in every tooth.

2) The dentist knew there was an additional large canal but could not gain access to it because it was either calcified (closed off), or too tiny to get into, or it was too curvy to instrument. So all of his efforts were extremely irritating to the tooth causing an inflammatory response.. thus initial swelling.

3) The fact that the post op xray showed "rubber material from the root canal procedure" clearly indicates that either the dentist did not remove the tooth in it's entirety (a root may still be present with some rubber material in it) OR the dentist may have removed the entire tooth but he may have perforated the tooth during the root canal and pushed the rubber material beyond the tooth into the jaw bone. Both occurrences are not uncommon, but very problematic. Leaving a piece of infected root, even just the tip of a root after an extraction can result in a chronic and severe infection. Perforating the tooth during a root canal procedure and then pushing the rubber material beyond the root tip into the bone or sinus can also result in a chronic and severe infection. Neither occurrence is acceptable to leave as is... an oral surgeon would need to make a definitive diagnosis, possibly do a dental CD scan, and then remove whatever is there.

4) The ENT referral may be warranted if the rubber material or piece of root was pushed up into the sinus cavity. I assume was an upper tooth?

5) The reason the area is still swollen is because there was likely a long standing infection in tooth/area prior to the root canal treatment which has now spread due to the additional problems created by the root canal treatment. Inflammation can be severe enough to actually close off a previous opening where the pus was able to drain out of. Antibiotics may help reduce some of the inflammation as it lowers the bacterial count, but it won't be of much help as long as the "culprit" of the infection (a piece of the tooth and/or rubber material from the rc procedure) is still keeping the infection brewing.

I would get a copy of the pre op xrays, post op xrays and the CT scan and consult with a different oral surgeon ASAP. Not an oral surgeon that your dentist refers you to, but someone you find on your own or through a friend, relative or colleague.

You still may end up at the ENT, but if this is a dental problem, which it appears to be, then a Maxillofacial Oral Surgeon would likely be able to take care of it.

In the meantime..... I would apply very warm "moist" heat to the outside of your face over that swelling, use a wet washcloth and cover it with a dry towel, hold it on there for 15 minutes. Do this 4 times a day, especially before bedtime. Sleep with your head elevated if possible. Rinse with very warm salt water 4-6 times a day swishing it deliberately in that area of your mouth. In 4 ounces of water add one teaspoon of salt and stir.

Both of these things will encourage blood to flow in that area and possibly help to soften up the tissue enough to create an opening for it to drain. Keep in mind that neither of these things are a cure as the opening will keep closing from the inflammation and infection.

~~~~ If it does open~~~~, use a drawing down motion with you cheek to draw out the contents but be sure to spit it out and rinse out your mouth thoroughly afterwards. Do not swallow it.

~~~~If it does open~~~ You can try to push on the outside of your cheek to encourage drainage.

~~~~If it does open~~~ Do not put your bare finger inside of your mouth to push on the swelling. You may use a sterile gloved hand or gloved finger to gently push, but not a bare hand. The last thing you want is further contamination.

If you smoke, stop. The chemicals in tobacco will cause further irritation and inflammation, prevent healing, and possibly reduce the effectiveness of the antibiotic. They also could easily cause severe complications post operatively.

Keep yourself well hydrated with water... drink half your weight in ounces. Ex: if you weigh 100 lbs, drink 50 ounces of water every day (does not include any other drink). Avoid sugary foods as they suppress the immune system, eat plenty of vegetables, fruit and lean protein all of which encourage the immune system to do its job~

Get in to see a different Maxillofacial Oral Surgeon asap but be sure to either bring copies of all of your pre op and post op xrays and scan or have them sent to his office prior to the appointment.

I hope this helps.... keep in touch to let us know how you are doing.
Bryanna

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Yikes, this situation sounds awful; I really feel for you.