Why are some dentists' injections more painful than others'?

[AL_n]

My previous dentist's injections were generally painless. Unfortunately his
other dental work was very poor, so I changed dentists.

My new dentist only recently completed her training. Her injections are the
most painful I have ever known. And that's despite her using a local
aneisthetic before injecting.

One injection she gave me (for a central upper incisor) was the most
painful I have ever experienced. It caused me to yell loudly. Her
explanation was that there "is not much room for the liquid to go".

Why would one dentist's injections be generally more painful than
another's?

Thank you..

Al

[Steven Bornfeld]

I'd cut her some slack. Some areas of the mouth are more difficult to
get numb; some injections are easier to miss altogether.
If the injection was under the lip for the upper central incisor, it
tends to be more painful--probably because there are a significant
number of muscle fibers inserting from the perioral musculature.
If the injection was on the roof of the mouth, her explanation makes
perfect sense. The palatal tissue is firm, and bound down to the bone
by heavy connective tissue. Injection must be made under pressure, and
the only place for the anesthetic solution to go is within or under the
periosteal tissue (because the tissue is tightly attached here.
An endodontist taught me a trick for making these injections less
painful--a very low-tech and easy method. But it was not taught to us
in school.
Of course, I'd like to think that with practice you get better--more
accurate, less painful. But short of not knowing the anatomy or a shaky
hand, most dentists' injections are probably pretty much alike.
There are some newer injection methods that may be less painful in
select applications. But by and large, certain injections are just
going to hurt--and the roof of the mouth behind the upper front teeth is
number 1 on most dentists' lists.

Steve


--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

[Brian]

On Wed, 14 Mar 2012 18:22:34 -0400, Steven Bornfeld
<bornfe...@dentaltwins.com> wrote:


> I'd cut her some slack. Some areas of the mouth are more difficult to
>get numb; some injections are easier to miss altogether.
> If the injection was under the lip for the upper central incisor, it
>tends to be more painful--probably because there are a significant
>number of muscle fibers inserting from the perioral musculature.
> If the injection was on the roof of the mouth, her explanation makes
>perfect sense. The palatal tissue is firm, and bound down to the bone
>by heavy connective tissue. Injection must be made under pressure, and
>the only place for the anesthetic solution to go is within or under the
>periosteal tissue (because the tissue is tightly attached here.
> An endodontist taught me a trick for making these injections less
>painful--a very low-tech and easy method. But it was not taught to us
>in school.
> Of course, I'd like to think that with practice you get better--more
>accurate, less painful. But short of not knowing the anatomy or a shaky
>hand, most dentists' injections are probably pretty much alike.
> There are some newer injection methods that may be less painful in
>select applications. But by and large, certain injections are just
>going to hurt--and the roof of the mouth behind the upper front teeth is
>number 1 on most dentists' lists.
>
>Steve
>

Certainly location is a big factor but so is the speed of injection. A
quick injection will hurt more.

[Ankur]

* Steven Bornfeld <bornfe...@dentaltwins.com>

> An endodontist taught me a trick for making these injections less
> painful--a very low-tech and easy method.

Would you mind sharing the method?

--
Ankur

[AL_n]

Steven Bornfeld <bornfe...@dentaltwins.com> wrote in news:jjr5n9$r4$1
@dont-email.me:

> If the injection was on the roof of the mouth, her explanation makes
> perfect sense.

Thanks for the unput. That particular (and most painful) injection, was
under the lip - not into the roof of the mouth.

Four out of the five of her injections have been more painful than most
injections I've had from other dentists.


Al

[Steven Bornfeld]

There tends to be some variation in the application of this general
rule (so often repeated in school, so often ignored in practice). In
loose areolar connective tissue, it is not nearly so important than in
attached, heavily collagenized tissue (such as on the palate).
So too, different patients will have varying perceptions of discomfort,
based on not only the elicited response, but also the duration of the
painful stimulus.

[Steven Bornfeld]

Not at all--I have a couple of patients waiting--but promise to post later.

