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Dr. Alex
Dr. Alex, Dentist
Category: Dental
Satisfied Customers: 1609
Experience:  I am a General Dentist and founder of the American School of Dental Assisting
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Yesterday dentist noticed tiny abrasion/ulcer in gum above

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Yesterday dentist noticed tiny abrasion/ulcer in gum above small premolar upper tooth (had rootcanal 5 yrs ago).She tapped it from below + side but I had no pain.No pain when I bite/chew.The "ulcer" has no pain+can just feel w/ tongue,I hadn't even noticed.No pus/discernable swelling.

Enquired about x-ray but dentist didn't think necessary.Have read since could be futile as shows only bone damage.

Advised to watch it.Could be ulcer in coincidental location.

Will wait 1 wk and see if heals up.If not,I'll return to dentist.If I get fever,I'll immediately see dentist+find amoxicillin if unable to be seen asap.

(1)is waiting 1 wk sensible?(2)Do you think its infection?(3)should r.canal reinfection show other symptoms?e.g.pain to surrounding tissues?

By the way,have just finished 2 wks ago, a 2 wk course 375mg co-amoxiclav(had probable immune reaction to testicular prosthesis and antibiotics taken just in case).I'm especially.amazed if r.canal reinfection just 2 wks after antibiotics.
Great question.

Yes, there is chance it may just be a transient ulceration of your gingiva that will heal in a week and be gone. This is the logic behind waiting 1 week, which makes it a sensible recommendation at first. However, I would recommend that an x ray be taken b/c this can show if an abcess/infection has recurred in this tooth. This is standard practice to take an x ray when an ulceration appears below a tooth. It can show bone loss, yes, but it can also show abcesses and infections. After one week, if the ulcer is still present, I would recommend you see your dentist for an x ray of the tooth.

Keep in mind that sometimes the ulcer will disappear for a week or two, and then come back. This is a common occurance with infected teeth as the infection ebbs and flows. So if you see the ulcer clear up after a week, and then resume in 2 weeks, be sure to revisit your dentist for an x ray.

Reinfections do not always have symptoms associated with them. In fact, many times they don't. If the tooth is dead from the initial root canal, then there is no nerve tissue present to fire an impulse. So do not weigh your decision based on your symptoms b/c they may/may not be present.

Finally, the fact that you just came off co-amoxiclav does not necessarily mean that you cannot have a reinfection in the tooth. Antibiotics do not cure tooth infections, they only keep them at bay. So 2 weeks after antibiotics the tooth very well may still show signs of infection.
Customer: replied 8 years ago.
Dr. Alex,
Thank you for your quick answer. I think your advice about going back after a week or in case of recurrence is very sound. I would just like to ask for a quick clarification before accepting.

If this is an infection, do you think there is there a significant risk of severe complications (e.g. septicemia, brain abscess). Or would you estimate that this is only a very small risk?

Judging by the agreement to wait a week/for recurrence, I would guess that the risk of this is extremely low?
The risk of any septicemia or brain abcess from a tooth infection is extremely low. Especially if we are not sure if your tooth is even infected in the first place, this is a very extremely low risk.
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Customer: replied 8 years ago.
Dear Dr. Alex, I appreciate your considered response. Thank you very much.