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Dr. Behere
Dr. Behere, Dentist
Category: Dental
Satisfied Customers: 2746
Experience:  Masters degree, years of experience with all kinds of dental problems.
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I developed jaw pain a few weeks ago. I have some TMJ

Customer Question

I developed jaw pain a few weeks ago. I have some TMJ related stiffness so initially attributed it to that until it worsened. As it turns out tooth #31 showed an abscess and root canal was done one week ago. I also started penicillin 2 days prior to the RC. Since the RC I have developed a more pronounced abscess in my sublingual space below my tongue and against the inside if my jaw. I still cannot chew solid food very well or spit into a sink. Endo switched me to clindamycin on Sunday. I was starting to get an earache and trouble swallowing. Last evening things improved about 30% but I'm concerned progress with the infection is waning. I've been on the antibiotic for over 48 hrs now.
My thoughts are to get a referral for extraction in the next day or so. Will it be possible for an oral surgeon to debribe this deep submandibular access once the tooth is out? I'm starting to get concerned that delaying puts me at risk unless there is substantial improvement on Day 3 of Clindamycin. Should I continue to be patient or get the offending tooth out of there?
Submitted: 1 year ago.
Category: Dental
Customer: replied 1 year ago.
Timeline: First noticed pain Oct 3rd
X-ray: October 10th
Penicillin VK 500mg qid: Ocotober 13th
Root Canal: October 15
Clindamycin 300 tid; October 18th
Expert:  Dr. Behere replied 1 year ago.

Hello,

Thanks for putting up your question on Just Answer, and being very precise in providing the necessary information.

An infection (swelling, particulary) in the sublingual and submandibular areas should never be ignored or treatment should never be delayed.

Infection from teeth, most commonly lower back teeth, can spread if not controlled. Our face is made of of muscles and bones, which have loose connective tissue between them.

These infections are caused by organisms like Staphylococci and Streptococci, which have the capacity to release hyaluronidase, an enzyme that can break through these barriers.

Thus this infection can spread very rapidly.

If untreated for long periods of time, this can result in large swelling of the face, reduction in mouth opening and enlargement of tongue and neck lymph nodes, which can restrict your capacity to breathe which can be fatal. This is called as Ludwig's Angina.

However, in your case, the offending tooth has been root canaled, and you already have been on antibiotics for 3 days. So the possibility of developing Ludwig's is very small.

I recommend:

1. Go see your Endodontist, an Xray will show how much of the infection has resolved after the root canal.

2. You may need a switch of antibiotics

3. Unless there is a massive swelling, external incision and drainage may not be required.

4. Extraction of the tooth is not required.

5. Keep applying ice from outside.

Hope this answers your question. Feel free to contact me again for more information. Please leave a positive rating for me if this answer has helped you. I do not get credit for it otherwise.

Good Luck !

Regards,
Dr. Behere

Customer: replied 1 year ago.
I guess the oral surgeon did not concur. Two surgeries coming in the AM, one to get the tooth out, the other to debride the abcess. IV antibiotics were started with close instructions to monitor airway, ability to swallow and open mouth. I had eaten before the consult thus the wait until morning. Sedation required due to extensive nature involved. Serious stuff.
Expert:  Dr. Behere replied 1 year ago.

Hello,

Thanks for the update.

Yes, this is full blown Ludwig's management protocol.

Everything will turn out well, dont worry.

Hope this answers your question. Feel free to contact me again for more information. Please leave a positive rating for me if this answer has helped you. I do not get credit for it otherwise.

Good Luck !

Regards,
Dr. Behere

Customer: replied 1 year ago.
Thanks. Surgery went well this AM. Much of the infection evacuated with the tooth so invasive gum cutting was minimalized.
Expert:  Dr. Behere replied 1 year ago.

Thats great !

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