[Bill]

"AL_n" wrote in message

>
> My previous dentist's injections were generally painless.
> Unfortunately his
> other dental work was very poor, so I changed dentists.
>
> My new dentist only recently completed her training. Her injections
> are the
> most painful I have ever known. And that's despite her using a local
> aneisthetic before injecting.
>

I had one dentist who was quite good at juggling patients. I would go
into one room and he would be finishing up work on another patient in
another room. He would stop working on that patient, then come into my
room and give me the topical - let it sit and then go back to the
other patient.

Then come back to my room and inject just a little and wait. The area
of the injection would get numb. Then he would inject a little more
and wait a bit. Then do the rest of the injecting. And then go back
and finish with the first patient. Then come and work on me.

They can also give you the option of gas.

If you are feeling pain, find another dentist!

[Steven Bornfeld]

On 3/15/2012 9:57 AM, Steven Bornfeld wrote:
> On 3/15/2012 5:00 AM, Ankur wrote:
>> * Steven Bornfeld<bornfe...@dentaltwins.com>
>>> An endodontist taught me a trick for making these injections less
>>> painful--a very low-tech and easy method.
>>
>> Would you mind sharing the method?
>>
>> --
>> Ankur
>
>
> Not at all--I have a couple of patients waiting--but promise to post later.
>
> Steve
>

The endodontist's advice was to take a bone file (I use one similar to
this):

> http://www.google.com/url?source=imglanding&ct=img&q=http://www.atlantadentalsupplies.com/media/catalog/product/cache/2/image/342x/9df78eab33525d08d6e5fb8d27136e95/h/-/h-friedy-1x-miller-colburn-bone-file-bf1x.jpg&sa=X&ei=uFliT72KKKfs0gGbioCrCA&ved=0CAkQ8wc&usg=AFQjCNHNZNLEfKvfudo9KB7fE7IiVtvdqg



I take a high speed bur and make a hole through the broad face of the
file. I apply topical anesthetic to the area to be injected (probably
unnecessary), and then place the face of the bone file flat against the
tissue surface to be injected. I apply a moderate amount of pressure,
certainly not enough to cause pain.
I then hold the bone file in place for a couple of minutes. This is
the toughest part of the procedure (to me) because it usually involves a
fair amount of tipping of the patient's head, and still requires some
bending of my back (and sometimes neck) to maintain this position,
depending on where the injection is to be given.
After perhaps 2 or 3 minutes, I inject straight through the hole in the
face of the bone file.
I presume the pressure desensitizes the area by transient ischemia,
much as one's foot can sometimes go to sleep if you sit in an odd
position (say, sitting on your feet).
The effectiveness varies somewhat, but most patients (and I do ask)
tell me that the injection given this way was not painful, or only
slightly so.

[Brian]

Having been on both the giving and receiving end of injections, I've
found that the speed of the injection matters pretty much everywhere.
Perhaps somewhat less so for a maxillary molar injection.

[Ankur]

* Steven Bornfeld <bornfe...@dentaltwins.com>

> I presume the pressure desensitizes the area by transient ischemia,
> much as one's foot can sometimes go to sleep if you sit in an odd
> position (say, sitting on your feet).
> The effectiveness varies somewhat, but most patients (and I do ask)
> tell me that the injection given this way was not painful, or only
> slightly so.

I had heard about applying pressure before a palatal injection, but
that particular trick seems very clever. Thank you for sharing :)

--
Ankur

[Steven Bornfeld]

I love low-tech solutions--but I wouldn't discount "the wand" or other
devices that have been used over the years to address this problem.

[AL_n]

"AL_n" <fgdf...@fghfghfg.com> wrote in news:XnsA0176508D9CC3zzzzzz@
130.133.4.11:

PS...

Unfortunately, the trend continues! I had another injection yesterday, from
the same dentist. It was the most painful I have ever experienced. She may
have hit a nerve or something, because the sudden pain was so intense. I
yelled very loudly and instinctively pushed her hand away from my face
(which she complained about afterwards). This particular injection was for
the very back tooth on the bottom left, and the injection was into the
inner side of the gum.

The percentage of her injections that are intensely painful are many times
that of any other dentist I've been to in 55 years. It seems that about one
in three of her injections hurt like hell.


