What could cause facial swelling after an RCT treatment?

Question

Hi doctor,

I had a root canal by a general dentist. I was told that the tooth was infected and going through with the procedure would be my best option. I consented and had my treatment. I was done with the treatment and came home full of instructions given to me.

I had Penicillin and Ibuprofen every six hours. Initially, it was fine, but I awoke the next day with more pain and a swollen face. When I called up my dentist, he said that he had to remove the cap and the tooth as the infection had spread to the jaw.

Apparently, the infection was already in the jaw, and he did not tell me that. If so, then I would have opted for extraction. I am aware that the roots of all the teeth are curved and have been told that it may make the procedure a bit difficult.

I understand that being neglectful has its price. I have attached the X-ray here for better management. I would appreciate any feedback. Thanks in advance.

Answer 1

Hello,

Welcome to icliniq.com.

As per the radiograph (attachment removed to protect patient identity), your tooth infection had extended beyond the root apex and entered the underlying bone, and it became a periapical abscess.

The tooth roots are also flared. Root canal treatment is a conservative approach to saving the natural tooth by removing the infected tissue within the pulp chamber and root canal.

Some teeth may have more root canals than usual. So, there may be chances to miss any canals during root canal treatment. For example, in lower molars, usually three canals are there, but in some patients, the same tooth may have up to five canals.

In some cases, the apex of the root canal may be very narrow, calcified, and curved. So, the orientation of the instrument may deviate from the exact root canal curvature and take another path. Hence, a part of the swellings will be untreated or not cleared of infected tissue.

Initially, it can be treated with antibiotics, but later the infection can be exacerbated after stopping antibiotics. One more reason for the secondary infection is the infected tissue that can be pushed beyond the apex during the procedure. It can also cause a secondary infection.

Your endodontist can attempt a repeated root canal treatment and wait for a week. If there is no progress in the condition, then go for the extraction of the tooth.

If swelling of the face is more, then better to get the extraction followed by incision and drainage of the abscess done by an oral and maxillofacial surgeon.

I hope this helps you.

Thank you.