Lymph Node Issues After Tooth Extraction: What You Need to Know

Lymph node issues?

Hello Doctor, I would like to consult you.
I had my upper left molar extracted on January 18, and the next day I developed an ulcer in the gum area.
It has not healed at all after three weeks.
During this time, I have seen several doctors who said it doesn’t look like anything serious.
Recently, I have been feeling swelling in my mouth, so I went to see an ENT specialist.
The doctor took an X-ray and said there was nothing wrong with my sinuses, and that the swelling in my oral and cheek area might be due to the ulcer.
I was prescribed a five-day course of antibiotics, but I still feel swollen.
I then went back to the dental clinic, where the dentist mentioned that the extraction site did not bleed much initially, making it more prone to poor healing and inflammation.
The swelling in my face is likely due to the extraction site.
I am really worried and unsure if there is a problem with the extraction site or if the gap from the extraction is causing friction against my cheek.
I am also concerned about whether there might be an issue with my lymph nodes or something serious developing.
I saw another doctor who said that it is unusual for inflammation to last this long after an extraction, but they did notice inflammation in my mouth and found a swollen lymph node in my jaw.
The doctor asked if it was painful, and said that if it isn’t painful, it’s less concerning, as long as it doesn’t get larger.
They prescribed a three-day course of anti-inflammatory medication, which should improve the situation.
However, I am still worried about potential lymph node issues.
I had an ultrasound of my neck on January 21, which did not show any problems with my lymph nodes or thyroid.
Is it possible for something serious to develop in such a short time? If I still feel swollen after finishing the medication, which specialist should I see next? Should I go back to the dentist or the ENT? What further tests can be done? I am very afraid that there might be an undetected tumor that could hinder early treatment.
Thank you, Doctor, for your help in answering my questions.
I really appreciate it.

Ms. Chen, 40~49 year old female. Ask Date: 2019/02/12

Dr. Zheng Jueyi reply Otolaryngology

Hello, swollen lymph nodes are often associated with infections in the gums or oral cavity.
If the condition persists without improvement, you may want to follow up with a dentist or an otolaryngologist for further evaluation and treatment.
Wishing you safety and good health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2019/02/12

More Info

Understanding lymph node issues after a tooth extraction can be quite concerning, especially when symptoms persist for an extended period. Based on your detailed description, it seems you are experiencing a combination of post-extraction complications, potential infection, and lymphadenopathy (swollen lymph nodes). Here’s a comprehensive overview of what you need to know and what steps you can take.

Post-Extraction Complications
After a tooth extraction, especially of a molar, it is not uncommon to experience some swelling and discomfort. The extraction site can become inflamed, leading to the formation of ulcers or sores in the mouth, as you have described. The fact that you have a persistent ulcer for three weeks is concerning, as most post-extraction wounds should begin to heal within a week or two.

1. Ulcer Formation: The ulcer at the extraction site may be a result of trauma during the extraction or subsequent irritation from food or dental appliances. If the ulcer is not healing, it could indicate an underlying infection or other complications.

2. Swelling: The swelling in your cheek and the feeling of fullness in your mouth could be due to inflammation from the extraction site. Infections can cause localized swelling, which may also affect nearby lymph nodes.

3. Lymphadenopathy: The swollen lymph node you mentioned is likely a response to the inflammation or infection in your mouth. Lymph nodes can swell when they are fighting off infection, and the fact that it is not painful is generally a good sign. However, persistent swelling should be monitored.

Diagnostic Steps
Given your symptoms and the duration of your issues, here are some recommendations:
1. Follow-Up with Your Dentist: Since you have already seen multiple specialists, it would be prudent to return to your dentist who performed the extraction. They can assess the healing of the extraction site and determine if further intervention is necessary, such as drainage of any abscess or additional treatment for the ulcer.

2. Ear, Nose, and Throat (ENT) Specialist: Since you have already consulted an ENT specialist, if your symptoms persist after completing the prescribed antibiotics, it may be worth revisiting them. They can perform a thorough examination of your throat and neck, and possibly order imaging studies if they suspect deeper issues.

3. Imaging Studies: If there is still concern about the lymph nodes or if the swelling does not subside, further imaging such as a CT scan or MRI may be warranted to evaluate the lymph nodes and surrounding structures more comprehensively.

4. Blood Tests: A complete blood count (CBC) can help assess for signs of infection or other systemic issues. If there are concerns about autoimmune conditions or malignancies, additional specific tests may be required.

When to Seek Further Help
If you notice any of the following, you should seek immediate medical attention:
- The lymph node becomes painful or significantly enlarges.

- You develop fever, chills, or other systemic symptoms.

- The ulcer worsens or shows signs of necrosis (dead tissue).

- You experience difficulty swallowing or breathing.

Conclusion
While it is understandable to be concerned about the possibility of a serious condition, many post-extraction complications are manageable with appropriate care. It is essential to maintain open communication with your healthcare providers and advocate for further evaluation if your symptoms do not improve. Remember, early intervention is key to managing any potential complications effectively.

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