Persistent Upper Lip Discomfort After Apical Cyst Treatment: What to Do?

Q: Persistent Upper Lip Discomfort After Apical Cyst Treatment: What to Do?

Hello Ms. <br>Cat： It is recommended that if you still feel discomfort in your lips after the apical surgery, you should return for a follow-up appointment with your dentist for further observation. <br>This may include taking X-rays to check if the jawbone is healing as expected

After the treatment of the apical cyst, there is still tenderness in the upper lip?

Hello, Doctor.
Six to seven years ago, I underwent root canal treatment and had crowns placed on my upper front teeth.
However, in January 2022, I developed an apical cyst on the canine tooth on my right cheek, and although my upper lip was not swollen, I experienced some swelling and pain in that area.
I sought medical attention, and the doctor diagnosed that the root canal treatment on my front teeth was incomplete, and the canine also required root canal therapy, which was performed at that time.
However, after the root canal was completed and the crown was placed, I still felt discomfort at the site of the original cyst and in my upper lip.
I then visited an endodontic specialist, who found that the root canal treatment on the canine was also incomplete, leading to an apicoectomy performed in March 2023.
Recently, during follow-up visits, the apicoectomy was very successful, and the bone is gradually healing, but I still feel discomfort in my upper lip (when I examine the lip, there are no visible abnormalities, but when I pinch the lip with two fingers, one inside and one outside, there is a slight hard lump sensation and it becomes painful; when not pinching, there is occasional swelling and pain).
During a recent follow-up for the apicoectomy, I consulted the doctor, who said that there were no visible abnormalities and that typically, if there are no external signs, no further treatment would be necessary.
However, I truly feel uncomfortable.
I am uncertain if this is due to the crown, if the bacteria from the apical cyst were not completely eradicated and have infected my upper lip, or if the apical cyst actually affected my nose at that time.
I really don’t know which specialty to consult or what tests to undergo, and I would appreciate your guidance.
Thank you, Doctor!

Mā, 20~29 year old female. Ask Date: 2023/08/19

Dr. Zeng Guanghui reply Dentistry

Hello Ms.
Cat: It is recommended that if you still feel discomfort in your lips after the apical surgery, you should return for a follow-up appointment with your dentist for further observation.
This may include taking X-rays to check if the jawbone is healing as expected.
Dr.
Tseng Guang-Hui, Department of Dentistry, Nantou Hospital.

Reply Date: 2023/08/19

More Info

Persistent discomfort in the upper lip following apical cyst treatment can be quite distressing, especially after undergoing multiple dental procedures. It’s essential to understand that the upper lip discomfort you are experiencing could stem from various factors related to your dental history and the treatments you've received.

First, let’s consider the timeline of your dental treatments. You had root canal therapy on your anterior teeth and subsequently developed an apical cyst associated with your canine tooth. The cyst was treated, but you continued to experience discomfort in the upper lip area. After further evaluation, it was determined that the initial root canal treatment was incomplete, leading to the need for additional procedures, including the apical surgery. While the surgery appears to have been successful in terms of healing and bone regeneration, the persistent discomfort in your upper lip raises several possibilities.

1. Residual Infection or Inflammation: Even after surgical intervention, there may be residual infection or inflammation in the area surrounding the previous cyst. This could lead to ongoing discomfort. It’s important to have a follow-up with your dentist or an endodontist to evaluate if any infection persists.

2. Nerve Involvement: The proximity of dental structures to the nerves that innervate the upper lip could also be a factor. If the cyst or the surgical procedure affected the nerves, it might lead to sensations of discomfort or pain. This could manifest as a form of neuropathic pain, which may require a different approach for management.

3. Scar Tissue Formation: After surgical procedures, scar tissue can develop, which might lead to a sensation of tightness or discomfort in the area. This can sometimes feel like a hard lump or a tight band, and while it may not be visible externally, it can cause significant discomfort.

4. Dental Crown Issues: If the crown placed on your tooth is not fitting properly, it could lead to pressure points that might cause discomfort in the surrounding tissues, including the upper lip. It would be wise to have the crown evaluated for fit and occlusion.

5. Psychosomatic Factors: Sometimes, persistent pain can have a psychosomatic component, where the discomfort continues even after the physical cause has been addressed. This can be particularly true in cases where there has been a long history of dental issues.

Given your situation, here are some recommendations on how to proceed:
- Consultation with a Specialist: Since you have already seen multiple specialists, consider consulting with an oral surgeon or a maxillofacial specialist. They can provide a comprehensive evaluation of the area and determine if further imaging, such as a CT scan, is necessary to assess for any underlying issues.

- Pain Management: Discuss pain management options with your healthcare provider. This may include medications such as NSAIDs for inflammation or neuropathic pain medications if nerve involvement is suspected.

- Physical Therapy: In some cases, physical therapy focused on the jaw and facial muscles can help alleviate discomfort, especially if there is tension or muscle strain contributing to your symptoms.

- Regular Follow-ups: Continue to have regular follow-ups with your dentist or endodontist to monitor the healing process and address any new symptoms that may arise.

In conclusion, while it’s understandable to feel frustrated with ongoing discomfort, a thorough evaluation by the appropriate specialists can help identify the underlying cause and guide you toward effective treatment options. Don’t hesitate to advocate for yourself and seek further opinions if you feel your concerns are not being adequately addressed.

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