Dr. Hall,

I had a root canal performed more than a year a half ago. At that time, the endodontist performing the procedure said there were C-shaped roots and she ‘hoped’ it worked. I was given the standard antibiotic regimen, which I followed. I was told to follow up with my regular dentist. About six weeks later I had a routine cleaning and mentioned to the hygienist I still had the same pain (referred to the tooth in front of the root canal treated tooth). The dentist was not in the office that day, she said she would have him call me after he looked at the x-ray. I never heard back from the dentist, so I assumed all was well. In December 2015, I saw my dentist for a routine cleaning. I reported I still felt the root canal was less than successful. The problem tooth was x-rayed again and showed signs of infection. I was told there was a problem and I should call the endodontist for re-evaluation. Due to holiday scheduling difficulties, the endodontist’s office prescribed Penicillin tablets and scheduled an appointment for later in in the month. I ended up having the tooth pulled on January 8, 2016 by an oral-maxillofacial surgeon. Since then I have had improvement of a myriad of symptoms: sinus symptoms and pain, facial pain, headache, ear pain. At this writing, I continue to have pain in my jaw directly under where the tooth was extracted. While the tooth socket has healed well and many symptoms have improved, I am concerned there may be simmering infection in the jaw bone. Is this possible? How best do I proceed? My faith in my regular dentist has, understandably, been shaken. The dentist who pulled the tooth did not schedule a follow-up appointment. Your opinion would be most appreciated. Thank you.

– Kellie from Missouri

Kellie,
It’s too bad you weren’t able to connect with the endodontist. A failed root canal isn’t the end of the world and most of these teeth can still be saved with re-treatment or root canal surgery. But extraction is often necessary anyway, and that’s where you are.

It’s quite rare to have a lingering infection in the bone after the extraction of a tooth. The open socket left after the extraction leaves a clear path for drainage and your body, in that case, has no trouble getting rid of the infection. Where you can occasionally get a post operative infection is in the case of a surgical extraction, particularly if the tooth is fully impacted, and the tissue is sutured closed over the extraction site. And from your description of your symptoms, it sounds like your jaw healed normally.

If There Is a Post-Operative Infection

Nevertheless, there are some cases where a stubborn infection can linger and it can require a strong dose of post-operative antibiotics to be completely rid of the infection. I would go back to the oral surgeon for an evaluation.

If that is the case, I would not go back to the penicillin, since you apparently took that over an extended period already. In the rare possibility that you have a lingering infection, that infection is probably penicillin-resistant. I would go to a strong antibiotic like clindamycin in a situation like that.
– Dr. Hall

Do you have a comment? We’d love to hear from you. Enter your comment below.

Click here to ask Dr. Hall a question of your own.