Should I change dentists?

TIA

Al

[Steven Bornfeld]

I assume she was attempting an injection called an "inferior alveolar
block".
In this particular injection, we aim for the area that the nerve
serving the lower teeth on that side exits the inside of the lower jaw.
The aim is to deposit the anesthetic close enough to the nerve that
all sensation from that point outward is "blocked". Sometimes we are
"lucky" (you may be forgiven for not accepting this descriptive) and hit
the nerve directly with the needle. The result is a sharp, stabbing
pain that usually radiates from the point of injection out to that side
of the lower lip. It is also possible to get a radiating pain out to
the tongue, if the needle happens to touch the lingual nerve--which it may.
There are injections for the lower jaw that avoid this area, but I'd
guess most dentists (myself included) usually still use the old
tried-and-true inferior alveolar block.
If this is what happened, you were just unlucky--it could happen to
anyone, and from any dentist utilizing this injection, and thus wouldn't
in my view be reason enough to change dentists. If I have not described
the pain accurately, there may be another cause, and that I cannot
comment on. Certainly if there is a clear pattern of painful
injections, after a certain amount of time it's more than bad luck. The
dentist should get help improving her technique, and you may consider
given the total package of dentist whether you should change dentists.

[AL_n]

Steven Bornfeld <bornfe...@dentaltwins.com> wrote in

news:jmp7ec$bps$1...@dont-email.me:

Steve,
Many thanks for your kind input. After the unexpected stab of intense
pain in the approximate location of the injection, I did feel a strange
sharp tingling sensation along the middle of my tougue to the tip, as if
someone had connected it to 9-volt electrical terminals. I guess this was
something to do with the lingual nerve you mentioned.

I was really glad that I had taken two codeines and 1mg of attivan prior
to the visit. I dread to think what that jab would have been like without
that.

After the mishap, the dentist told me that the injection can be done on
the outside of the jaw, but with less effectiveness. I suggested: "Well,
how about doing it that way, and increasing the dose of lignocaine?" She
seemed to think that was an option. Would you agree? If so, I will
*always* ask them to do it that way in future!

This dentist seems exceptionally good at hitting nerves. Only a coupl of
injections prior, she injected me for work on a central upper incisor.
The needle went in high up under my lip, and the stap of pain, a few
seconds after the needle entered, was just as sudden and unexpected, and
almost as intense.

All this is enough to make me more fearful of dentistry than I have been
since I was 5 years old, when drills ran on pulleys, and rubber gas masks
were forced upon you, stinking of evil death).

Al

[Steven Bornfeld]

On 4/19/2012 11:03 AM, AL_n wrote:
>
> Steve,
> Many thanks for your kind input. After the unexpected stab of intense
> pain in the approximate location of the injection, I did feel a strange
> sharp tingling sensation along the middle of my tougue to the tip, as if
> someone had connected it to 9-volt electrical terminals. I guess this was
> something to do with the lingual nerve you mentioned.
>
> I was really glad that I had taken two codeines and 1mg of attivan prior
> to the visit. I dread to think what that jab would have been like without
> that.
>
> After the mishap, the dentist told me that the injection can be done on
> the outside of the jaw, but with less effectiveness. I suggested: "Well,
> how about doing it that way, and increasing the dose of lignocaine?" She
> seemed to think that was an option. Would you agree? If so, I will
> *always* ask them to do it that way in future!
>
> This dentist seems exceptionally good at hitting nerves. Only a coupl of
> injections prior, she injected me for work on a central upper incisor.
> The needle went in high up under my lip, and the stap of pain, a few
> seconds after the needle entered, was just as sudden and unexpected, and
> almost as intense.
>
> All this is enough to make me more fearful of dentistry than I have been
> since I was 5 years old, when drills ran on pulleys, and rubber gas masks
> were forced upon you, stinking of evil death).
>
> Al
>

