Managing Dental Emergencies: Dealing with Swelling After Root Canal Treatment - Dentistry

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Halfway through the root canal, my face swelled up... I have received emergency treatment?


Hello, doctor.
I had a root canal treatment on my molar when I was in elementary school, but it may have been incomplete at that time.
Occasionally, when I stay up late, I develop a pus-filled abscess on my gums.
Recently, I noticed that the crown on this tooth has been getting larger, so I visited a nearby dental clinic to redo the root canal and place a crown.
Although I no longer see the abscess, I do feel some pain when I press on the gums, which is different from my other teeth.

During the first attempt to remove the old filling material, there was no issue.
However, during the second attempt, after administering a lot of anesthesia and drilling with a dental needle, I filled the tooth and the next evening, I suddenly noticed swelling in my lower jaw.
I did not have a fever or any other unusual symptoms, and I was able to eat normally.
The following Sunday morning, I went to a clinic for an injection and medication, where I was diagnosed with cellulitis.
On the day of the Dragon Boat Festival, I went to a large hospital's emergency department for more antibiotics and double the anti-inflammatory medication, and I also had blood tests done (currently, the inflammation markers do not indicate spreading, and my white blood cell count is normal).
I would like to ask the doctor if, since my gums around the molar are noticeably swollen and hard, I should have the plastic surgery department (which the emergency department referred me to) perform an incision and drainage to remove the pus, or should I let my original dentist handle it directly without waiting for the swelling to subside? I think it might also be possible to open the pulp chamber to drain the pus.
Should I wait until the inflammation and swelling have completely subsided from the antibiotics before seeing the dentist? If there is a drainage tube in the gums, can the dentist still proceed with treatment, or should I wait until the drainage tube is removed?

Niu, 30~39 year old female. Ask Date: 2018/06/19

Dr. Zeng Guanghui reply Dentistry


If the molar experiences gum swelling after root canal treatment, potentially leading to cellulitis, in addition to administering antibiotics and performing incision and drainage, it is essential to thoroughly debride the root canal of the affected tooth.
After cleaning the root canal, it should be filled with gutta-percha.
Once the source of infection is eliminated, the gum swelling will gradually improve.

Reply Date: 2018/06/19

More Info


Managing dental emergencies, particularly after root canal treatment, can be quite challenging. In your case, it seems you are experiencing swelling and discomfort following a root canal procedure, which may indicate an underlying issue that needs to be addressed promptly.

Firstly, it’s important to understand that swelling after a root canal treatment can occur for several reasons. One common cause is the presence of an infection, which may not have been completely resolved during the initial treatment. This can lead to the formation of an abscess, which is a collection of pus that can cause swelling and pain. The fact that you have experienced a hard lump in your gum and have been diagnosed with cellulitis (a type of skin infection) suggests that there may be an ongoing infection that needs to be managed.

Given your symptoms, it is crucial to follow a systematic approach to treatment. Here are some considerations:
1. Antibiotic Therapy: Since you have already started on antibiotics, it is essential to complete the full course as prescribed by your dentist or physician. Antibiotics can help control the infection, but they may not resolve the issue entirely if there is an abscess that needs to be drained.

2. Pain Management: Over-the-counter pain relievers such as ibuprofen or acetaminophen can help manage discomfort. However, if the pain persists or worsens, it is important to consult your dentist for further evaluation.

3. Drainage of Abscess: If there is a significant amount of swelling and a hard lump, it may be necessary to drain the abscess. This can be done by your dentist or an oral surgeon. They may make an incision to allow the pus to escape, which can provide immediate relief from pressure and pain. If you are referred to a plastic surgeon, they may also be able to assist with drainage, but it is typically best handled by a dental professional who understands the anatomy of the oral cavity.

4. Follow-Up Care: After drainage, your dentist will likely want to reassess the tooth and surrounding area. This may involve further imaging, such as X-rays, to determine if there are any remaining issues with the root canal or if additional treatment is necessary.

5. Timing of Treatment: It is generally advisable to address the swelling and infection before proceeding with any further dental work, such as placing a crown or performing additional root canal therapy. If the swelling is significant, it may be best to wait until the infection is under control before any invasive procedures are performed.

6. Communication with Your Dentist: Keep an open line of communication with your dental care provider. Inform them of any changes in your symptoms, including increased swelling, pain, or fever. They will be able to guide you on the best course of action based on your specific situation.

In conclusion, managing swelling after root canal treatment requires a careful evaluation of the underlying causes. It is essential to address any potential infections promptly, and drainage may be necessary to relieve symptoms. Always consult with your dentist or an oral surgeon for the best treatment options tailored to your condition. Your health and comfort should be the top priority, and timely intervention can prevent further complications.

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