left maxillary pain w/ headaches & eye pain

[Rose2004]

I had a root canal done by an endodontist on tooth #14.  A dead nerve was diagnosed w/ no infection present.  One week later my face started swelling & left eye was red & tearing.  An infection was found & I was put on Clindamyacin--that was very helpful with the swelling.  After getting off the antibiotic my maxillary, headaches & eye pain have returned.  My medical doctor ruled out migraines & sinus infection.  Am I heading for a tooth extraction?  What is next?

[Ramin Mehregan, DMD]

Dear Rose2004
Was the swelling due to the untreated tooth or was it after the root canal? If it was after the root canal and it is still recurring may there is an accessory canal that was missed or the infection could be stemming from another tooth. Has a fracture of the root itself been ruled out? I would recommend you have another evaluation by the endontist.

[Rose2004]

The swelling and infection was one week after the root canal was done. I did have a second visit to the endodontist after I started the antibiotics.  The recommendation was to hold off on the crown repair for a week after getting off the antibiotics to determine if the symptoms would return.  The maxillary pain has returned affecting my eye w/ headaches. Possible extraction was mentioned.  Originally-----I did not have classic symptoms of an absess (abscess)--tooth pain, sensitivity to hot & cold----originally the nerve was dead with no infection. The pain I experienced did not originate in the tooth but was maxillary & felt in the low cheek bone.

Thank you for your help.

[Ramin Mehregan, DMD]

Dear Rose2004,
There could be a suspicion of a fractured tooth abscess. There are some other possibilities: 1) Possibility of a pathology in that area which should be evaluated be an oral surgeon with a Panrex x-ray. 2) Possibility of bite associated muscle pain syndrome, especially of a muscle that originates from the zygomatic process and arch (which is the area right below your eye an also the sinus area) In this particular muscle (masseter muscle) Trigger points in it can cause molar pain, maxillary sinus symptoms and aching in the jaw. It is common for masseter trigger points to cause these symptoms, but it is also common for master trigger points to be set up by these symptoms. Especially when sinusitis or dental cavity pain has been slow to resolve, it is more likely that trigger points are created that sustain the symptoms after the medical or dental condition has been successfully treated. In these situations, palpation of the trigger points will cause the symptoms for the client and resolution of the trigger points tends to resolve the symptoms.
Before you consider extraction, because that might not get you out of pain, I also would recommend a consultation with a TMJ expert.
Good luck