Dental Advice, please - swollen face??

  1. Hi everyone,

    About 1 month ago, I had a deep filling. I didn't have any pain afterward. About 2 weeks later, I started having some pain and soreness. I waited about 1 week and then went to the dentist because the pain was getting worse. It turned out the filling was too high. 3 days later, the pain was even worse (I could no longer bite without severe pain). I returned to the dentist and found the filling was still too high. The dentist also took an x-ray of the tooth, did a cold test (with spray), tested with air, checked something at the gums, etc. On the x-ray, he noticed the root was starting to enlarge slightly. However, I assumed this can be due to the pain the high filling caused to the ligament of the tooth, since the tooth reacted normally to all tests. After they corrected the high filling, I stopped having pain. However, it is now 4 days later and my face is still slightly swollen. It isn't noticeable to other people, but I can feel it when I try to smile and it is tender to touch. I don't have any pain, only some soreness. My gums look normal. The swelling is above the gums - say between the lips and bottom of the nose. Should I be concerned? Or, should this correct itself soon now that the high filling is fixed? The swelling has not gotten any worse since my appointment on Monday, but I also can't tell if it's improving yet or not.

    Thanks for reading all of that! I hope someone might have some advice on this. Thanks in advance!
     
  2. Hi, I am sorry to hear that you are having this trouble. There are a couple of things to advise in this case:
    1. You had a deep filling which was followed by no pain. If the filling was too high, you would have been aware of that immediately. Most patients with a high fill will present for an adjustment within a few days.

    2. Pain occurred two weeks later, with a feeling of highness in the fill which was adjusted. This to me sounds like the pulp or "nerve" is dying and beginning to abscess. The toth sits in the bone in a sling of fibres called the periodontal ligament. this area is full of nerves and allows us to locate a grain of sand or the dratted eggshell etc when biting. When a dying pulp produces purulent response (pus), this pus can invade the periodontal ligament and slightly extrudes the tooth making it feel a little high. If the problem is not diagnosed at this point, the tooth may be adjusted with some temporary minor relief.

    3. As the tooth continues to die/produce an inflammatory response, more pressure is placed ont eh periodontal space and the tooth can become exquisitely tender to bite on. This process can also be accompanied by pain from the tooth itself, usually beginning with cold (throbbing) followed by heat (ache which can last of some duration) followed by spontaneous pain which can occur anytime and wake the patient at night.

    4. The nerve fibres are usually the last thing to go in a dying tooth. In the early stages of abscess development, it may not be apparent radiographically and the tooth may respond semi-normally to the cold test. The real indication is not if you feel the cold but how long it takes for the cold to go away. More than a few secs is a bad sign.

    5. Now you can feel a swelling up high at the base of the tooth. this means the pus is tracking along the path of least resistance which is usually to the outside of the bony envelope. If the swelling becomes chronic, it may form a little opening (parulis) ont he gums and leak into the mouth. This is why long term abscesses are usually painless as the pressure is relieved by the leakage of the fluid so the tooth is no longer sore to bite on, pulp is completely non vital (dead) and so doesn't respond any longer to thermal stimulus. If the swelling doesn't track into the mouth, you may wake up one morning with a cellulitis which means all the pus gets into the facial tissues. It can swell the eye closed. If this occurs, you may need surgery to drain it. BUT THIS IS NOT COMMON

    Anyway, if I am on the right track about this, YOU NEED ROOT CANAL! A healthy tooth will not swell from a high filling unless it was on the verge of karking it anyway.

    Good luck!
     
  3. Hi rupbasoli,

    Thank you so much for your detailed reply. It is very helpful and I really appreciate it!!

    About 2 days before the "high filling" issue occurred, I went to the dentist to have impressions made for invisalign. Since there was a good deal of pulling on the teeth to remove the molds, I initially also thought this could have had something to do with the issue. However, what you explained makes more sense, especially since it was a deep filling (below the gum) to begin with. Unfortunately, I chipped the tooth 6 years ago on candy and have had 3 unsuccessful fillings (by 3 different dentists) since.

    My dentist is going to be away next week, then I am away the following week. I sent him a message after seeing your reply and asked if it is okay to wait another 2 weeks for a root canal given that I still have the swelling. He said it should be okay. Do you agree? Or, do you think I should try to see another dentist next week? I'm concerned about being in a foreign country with this issue (and the possibility of it ruining my vacation - which is supposed to be my first relaxing one in years!). Honestly, it doesn't bother me much at the moment (just that I can feel the swelling when I smile/laugh and sometimes a little bit of throbbing if I haven't taken ibprofen), so I could live with it for 2 more weeks. It is more the fear of it getting worse that is the issue. Please let me know what you think. Thank you so much!! :smile:
     
  4. Maybe you're having a slight allergic reaction? My co-worker went in to have both a filling and impressions for invisalign. They did MANY of the latter and as a result, she suffered an enormous allergic reaction and had to stay home for 2 days. When I saw her on day 3, her face was stil swollen. The puffiness eventually went down after a week but this is something you might want to consider. Good luck!
     
