An infection has occurred at the tip of the root of one of your teeth. Sometimes this does not cause any symptoms but usually people are aware of discomfort and occasional episodes of swelling, gum boils or bad taste. You may well already have 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. As well as causing pain this can lead to the loss of bone surrounding the root. As a result the tooth will become loose.
What does treatment involve?
Your dentist will have already tried to get rid of the infection by removing the nerve of the tooth and placing 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 the root with a small filling.
It is necessary to make a small cut in the gum over the root of the tooth and then lift the gum off the bone. The area of infection is 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 2-3mm of the root tip are removed. The root is sealed with a small filling. The gum is then stitched back into place with dissolvable stitches that take around two weeks to disappear. The whole procedure 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, ie an injection into the gum that numbs the area. This anaesthetic 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. If it is likely to be very sore your surgeon will arrange pain killers for you. It might also be necessary to take a course of antibiotics. The discomfort is usually worse for the first few days although it may take a couple of weeks to completely disappear. 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 surgery. If it is difficult to use a toothbrush the area can be kept free of food debris by gently rinsing with a mouth wash or warm salt water (dissolve a teaspoon of kitchen salt in a cup of warm water) commencing on the day after surgery.
What are the possible problems?
It is unusual for the area to bleed after surgery but should this 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 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 but sometimes the tooth is better removed.