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What is the problem?
An infection has occurred at the tip of the root of one of your teeth.[1] Sometimes this does not cause any symptoms, but usually people experience discomfort, occasional episodes of swelling, gum boils or bad tastes.
You may well have already been given a course of antibiotics in an attempt to treat the infection.
Why do I need treatment?
If left untreated, the infection is likely to develop into an abscess or cyst. In addition to causing pain, this can lead to a loss of bone surrounding the root, which in turn makes the tooth loose.
What does treatment involve?
Your dentist will already have tried to get rid of the infection by removing the nerve of the tooth and inserting a root filling. The infection now needs to be removed surgically in a procedure called an ‘apicectomy’.
This involves cleaning out the infection from the bone, removing a small portion of the tip of the root of the tooth and then sealing it with a small filling.
To do this, it is necessary to make a cut in the gum over the root of the tooth and then lift the gum off the bone.
The area of infection is then uncovered by removing a small amount of bone with a drill.
Any infected tissue is thoroughly cleaned away from the tip of the root before a portion of the root is removed and sealed with a small filling.
The gum is then repaired with dissolvable stitches that take a few weeks to disappear.
The whole process will take around 30 minutes from start to finish.
What type of Anaesthetic is used?
Usually an apicectomy is carried out under a local anaesthetic injection into the gum that numbs the area. This will prevent you feeling any pain during the procedure.
What can I expect after the operation?
When the local anaesthetic wears off a few hours after surgery, there will be some discomfort. It is likely to be very sore and, if needed, your surgeon will arrange pain killers for you.
The worst of the discomfort is usually experienced in the first few days, although it may be a couple of weeks before it completely disappears.
You may require a day or two off work, during which time you should avoid strenuous exercise.
Some swelling can occur, both inside and outside the mouth, after surgery. This is usually most noticeable for about two days. It is important to keep the site of surgery as clean as possible for the first few weeks after the operation.
If it is difficult to use a toothbrush, the area can be kept free of food debris by gently rinsing with warm salty water (dissolve a teaspoonful of kitchen salt in a cup of warm water) the day after surgery.
What are the possible problems?
It is unusual for the area to bleed after surgery, but if this does happen it can usually be stopped by applying pressure over the area, for at least 10 minutes, with a rolled-up handkerchief or swab.
If the bleeding does not stop, please contact the Oral Surgery department.
Lifting the gum to uncover the root of the tooth can occasionally lead to a numb feeling in the gum.
This usually disappears after a few months. Because the gum is cut, it can occasionally shrink back a few months after surgery as scar tissue forms.
This is not normally a problem, but if the tooth has been crowned, the edge of the crown may become exposed.
Even if all the infection is successfully removed it can sometimes return months or even years later.
If this happens it might be necessary to have the operation repeated, or to have the tooth removed altogether.
For further information, please contact:
Montagu Hospital on 01709 649064.
Patient Advice & Liaison Service (PALS)
The team are available to help with any concerns, complaints or questions you may have about your experience at the Trust. Their office is in the Main Foyer (Gate 4) of Doncaster Royal Infirmary. Contact can be made either in person, by telephone or email.
The contact details are:
Telephone: 01302 642764 or 0800 028 8059
Email: dbth.pals.dbh@nhs.net
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