Wow--your dentist used sweet air? I'm JEALOUS!! Generally, the old
timers didn't like to use anesthetic if they could help it--because
after you gave an anesthetic injection, you had to WAIT. The
anesthetics were poor, too. Most of the dentists back then were seeing
maybe 30 or more patients per day, so they didn't have time to wait for
anesthesia.
The motorized drills with the pulleys and trombone arms were slow, but
to give them their due they had superior torque.
The modern high-speed turbine drill was introduced about 1958 as the
"Borden AirRotor". It didn't take long for dentists to adopt it, given
its superiority to the motorized drill.
I remember when we moved to Brooklyn, our 3rd dentist used the new high
speed drill. This was about 1960 or 61. My dad (uncharacteristically)
was the first to see this dentist. He came back raving: "He's got this
new 'water drill' that sprays water and doesn't hurt AT ALL!"
I don't necessarily think my dad was above lying to get us less afraid
of the dentist, but I don't think it was really an issue for him, and
not much of an issue to me. It really was superior, allowing dentistry
to proceed more quickly with less pain. However, over the years we've
all adjusted to the drill, and given that far more dentistry tends to
get done in a given visit (with far fewer patients seen per day), we're
probably almost as afraid of the "water drill" as we were of the old
cable-and-pulleys.
As far as alternative injection techniques for the lower jaw--we were
never taught an extraoral approach. We briefly touched on the other
intraoral techniques named for Gow-Gates and Akinosi. They are supposed
to carry less risk, but by habit and appearance I still favor my
standard inferior alveolar approach. A quick search however did reveal
an extraoral approach (two, in fact!) for anesthesia of the lower jaw.
You may (or may not!) wish to take a quick look at this:

http://www.dent.osu.edu/anesthesiology/LA_Protocol.htm

I see no reason why they wouldn't work. However, after all these years
it would take a compelling reason to teach this old dog a new trick.

[AL_n]

Steven Bornfeld <bornfe...@dentaltwins.com> wrote in

news:jmp7ec$bps$1...@dont-email.me:

> The result is a sharp, stabbing
> pain that usually radiates from the point of injection out to that
> side of the lower lip. It is also possible to get a radiating pain
> out to the tongue, if the needle happens to touch the lingual
> nerve--which it may.
>

Ever since this horrible experience, six days ago, I have been suffering
badly from an intense, dull ache in the same area. Is that normal?

I'm not sure if it is due to that injection or due to the root canal
treatment she did on the tooth next to it. After that injection-that-went
wrong, she suggested we end the session. However, I did not want to waste
a visit and we agreed that she'd simply apply a temporary filling to that
rearmost tooth, and then focus on finishing off the root canal treatment
on the tooth next to it. She gave me another injection for that, which
was relatively painless. This tooth was one that had previously been
crowned, so she had previously drilled through the crown to do the work.

The front root canal had closed up on its own at some time in the past,
so she couldn't do much with it. She cleaned out the other two root
canals as desired. She filled the cavities with some kind of soft
filling, and then filled the access-hole with a temporary filling, and
covered that with a hard filling.

That same evening, I bit down on some toast, and felt a stab of acute
tenderness from that tooth. I had an immediate hunch that I might have
pushed the filling down into the tooth, because teh toothe now felt kind
of pressurised. This was confirmed by what I could feel with my tongue; I
could feel a cavity rather than a filling. After three days, the whole
lower jaw at the back started aching, and yesterday I went back to see
her in an emergency appointment. She confirmed that the filling had been
pushed down into the hole! She told me that now was not a suitable time
to give me lignocaine and re-work the tooth, because the extra blood in
the area would tend to wash it away too quickly. Instead, she filled over
the compressed/depressed filling. I asked her: isn't it likely that when
the filling was pushed down into the hole, it would cause quite extreme
pressure inside the tooth? She told me that it wouldn't really, becuase
the soft filling material inside has a lot of 'give' to it. I also asked
her: "Do I ned to be careful not to chew anything on that side?" She
said, "no you can chew on it as normal".

The fact that the filling was so easily able to be pushed down into the
tooth, seems like careless dentistry to me (or inexperienced dentistry,
at least). Is that a reasonable conclusion?

