Post-extraction for dental abscess
 

I was diagnosed with a dental abscess a couple of weeks ago. My dentist prescribed penicillin to try to bring the infection down before extraction. That didn't work so he prescribed a couple of other antibiotics in succession, in an attempt to reduce the infection (Metronidazole, followed by Amoxycillin). I reacted to both - facial and neck rash - so had to stop taking them.
Since the extraction 6 days ago I have had no antibiotics to deal with any residual infection.
My socket seems ok but it's pretty sore near the root area and I am wondering how long I should leave it before contacting my dentist as I really don't know what to expect post-op.
Forum members' advice would be very welcome.
Thanks from a new member!

Hi sarahgee,

I am in the dental field and can offer some information here but first a couple of questions....

What tooth was extracted? Had the tooth been root canaled?

Bryanna

Hi Bryanna
Many thanks.
It was a lower left premolar which had had root canal root treatment back in the past. The dentist took an x-ray a few days before the extraction and it looked clear of infection.

Hi sarahgee,

What your dentist may not have told you is that root canaled teeth are always infected to some degree because during the root canal procedure the nerve tissue cannot be removed from the microscopic canals. So the tooth always harbors some degree of infection from the dead nerves inside those canals. In some people the tooth flares up with symptoms soon after the rc procedure in other people it can take years for symptoms to develop. However, in either case there is an infection developing.

If you had an abscess which is typical of a root canaled tooth for the reasons that I mentioned above, then the antibiotics temporarily subsided the inflammation associated with the infection. Which could make the tooth look somewhat "better" on the recent xray. But in reality the infection was still present.

Did you see a general dentist or an oral surgeon? Do you know if the dentist scrape the bone clean of the periodontal ligament or did he just remove the tooth and put a piece of gauze in your mouth?

Do you know if there was a cyst at the end of the root tip prior to the extraction? This would show up on the xray as a black circle at the root tip just in case the dentist mentioned it or showed it to you on the xray.

Bryanna

Thank you, Bryanna
 

Hi Bryanna
Many thanks for your concern and help - it's much appreciated.

My dentist has always been careful to keep me in the picture about what is happening in my mouth, so I was aware of residual bacteria in root canal fillings.

The x-ray was taken when the symptoms first appeared and before I took any antibiotics. It showed no infection, and no cyst, at the base of the tooth (I used to work in radiography department - I could see there was no shadow when shown the x-ray).

It was diagnosed as a gingival abscess.

It was my own dentist who treated me.

He was concerned not to disturb the nerve (the bit which showed up as a tiny white blob near the root and which I don't remember the technical term for, but it deals with sensation to the lip) when extracting so did no additional exploration after taking the tooth and fragments out. He put in a gauze pad.

There was no cyst as far as I know. Certainly didn't show up on the x-ray.

A major concern for me is the length of time this is taking to 'heal', especially given I am not taking antibiotics because of my allergic reactions to two of them. I'm not sure how well my body can fight off the infection without some pharma assistance.

I think, given the issues you have raised for me, that I will ring the dentist today for a telephone consultation to check these issues out.

Many thanks. You have been really helpful in identifying issues for me!
It's much appreciated.

Hi sarahgee,

Okay to help clarify...... the infection was diagnosed as a gingival abscess. In dental terminology that simply means that the infection from the inside of the tooth was draining into the gum tissue. It does not mean you had a gum infection. This occurrence is typically seen with root canaled teeth.

The root of a lower pre molar, especially the second pre molar, is in close proximity to the mental foramen. This is a small hole in the jaw bone that allows certain nerves and blood vessels to pass through it. This would show up as a dark gray area on an xray and it is fairly low in the mandible. Perhaps that is what the dentist was referring to?

So am I understanding you correctly in that he did not scrape the socket clean and remove the periodontal ligament? Did he irrigate the socket with saline?

I ask because the discomfort that you describe in the location of where the root tip would have been is classic of the socket not being debrided. So you may want to talk to him about that.

Bryanna

Thanks for advice
 

Hi Bryanna
That's really helpful. I'm much clearer now on what to discuss with my dentist when I have a consultation tomorrow.
I think he was concerned to avoid the mental foramen (I sustained nerve damage on the other side of my jaw years back when a wisdom tooth was extracted, so my dentist and I are keen not to repeat the problem).
Although he cleared debris, he did no debriding as far as I am aware.
I have been irrigating with saline several times a day on his advice.
(and it's feeling a bit less sore today)
Many thanks again.

Sarahgee,

The nerve injury to the other side of your mouth after the wisdom tooth removal is much more common than nerve injury from a pre molar extraction. Has that injury healed completely?

Regarding the at home irrigation with saline is helpful but be careful not to be too aggressive with that and don't over do it. The self irrigation cannot remove any ligament that is still attached to the bone. That had to be scraped out at the time of surgery. It is important for the extraction site to not be disturbed too much or too often during the initial healing phase as the bio-film that is forming to help protect the clot and heal the wound needs to do it's job. The irrigation is only meant to gently dislodge food debris from the socket.

Glad to hear that it feels less sore today... that is a good sign!
Bryanna