Sensitive cheek
 

I had an abscess tooth in May. It was from an old root canal on #14 and turned out to be an extra root. Anyway, my cheek was swollen and I was given a week's worth of clindamycin. The swelling went down and the root canal redone in July. It felt fine initially, but now I'm feeling something in my cheek where it was swollen and the tooth behind 14 is sensitive. Any ideas? Is the infection gone, and is this normal? Thanks.

Hi redogreeen,

All teeth have both large and tiny canals inside of them that contain nerve tissue. The only canals that can be accessed and instrumented during a root canal procedure are the large ones. The tiny canals, called dentin tubules of which there are many many hundreds of, cannot be accessed because there is no instrument small enough to get inside these microscopic canals. Therefore, these canals will continue to harbor nerve tissue which becomes mummified and necrotic after the root canal is performed. When a root canal is done twice or any number of times, the only canals re instrumented are the ones that are visible and large enough to get into to. It is possible that a large canal was missed during the first root canal, but it is irrelevant when there are so many hundreds of tiny canals that can never be cleaned out.

The tooth abscessed because of the bacteria that grew inside of the tiny canals and probably inside of the missed canal too. So even though the procedure was done again, the bacteria is still present in those tiny canals.

Not all dental abscesses have obvious symptoms until they become quite large or severe. Some rc teeth abscess soon after the first or second procedure... others might not abscess until weeks, months or even years later. But from the time the first rc is done until the tooth is extracted, the tooth will contain infectious bacteria inside those tiny canals. The longer the rc tooth is retained in the mouth, the more progressive the infection can become. The bacteria can travel to the bone, the sinus, and beyond. It can become very irritating to the vessels and nerves inside the jaw bone leading to various symptoms of neuralgia.

Antibiotics can at best temporarily subside the symptoms as they cannot reach into the dentin tubules or cure the infection because the lack of vitality in the tooth actually encourages bacteria to multiply.

The swelling in the cheek indicates pressure and inflammation building up from the bacteria and your cheek is an easy place for that inflammation to travel to. The adjacent tooth may be sensitive now due to the spread of infection and/or the inflammation.

Unfortunately, the only attempt to cure this infection is to remove the source of it which is the tooth. If you decide to do that, it is usually best to see an oral surgeon for the removal as they are the most knowledgeable and experienced at removing infected root canaled teeth. It is also best to have it done while you are on the antibiotic.

I am attaching a diagram to show you what the dentin tubules are so you have any idea of the magnitude of them in each tooth. They are marked dentin tubules at the top of the diagram and they are indicated by the brown lines.

Feel free to ask questions and voice your concerns here.

Bryanna