She put me on a course of antibiotics and made an appointment to see me
in a week's time. I've now been on the antibiotic for 24 hours and the
dull aching continues just as intensely. Ibuprofen is having little
effect. If I wiggle the tooth, I can feel a slight tenderness, but it has
been like that for a long time. The intense dull ache is completely new,
and started on the day she gave me those injections. Even the abscess
didn't give me any pain like this. All it did was cause my gum to swell
up.

Any clues as to what might be going on?

Thanks again...

Al

[Steven Bornfeld]

Just to be clear--the dull ache is in the area of the root canal? Or
is it related to the injection?
I'm guessing it's the root canal. I wouldn't make too much of the
temporary filling being displaced--it happens. If there is an intention
of going back into the tooth we don't want to put anything in there that
is going to take a lot of time to remove. It's also not unusual to have
pain after root canal treatment. Is the treatment completed, or are the
canals yet to be filled?
Postoperative pain seems to be less of a problem with the newer rotary
instrumentation, as the tip of the root seems less likely to be
overprepared, and therefore there is less chance of overinstrumentation
or extrusion of either irrigating fluid or filling material past the tip
of the root. However, even if there has been overinstrumentation, if
all the infected material is removed there should be gradual
improvement. It may take a couple of weeks. Certainly if it gets worse
from here or starts to swell I'd consider it a red flag. You may need
something a bit stronger than ibuprofen in the meantime.

Good luck,

[AL_n]

Steven Bornfeld <bornfe...@dentaltwins.com> wrote in

news:jn938a$4um$1...@dont-email.me:

>
> Just to be clear--the dull ache is in the area of the root canal?

Thanks again for your input, Steve. The whole back-end of the lower jaw
is aching, but I think it is emanating from the RCT'd molar. It started
immediately after I dmaged the filling, pushing it down into the tooth.
The most intense waves of aching seem to last for a few hours, before
abating somewhat - also for a few hours. Luckily, I have plenty of
painkillers with me: codeine, paracetamol and ibuprofen.

> I'm guessing it's the root canal. I wouldn't make too much of
> the
> temporary filling being displaced--it happens. If there is an
> intention of going back into the tooth we don't want to put anything
> in there that is going to take a lot of time to remove. It's also not
> unusual to have pain after root canal treatment. Is the treatment
> completed, or are the canals yet to be filled?

She did say that the RCT was completed. However she only used a thin hard
filling over a temporary-type filling - perhaps 'just in case' she has to
go back in.

> Postoperative pain seems to be less of a problem with the newer
> rotary
> instrumentation, as the tip of the root seems less likely to be
> overprepared, and therefore there is less chance of
> overinstrumentation or extrusion of either irrigating fluid or filling
> material past the tip of the root. However, even if there has been
> overinstrumentation, if all the infected material is removed there
> should be gradual improvement. It may take a couple of weeks.
> Certainly if it gets worse from here or starts to swell I'd consider
> it a red flag. You may need something a bit stronger than ibuprofen
> in the meantime.

Many thanks for the clarifiaction. I am not sure what instrumentation she
used. I don't recall her using rotating files. I am under the impression
that the files were handheld ones. She showed me one.

During the penultimate session, she took an x-ray of the tooth with files
inserted into the root canals, for some reason. That's when she
discovered that two of the files had ended up in the same root canal by
accident. I think this led her to the discovery that one of the canals
was too closed-up to penetrate.

She did three separate sessions of root canal work on that tooth. She
thinks that the tooth has been suitably treated now, because the gum
swelling has not recurred.

I'm a little surprised that she says the treatment is finished, when says
she has left some kind of soft material in the tooth. I was under the
impression that root canal work is completed when the root canals are
finally filled with strong hard permanent filling.

She doesn't seem to mind me asking for clarification on her work, which
is one thing I like about her. She took the time to show me the x-rays
and explain them. She also showed me one of the fine files.

Each time she did a session of root canal work, the tooth was indeed
sensitive to pressure for a few days afterwards. However, it is only this
last session which has left me aching miserably, even a week after the
work. So I greatly appreciate your clarification and reassurance that
this kind of discomfort is not uncommon. I will take your advice and keep
taking the pain killers. I have a good supply of paracetamol, ibuprofen
and codiene. I haven't yet determned which is the most effective. I think
it's probably the codeine.

