Managing Gum Swelling and Pain After Root Canal Treatment

Q: Managing Gum Swelling and Pain After Root Canal Treatment

Hello： It is recommended that you continue to use 0.2% chlorhexidine mouthwash (three times a day). <br>If the swelling and pain do not improve, you may first ask a local pharmacy abroad to prescribe 500mg Amoxicillin (take one every 4 to 6 hours) along with an NSAID for pain rel

Swelling and pain in the gums around a root canal treated tooth?

Hello Doctor,
I had a root canal treatment on my upper left molar over ten years ago, followed by a crown.
In November 2019, I experienced inflammation and swelling, and after an X-ray, the doctor indicated there was pus inside, leading to a second root canal and a new crown.
Initially, I was prescribed antibiotics during the process.

However, I often experience food getting stuck on one side of that tooth, which causes a foul odor.
I returned for a dental cleaning in January and have been using dental floss and mouthwash regularly.
The odor issue has significantly improved, but on the evening of April 10 this year, I started experiencing swelling in the gums on the "inner side" of the opposite side.
On the evening of April 11, I felt pain when biting down, which subsided after a while, but the gum swelling has not improved, and the tip of my tongue feels painful when it touches that area.

Currently, I am stationed overseas, and due to the severe pandemic situation, the country is under quarantine, making it impossible for me to seek medical care.
On the night of April 11, I took 300 mg of aspirin (three 100 mg children's doses I had on hand) and used 0.2% chlorhexidine mouthwash.
Upon waking on April 12, the gum swelling had not improved, and I have avoided using that side for eating.

I am concerned that, like last time, there may be pus inside requiring another root canal treatment, but it is inconvenient to seek medical care right now, as only pharmacies are open.
Should I take antibiotics, or do you have any recommendations on how to handle this situation? Thank you very much for taking the time to respond amidst your busy schedule, and I wish you good health.

Ms. Zhang, 30~39 year old female. Ask Date: 2020/04/13

Dr. Lin Jiayong reply Dentistry

Hello: It is recommended that you continue to use 0.2% chlorhexidine mouthwash (three times a day).
If the swelling and pain do not improve, you may first ask a local pharmacy abroad to prescribe 500mg Amoxicillin (take one every 4 to 6 hours) along with an NSAID for pain relief.
Once you start taking antibiotics, please complete at least a 3-day course.
Aspirin is less effective for pain relief and may lead to excessive bleeding.
Thank you!

Reply Date: 2020/04/13

More Info

Managing gum swelling and pain after root canal treatment can be a complex issue, especially when previous treatments have not resolved the underlying problems. Based on your description, it appears that you are experiencing recurrent issues with your upper left molar, which has undergone root canal treatment and has been capped with a crown. The presence of swelling and pain, particularly after a previous episode of infection, raises several concerns.

Firstly, it is important to understand that root canal treatment aims to remove infected or inflamed pulp tissue from the tooth and seal the canals to prevent further infection. However, if the infection persists or recurs, it could indicate that not all canals were adequately treated, or there may be new issues such as a fracture in the tooth or surrounding bone infection (apical periodontitis). The fact that you have experienced a foul odor and food trapping suggests that there may still be an issue with the tooth or the surrounding gum tissue.

Given your current situation, where you are unable to access dental care due to quarantine restrictions, here are some steps you can take to manage your symptoms:
1. Pain Management: You mentioned taking aspirin, which can help reduce pain and inflammation. However, be cautious with the dosage, especially since you are using children's doses. Over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen may also be effective if you can obtain them. Always follow the recommended dosages on the packaging.

2. Oral Hygiene: Continue to maintain good oral hygiene. Using a chlorhexidine mouthwash is a good choice as it can help reduce bacteria in the mouth and promote healing. Make sure to follow the instructions for use, as excessive use can lead to staining of the teeth and tongue.

3. Dietary Adjustments: Since you are experiencing pain while chewing, it is advisable to avoid using the affected side for eating. Stick to soft foods that require minimal chewing to avoid exacerbating the pain.

4. Antibiotics: If you suspect that there is an ongoing infection, it may be necessary to consider antibiotics. However, antibiotics should only be taken if prescribed by a healthcare professional. If you can consult a pharmacist, they may be able to provide guidance on whether an antibiotic is appropriate based on your symptoms.

5. Monitoring Symptoms: Keep a close eye on your symptoms. If the swelling worsens, or if you develop a fever, increased pain, or drainage from the gum, these could be signs of a more serious infection that requires immediate dental attention.

6. Future Dental Care: Once you are able to access dental care, it is crucial to have a thorough examination, including X-rays, to determine the cause of your symptoms. A dentist may need to reassess the root canal treatment, check for any missed canals, or evaluate the integrity of the crown and surrounding structures.

In conclusion, while managing gum swelling and pain after root canal treatment can be challenging, especially in the context of limited access to healthcare, there are steps you can take to alleviate your symptoms. However, it is essential to seek professional dental care as soon as possible to address the underlying issues effectively. Your oral health is vital, and timely intervention can prevent further complications. Stay safe and take care of your health during this challenging time.

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