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Causes of swelling and pain after treating RCT 3 days ago
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Causes of swelling and pain after treating RCT 3 days ago

Hello!
                 I am a general dentist.I also had such experience 3 days ago.I gave a RCT treatment to my patient who has  chronic periapical abscess at lower right 6 but  no sinus and swelling was  present in her mouth.But I saw that abscess in intra-oral periapical view.While I was treating her tooth, everything was alright.And then,2days after treating RCT, she suffered a slight pain and swelling at submandibular region.I forgot something to explain that I saw a root fracture line in X-ray but  that tooth was not mobile.And patient refused to take an extraction so I chose RCT.Now.I really want  to know the cause of this RCT failure.
            I advised some medicinel
(Ampiclox 500mg for 7 days
Metronidazole 200mg for 5 days) 3 times a day.
           Patient already taken all these medicines.
             Please give your expert opinion and management.
                                                  Debbie.


This discussion is related to I had a root canal two days ago and now my face and neck are swollen.
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3 Comments Post a Comment
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Avatar_m_tn
If there is fracture line present on pa radiograph, the tooth certainly is hopeless. If the patient was asymptomatic and refused  extraction, do,nt do anything. On the other hand, if patient was hurt and refused extraction, just prescribe antibiotics and pain killer. The bottom line is, rct is futile and may introduce microorganisms to periapical tissue, w which may cause more infection.
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Avatar_f_tn
Hello! Scottma,
               I'm really sorry that my reply is too late. Thank you for giving me  advice.But I forgot to write in my message.My patient went to another dentist before she came to see me 2 months ago.He opened pulp chamber and placed dressing for that tooth.He told my patient that multiple visits need for RCT.But she didn't go and see him.
                 After 2 months, she came to see me and at that time,  she told me that she put a small cotton into that tooth when she eat.After removing that cotton,I saw some bleeding near pulp chamber and she said she had no feeling for that tooth but actually she came to me to receive a filling treatment. and at first, I advised her to take intra-oral periapical view.In that X-ray, I saw one fracture line near apical third. Firstly, I told her to receive extraction because she had to go to other country and she had  1 week  to stay here.But she refused my advice.and then she asked me is there any treatment except extraction.So,I told her another treatment,RCT. I told her that I was not sure to cure it completely, but she accepted it.And then I gave her root canal treatment.During that treatment,she had no pain and no swelling.But 3days after obturating that tooth,she suffered swelling and slightly pain,I want to know what cause it is.
              I requested my senior dentist about that case.
              He precribed Lincomycin and Metronidazole 200mg for 10 days.
              But 2days after taking that medicine,swelling is near completely reduced and her face changed to normal position and she didin't feel pain anymore.That was amazing.
                  Could you tell me what cause it is?
                  I really want to know that.
               Please give your expert opinion and management .
                                                                  Yours sincerely,
                                                                         hanako.
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Avatar_m_tn
Firstly, root fracture commonly occurs in upper half,instead of apical third. You may need to re-evaluate x-ray again.post obturation pain and swelling are commonly associated with acute periapical infection,systemic administration of appropriate antibiotics generally can clear up acute infection, there is no magic at all. As long as there is no fracture and the canal is optimally obturated, the prognosis is good.clindamycin is very effective for bone infection.metronidazole is effective for periodontal pathogens. Clindamycin +metronidazole is a common prescription for jaw bone infection, including post lower 3 molar extraction medication.
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scottma
taipei, Taiwan