Thanks again,

Al

[Steven Bornfeld]

They all have their problems. Most studies show 600 mg of ibuprofen to
be as effective as 1/2 grain of codeine. Codeine, as with any narcotic,
can cause nausea and constipation. Ibuprofen can cause stomach upset.
Ibuprofen is antiinflammatory, codeine and paracetamol (we call it
acetaminophen in the States) are not. You should not drink while taking
paracetamol, as it increases the potential for liver damage. You
shouldn't drink while taking ibuprofen, and it will increase the
potential for stomach bleeding.
The material most commonly used for root canal fillings no doubt is
still gutta percha, which is basically rubber, similar in quality to
latex. It's not hard. Some dentists are starting to use resin root
canal fillings, but I'd say it's a small minority. Certainly if your
dentist is still using hand instrumentation I'm guessing she's not
trying the latest root canal filling materials.
Hope you feel better soon.

[AL_n]

Steven Bornfeld <bornfe...@dentaltwins.com> wrote in

news:jn9k6k$i7q$1...@dont-email.me:

> They all have their problems. Most studies show 600 mg of
> ibuprofen to
> be as effective as 1/2 grain of codeine. Codeine, as with any
> narcotic, can cause nausea and constipation. Ibuprofen can cause
> stomach upset. Ibuprofen is antiinflammatory, codeine and paracetamol
> (we call it acetaminophen in the States) are not. You should not
> drink while taking paracetamol, as it increases the potential for
> liver damage. You shouldn't drink while taking ibuprofen, and it will
> increase the potential for stomach bleeding.
> The material most commonly used for root canal fillings no doubt
> is
> still gutta percha, which is basically rubber, similar in quality to
> latex. It's not hard. Some dentists are starting to use resin root
> canal fillings, but I'd say it's a small minority. Certainly if your
> dentist is still using hand instrumentation I'm guessing she's not
> trying the latest root canal filling materials.
> Hope you feel better soon.
>
> Steve

Thanks.. I've just noticed that there may now be a NEW gum swelling! Just
behind (I think) where the earlier abcess was, there is now, another
swelling that is sensitive to finger-pressure. I guess it may be another
abscess, possibly at the base of one of one of the other roots of the
same tooth.

When I accidentally forced the filling down into the tooth, is it
possible that some infected material got forced out through the end of
one of the roots?

When I saw the dentist a couple of days ago, she asked me if I had
noticed anything unusual happening around the gum. I said "no", because,
at the time, I hadn't noticed anything.

Perhaps she suspected infection anyway, hence the new amoxicillin
prescription. She said it would probably cause the aching to subside in
around 48 hours. I'm surprised, because, when she gave me amoxicillin for
the first swelling, several weeks ago, it had no noticeable affect.

Anyway, I hope she was right when she said it would cause the aching to
subside. Only 36 hours have so far passed since I started taking the new
course of antibiotic.

Al

[Steven Bornfeld]

On 4/26/2012 12:29 AM, AL_n wrote:
>
>
> Thanks.. I've just noticed that there may now be a NEW gum swelling! Just
> behind (I think) where the earlier abcess was, there is now, another
> swelling that is sensitive to finger-pressure. I guess it may be another
> abscess, possibly at the base of one of one of the other roots of the
> same tooth.
>
> When I accidentally forced the filling down into the tooth, is it
> possible that some infected material got forced out through the end of
> one of the roots?

If the root canals had been filled at the time, depressing the
temporary filling should not have forced anything through the root end.

>
> When I saw the dentist a couple of days ago, she asked me if I had
> noticed anything unusual happening around the gum. I said "no", because,
> at the time, I hadn't noticed anything.
>
> Perhaps she suspected infection anyway, hence the new amoxicillin
> prescription. She said it would probably cause the aching to subside in
> around 48 hours. I'm surprised, because, when she gave me amoxicillin for
> the first swelling, several weeks ago, it had no noticeable affect.
>
> Anyway, I hope she was right when she said it would cause the aching to
> subside. Only 36 hours have so far passed since I started taking the new
> course of antibiotic.
>
> Al
>

I don't recall when the actual root canal was done. If there is
evidence of new infection 2 weeks or more after the completion of the
root canal treatment, it's unlikely that antibiotics will solve the
problem (though they certainly can suppress the infection during the
time you're taking them).

