Oral and Maxillofacial Surgery Expert Forum
Lt Maxillary Pain w/ headaches & eye pain
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Questions in the Oral and Maxillofacial Surgery forum are answered by Dr. Michael H Kirsch and Dr. Mario Tuchman. Topics covered include teeth extractions, wisdom teeth, dental implants, bone grafting, orthognathic surgery, facial bones realignment, facial trauma repair, jaw alignment, anesthesia , jaw cyst or tumor diagnosis, reconstructive jaw surgery, temporomandibular joint syndrome (TMJ) and TMJ surgery.

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Lt Maxillary Pain w/ headaches & eye pain

I had a root canal on #14 due to a dead nerve. No infection was found. The endodontist drilled thru a crown that was on the tooth.  One week later the left side of my face started swelling, my eye reddened and was tearing.  I was put on Clindomyacin for an infection----that was now seen on the x ray.  The antibiotic worked great, swelling & pain went away.  Now that I am off the antibiotic---the pain is returning, left maxillary, eye pain & head aches---no swelling at this time.  My medical doctor ruled out sinus infection & migraines.  My endodontist---said it may be a cracked tooth & may need to be extracted.  Can the crack be confirmed before extraction?  What are any other possibilities?
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Often times, a fractured tooth is a diagnosis made by excluding other possibilities such as infection.  In some cases, the fracture may be identified directly under magnification while the root canal is being completed, by radiograph, or by transillumination whereby a fiberoptic light source is directed thru the tooth.  

In my experience, the "crack" cannot always be identified before extraction.  

Another possibility is the presence of an infection in the maxillary jaw bone adjacent to the tooth root(s).  Antibiotics do not cure these infections in many cases and a procedure called apicoectomy (root surgery) is necessary to attempt to save the tooth.

The decision for Apicoectomy vs. Extraction should be may by you after consulting with a Board Certified Oral and Maxillofacial Surgeon who routinely performs these procedures.   They will be able to provide you with realistic expectation and long term success probabilities.

Be advised, the apcioectomy long term success rates for tooth #14 given your history of symptoms is between 50-70%.

Information contained within this reply is intended solely for general educational purposes and is not intended nor implied to be a medical diagnosis or treatment recommendation.  This is not a substitute for professional medical advice relative to your specific medical condition or question. Always seek the advice of your own doctor for medical condition. Only your doctor can provide specific diagnoses and therapies.
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Thank you for your help.  I feel better equipped to talk with my endodontist next appointment.
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I'm sorry that I didn't have the opportunity to reply earlier. I'm not being notified when there are postings to this forum. I agree with Dr Kirsch. If you are seeing evidence of an infection on the x-ray you may be a candidate for an apicoectomy (reverse root canal). I would first check with your endodontist as a lot of them perform apicoectomies routinely. If they aren't comfortable with the procedure you can consult an oral & maxillofacial surgeon to consider that treatment. The decision on undergoing an apicoectomy versus extraction/dental implant should be made after consulting with your dentist and endodontist or oral surgeon. Good luck.


Information contained within this reply is intended solely for general educational purposes and is not intended nor implied to be a medical diagnosis or treatment recommendation.  This is not a substitute for professional medical advice relative to your specific medical condition or question. Always seek the advice of your own doctor for medical condition. Only your doctor can provide specific diagnoses and therapies.
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Michael H Kirsch, DDSBlank
Dr. Michael H. Kirsch
Caldwell, NJ
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