  5. If you are unable to see your dentist for root canal, I would suggest a course of antibiotics to minimize the risk of cellulitis while you are away.

    This is not an allergic reaction, it is too localized .

    Why has this tooth been filled three times? Are you able to post or PM me a photo up close?
     
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  6. If the filling is under the gum, perhaps it is hard to seal up and that is why it keeps failing. As strange as it sounds, white filling materials don't like a moist environment while they are setting. The mouth is wet and keeping an area dry can be difficult.

    Of course it is difficult without seeing the tooth but if it cannot be sealed properly, root canal is a waste of time. Any ingress of bacteria through a poorly sealed margin will guarantee failure of the root canal treatment. It may be worthwhile having a chat with your dentist about the long term prognosis. As this seems to be a difficult tooth, it may be worthwhile seeing a specialist as once root canal treatment has been done, any retreatment at a future date has a lower prognosis. It is best to get it done properly the first time if it can be done.

    If the tooth is not worth root canal, options for replacement are possible. This ,of course, cannot be assessed on line.
     
  7. Hi hermes_lemming - thanks for your reply! Unfortunately, it has already been a few weeks since the Invisalign impressions, so it's too long to be an allergic reaction :sad:

    Hi rubasoli,

    Thanks for your reply again!! I'm not sure exactly why the filling has been done 3 times - I've always assumed it's because each dentist has not drilled deep enough to remove all of the decay each time it has been done. The first time (when I chipped the tooth), I was finishing college and waited a couple of months to go to my parent's dentist (not a great idea, I know). He was the first to do the filling. After that, I moved to NYC for work and took about 1.5 years to find and go to a dentist (also not a good idea). At that time, I needed the tooth filled again because the x-ray showed a dark area below the original filling. This time, the dentist warned me it would be close and might need a root canal. After he did the filling, he told me again that it was close, but would be okay for the moment unless it started to bother me. He did say it was possible I might need a root canal sometime in the future (maybe years into the future). I continued to go to that dentist in NY until moving to Amsterdam 3 years ago. I've been going to an expat dentist here and the tooth seemed okay until the last x-rays - where there was again a dark area beneath the filling. This time was the first time that the filling went below the gum.

    The tooth is my upper right 1st pre-moler. I will ask someone to take a couple pictures and post in a minute.

    Before seeing your reply, I found a dentist who is willing to see me today (due to the fact I have swelling). I will be sure to discuss the options with them and see if a root canal is a good option or not. I certainly prefer it, but I do understand it's a waste to do it and then have it fail. I'm also not sure how the dentist did the sealing/drying of the white material this time. In NY, I always remember they had this instrument to cure the fillings (I think it was some sort of light that would always make a beeping noise?). I don't remember that at the last filling.

    Thanks again and pictures to follow! :smile:
     
  8. Here are the pictures - I hope they are okay. I only have my iphone with me at the moment.

    Also, it seems there are no specialists for root canals here. All normal dentists perform them. It seems you are sent to the hospital for extractions, but everything else is done by the dentist. (Atleast this is what I'm told). :wondering
     
    tooth2 copy.jpg tooth1 copy.jpg
  9. I'm back from the appointment with the other dentist.

    You were absolutely right, rupbasoli! The swelling is an infection due to the fact that the nerve was dead. The recent pain over these last weeks was from it dying. She took an x-ray and explained the root canal option and procedure (and checked the neighboring teeth). I felt comfortable with that and decided to proceed. She cleaned the 2 roots and put a medicine inside due to the infection. She put a temporary filling on the tooth. I told her I would be traveling next week, so she said she used a harder filling because of that. I will return for the 2nd appointment the following week. If all was successful, I will get a crown on the tooth to protect it from further damage. I also have a prescription for antibiotics, which I will start right away.

