Last year scaling was performed between teeth 12 and 13 – the gum was slightly inflamed, and would occasionally bleed when flossing. The gum had marginally separated from one tooth, but produced no pain. The procedure was performed by a hygienist, rather than the dentist, and appeared to go well. However in the weeks to come increasing deep pain began - deep bone pain at the center of a bicuspid, which would radiate outward into other teeth, the skull, the eye; the lymph nodes on the left side of the face also swelled.
The first dose of cephalexin did not entirely remove the pain, which progressively grew again. The separation between tooth and gum had by then healed, and a specialist was sought while a stronger dose of cephalexin undergone. Despite good digital x-rays, the specialist could find only swelling of a ligament. These x-rays are available for review. The pain and related symptoms have since intermittently returned for the last six months and recently began very deeply at the bicuspid again, which shows a thickening of the ligament under new x-rays. The pain has spread up again into the left eye and the lymph nodes are swollen again. A cold test for # 13 indicates increased sensitivity. Amoxicillin reduces the pain. Root canal therapy has been proposed.
Which is the more accurate cause and effect in this scenario?
A: the patient would experience no pain from an infected tooth root, which eventually slightly swelled and separated the gum from the tooth, and only after the separation was repaired through scaling the patient began to experience ongoing profound pain for six months in the root of the tooth followed by the related symptoms of swollen lymph nodes, etc.
B: during the scaling bacteria was pushed deeper into the gum, which then closed, locking and spreading the bacteria against the tooth; eventually, due to prolonged infection, the tooth root was irreparably damaged.
Thank you and kind regards,