[AL_n]

Steven Bornfeld <bornfe...@dentaltwins.com> wrote in

news:jnbm96$lv0$1...@dont-email.me:

> I don't recall when the actual root canal was done. If there is
> evidence of new infection 2 weeks or more after the completion of the
> root canal treatment, it's unlikely that antibiotics will solve the
> problem (though they certainly can suppress the infection during the
> time you're taking them).
>
> Steve
>

Thanks.. The RCT was finished on 18 April (8 days ago). However, she still
only used a soft filling, with a thin hard filling over the surface.
According to her, the insde of the tooth still contains some kind of soft
material (possibly gutta percha).

There is definitely a return of the gum swelling now (slightly further back
this time). The pain has not been as bad today as it was yesterday. 48
hours have just passed since I started the amoxicillin.

All was well until 18 April when she last worked on the tooth, and then I
chomped on something which pushed the filling into the tooth. That hurt,
and immediately after that the acheing started and got progressively
worse. Only yesterday, did I start to notice the swelling on the gum.

I've been in less pain today, so hopefully the AB is starting to work.

She alluded to the possibility that I might lose the tooth; I sure hope
not, because the molar behind it is not in great shape.

Al

[Steven Bornfeld]

On 4/26/2012 12:50 PM, AL_n wrote:
>
> Thanks.. The RCT was finished on 18 April (8 days ago). However, she still
> only used a soft filling, with a thin hard filling over the surface.
> According to her, the insde of the tooth still contains some kind of soft
> material (possibly gutta percha).
>
> There is definitely a return of the gum swelling now (slightly further back
> this time). The pain has not been as bad today as it was yesterday. 48
> hours have just passed since I started the amoxicillin.
>
> All was well until 18 April when she last worked on the tooth, and then I
> chomped on something which pushed the filling into the tooth. That hurt,
> and immediately after that the acheing started and got progressively
> worse. Only yesterday, did I start to notice the swelling on the gum.
>
> I've been in less pain today, so hopefully the AB is starting to work.
>
> She alluded to the possibility that I might lose the tooth; I sure hope
> not, because the molar behind it is not in great shape.
>
> Al

Just a guess, but I think you're still probably in the window that the
gum swelling may be due to something that has been extruded through the
root of the tooth and not due to a problem with the tooth or root canal
treatment itself.
At this point you should probably let the antibiotics work and see if
the swelling and pain resolve. Your dentist will have to follow this
tooth to make sure any infection doesn't recur.
If any infection reappears after this swelling has resolved, it probably
means there is a problem with the tooth and/or root canal treatment that
has not been addressed. You'll just have to wait it out and hope for
the best.

[AL_n]

Steven Bornfeld <bornfe...@dentaltwins.com> wrote in

news:jncef0$e59$1...@dont-email.me:

> Just a guess, but I think you're still probably in the window that the
> gum swelling may be due to something that has been extruded through
> the root of the tooth and not due to a problem with the tooth or root
> canal treatment itself.
> At this point you should probably let the antibiotics work and see if
> the swelling and pain resolve. Your dentist will have to follow this
> tooth to make sure any infection doesn't recur.
> If any infection reappears after this swelling has resolved, it
> probably means there is a problem with the tooth and/or root canal
> treatment that has not been addressed. You'll just have to wait it
> out and hope for the best.
>
> Steve

Thanks again, Steve. I'm very glad to say that the swelling disappeared
during the night, last night. I have been almost entirely without any aches
today. What a relief! I sure hope it stays permanently cured now.

All the dental problems I've had over the past 2 years have been a real
grind. I'm beginning to understand why my father decided to have all his
teeth pulled out when he was in his 40s! Mind you, he did regret it later
when he found out how uncomfortable dentures were. That's why I'm following
the opposite policy: hanging on to every tooth for as long as possible.

Al