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Q. What causes pain in the extracted tooth area with bone exposure that extends upto ear?

Answered by
Dr. Geethanjali Sadasivam
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Jan 16, 2020 and last reviewed on: Jan 21, 2020

Hello doctor,

I had a root canal done three months ago on tooth 19. I have not had a crown done yet due to financial reasons. I went to a new dentist for tooth pain in that area and he said he could not help me because the x-rays showed the root canal was not finished. I called my endodontist back and they basically refused to see me back and said they did complete the root canal and the reason they did not fill one of the roots was for post space.

Well, my x-rays have been reviewed by an oral surgeon and another endodontist in the meantime, who have all concluded that the root canal does not look complete, as one of the roots is not filled with the filling material that is used. It was also determined that tooth 18 needed a root canal but was not going to be certain to work and I may end up losing that tooth.

For financial reasons, I opted to have tooth 18 pulled five days ago in hopes of helping the severe tooth, jaw and ear pain that I am having. It did not work. I am still having the pain, and to complicate matters, I now have bone exposure on the tongue side of where my tooth was extracted. I saw the surgeon yesterday and he filed it down. My headaches are ridiculous and of course, I worry the infection is spreading to my head. I have had three recent sinus surgeries and this does not feel the same. I have been on Amoxicillin for over a week now but my tooth pain in 19 has increased since the extraction. Do you have any suggestions?

I am currently taking Amoxicillin and Norco.

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Hi,

Welcome to icliniq.com.

I have read through your complaint and the relevant details and also saw the x-ray you have attached. (attachment removed to protect patient identity).

Tooth number 19 seems to have a good apical seal in the root fillings. The first dentist was right in saying that there is a space prepared for the post fixture. There is one cusp missing in the tooth, hence the treatment plan was a post and core followed by a crown.

The pain is definitely not because of this root canal treated tooth. The reason behind this is that only poorly cleaned, prepared or poorly filled roots retain the bugs to stay within the roots while deteriorating the tooth and give pain. In your case, the root fillings are excellent. Since you told you are not able to get a crown due to financial reasons at the moment, the treatment plan could have been changed. Maybe at least the post could have been fixed leaving the crown fabrication at the last. In that case, at least the tooth stays stronger for a while and does not break off when you bite hard food.

Next regarding the tooth extracted area, you have mentioned that the bone is exposed. Now I doubt if you have got dry socket (not to be mistaken for infection) due to improper healing of the gums over there. This might be the reason for the severe pain. Secondly, tooth number 20 also has decay on the sides which makes me to advise you to get another x-ray for that tooth. The current x-ray does not show the complete tooth. This particular tooth might also be the reason for pain.

Please do not worry that the infection spreads to the head. There is no such possibility for that right now. Either 18 dry socket or 20 decay has to be addressed to help you get rid of the pain. Continue taking Amoxicillin as prescribed and for pain relief, you can switch to Ibuprofen 400 mg orally eight hourly for two days provided you do not have asthma or gastritis problems. Else continue Norco tablet for two more days.

Hence, I advise you to visit back to the dentist and get done with further checkups as I mentioned above.


Investigations to be done:

Periapical x-ray for tooth number 20 to rule out interproximal caries.

Differential diagnosis:

Pulpitis in 20.

Treatment plan:

Saline irrigation and zinc oxide eugenol dressing for dry socket in 18.

Preventive measures:

Gargle mouth with lukewarm saltwater thrice daily for three days to flush out debris from the gums and in the extracted socket in case it not healed yet.

Regarding follow up:

Follow up after three weeks.


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