    I can't thank you enough for all of your advice and clear explanations. Without you, I would have waited it out another two weeks (and quite possibly ruined my vacation in the process). Thank you so much!!:biggrin:
     
  10. that is a pleasure!

    i would wait 3-4 weeks prior to finishing the root canal treatment. Root canals in a dead tooth don't have as good a long term prognosis as when the nreve is taken out of a dying tooth before it completely dies. Coupled with the fact that you are going to take a course of antibiotics, i would prefer to wait an extra couple of weeks to make sure the root canal is effective and not just symptoms masked due to the antibiotics. It is imperative that all the dead tissue is removed from within the root chamber as antibiotics WILL NOT affect this area. As there is no blood supply anymore, antibiotics can not get inside the tooth so if is up to the root canal treatment alone to properly clear the infection.

    If you aren't in alot of pain, I would delay taking the antibiotics to make sure the root canal treatment works.
     
  11. Pain! My friend had an infected wisdom tooth about 10 years ago and it was excruciatingly painful. As soon as the infection went away and as he had all four pulled. He haven't had a problem since. I know nowadays dentists won't bill you and demand payment up front. Maybe you could talk to them and make out some kind of a payment plan. Tell them you'll sign something and pay a certain amount each month. Crying may help, especially if you're a man.
     
  12. At the moment, the 2nd appointment is scheduled two weeks after the 1st (from yesterday). I made it for right after my return because I'm supposed to start Invisalign later that week. (However, I assume I do need to delay the Invisalign anyway - how long should I wait after having the crown done? (assuming everything is okay at the 2nd root canal appointment and they advise to go ahead with a crown). I will schedule the 2nd appointment for a week or two later.

    Do you think my chance of success is much lower? I'm hoping it will be okay since it is a pre-molar with less roots (and hopefully less complicated ones).. Will the medicine put inside the root be of any help?

    Also, I was wondering if it's normal for the tooth to die and abscess into my cheek so quickly? It all happened within 4 weeks of my last filling, so I wonder if I already needed a root canal at the time of that filling.

    I started the antibiotics with dinner last night. I wouldn't say I'm in a lot of pain (compared to the very excruciating pain of a week ago), but I feel a lot of pressure (some pain) whenever I try to smile or laugh.

    Thanks again! :smile:
     
  13. If the root canals have been completely cleaned I would wait 3-4 weeks to make sure it is completely settled. Especially since you are taking abs. We need to make sure the antibiotics don't bandaid the tooth, ie mask an ineffective cleaning.

    Assuming all is well, the tooth needs cuspal protection as it is at risk of vertical root fracture. This can be achieved with a white filling buildup called a cuspal overlay or composite crown. This will buy some time while protecting the tooth to make sure the root treatment is stable. If the tooth is asymptomatic after six or twelve months you can consider a crown. A well designed cuspal overlay bonded well should last 3-4 years before needing a crown.

    Answer to questions: it is possible that the tooth can "die" this quickly after a filling, especially given this tooth has been filled many times and deeply. I suspect the tooth may have been in a state of necrobiosis which means it had some beginnings of breakdown and even just refilling the tooth is enough to tip it over the edge.

    The medicine in the tooth will not really help. We used to think that placing a high pH material as an inter appointment medicaments helped augment instrumentation but we now now this is not the case. The medicament is not critical, it is the effectiveness of the filing that is important. Copious irrigation while filing is critical.

    Another question, Please please please tell me the dentist used rubber dam!
     
  14. Thanks for answering my additional questions. :smile: It's really good information to know. When I had the filling done, the dentist was already talking to me about upgrading to a porcelain crown, so I didn't realize I should wait 6-12 months for this. It's reassuring to know the composite crown can work well in the meantime.

    The dentist did use a rubber dam. I hope it will turn out to have been successful.
     
  15. Apologies, OP, for the hijack but would really appreciate some help from rupbasoli on the points underlined in the above quote.

    In a nutshell - pain from tooth over Xmas (having appt booked in Jan for replacement filling). Due to not being able to get to dentist I took Amoxycillin and analgesics to control the pain, which was tracking up into my ear and jaw. Pain decreased after taking Amoxy, but started up again within 24hr of stopping.

    Finally got to dentist (who told me off, rightly so, for self-medicating and potentially setting up resistance to broad spec antibiotics). Xray showed no sign of infection in tooth, but dentist convinced pain coming from Gingivitis - albeit I had managed to vastly reduce due to intense mouth hygeine incl flossing and chlorhex mouthwash. Tooth cleaned out and filled. Rx Metronidazole 5 days. Made me feel sick as a dog - still do, 4 days after finishing course.

    My concern is that the tooth (area) is now extremely painful after cold/hot stimuli...and lasts minutes after the stimulus removed. Worried that dentist will think I am being a nuisance as she couldn't see anything on Xray so wondered if you could please advise?

    Many thanks. OP, hope your tooth issue resolved :smile: