This is the dental photograph of a middle-aged man showing swelling on his palate. He does not have much pain because of this swelling.
The swelling on his palate is because of a bad molar — you can see that one of his upper molar is having a cavity. He never went to any dentist earlier with the result that the carious process involved pulp of the tooth (sometimes people call it – nerve of the tooth) which further progressed to periapical area (means the tip of tooth root).As you can see in this photograph, the adjoining tooth has drifted outwards and downwards –it is because of the fact that there are no molars on his left side of lower jaw so the teeth are drifting downwards.
In this case, swelling on the palate appears to be contributed by the associated gum disease alongwith a bad molar. A dental radiograph will confirm the diagnosis.
Once the infection has reached the periapical area, it is usually very painful. However, once it spreads beyond that i.e either into surrounding tissues on face or inside the oral cavity like hard palate in this case, immediately person gets considerable pain relief. Pain relief is there as pus no longer presses on hard, bony tissues –it spreads into surrounding areas.
What is its treatment? – Immediate treatment is giving antibiotics and pain-killer cum anti-inflammatory tablets. Mostly Amoxycillin is the treatment of choice – in my 28 years of clinical practice, i have seen that it works in 99% (if not more!) of such cases. It is given in the dose of one capsule 250gm to be taken every 8-hourly for three-four days alongwith some Ibuprofen-paracetamol combination to be taken twice or thrice daily as per requirement.
In most of cases, the swelling goes down with this treatment. Alongwith above treatment, frequent warm saline mouth rinses are advised. No need to spend on costly mouthwashes – these are of little help in such cases.
Once the acute stage is over and the patient is comfortable, such teeth should be radically managed –it means that such treatment should be root canal treated (RCT) followed by crowning of teeth.
However, that ideal situation is rarely seen in India. Once swelling and pain is over, patient never returns until next bout of such painful episode. Again , the antibiotics and anti-inflammatory drugs. The circle goes on for a couple of years till the tooth becomes so much shaky or it gets so much decayed that even RCT is not possible. Then, ultimately it is extracted and that’s all.
One thing to add – some of the patients who opt for RCT of such teeth, they never return to their dentist for an artificial crown. And one of common complication in Root canal treated molars which have not been artificially “capped” is their breakage —yes, molars on which RCT has been done need be “crowned” as otherwise due to “brittleness” of tooth after RCT, they just break after sometime.