Dental Education Lecture: Slow Recovery from Apical Surgery

Ms. Pan is very unfortunate to have pain after root canal for a second time.  Three months ago, we did root tip surgery involving three root tips (Fig.8,9).  She has a slow recovery.  Following is email messages between doctor and patient.

Xiao Pan:
How is your wound?  I hope that you are recovering steadily.  I have not had chance to call my previous patients for your concern.  It is much easier for me to write an article about the surgery.  Although at slower speed than I expect, my patients usually recover apical surgery finally.
By the way, there are two or three very small cavities in your husband (front teeth).  If he does not want to fix them immediately, he should floss daily.  Xin Wei, DDS

Hi, Dr. Wei, 
Thank you very much for your caring. My tooth #3 seems not have any progress since last time I visited your office. Either nothing has been changed indeed or things are changing so slow that I couldn't discern.
 
My gums still feel numb and discomfort. Due to the numbness, the surrounding skin feels tight and weird.  I also found I am more sensitive to different flavors recently. In other words, I will feel more salty or spicier on the foods than usual. When I push the place (on my cheek side) where you said you cut some bones, I still feel the same pain as you examined last time.
 
I have read your new articles. But looks like they didn't have the experience on numbness and how long it can be gone. From my symptom above, do you think the pain and discomfort is from the wound, or loss of bone, or numbness? Should I continue to wait or take some actions? 
 
I will remind my husband about his cavity and flossing carefully. Thanks a lot! 
 
Best Regards
Xiao Pan

Dear Xiao Pan:

I am so sorry to learn that you are worrying about numbness so much.  It must be very uncomfortable.  But this is NOT a big issue.  The nerves I damaged during surgery are not important, especially from cheek side.   Bone will heal if I remove all of the bad stuffs, which I think I have accomplished. 

Retrospectively, most of my patient having your type of surgery (apicoectomy) do have very slow recovery.  It makes me feel very bad.  But it also makes me appreciate that my patients bear pain and discomfort for me.  It makes me keep learning and writing dental articles.  Every single word in my every article contains my desire to alleviate pain for my patients and those patients I do not have opportunities to treat.  But all of them recover in the end. 

Last July I did apiceotomy for a 57 year old lady.  First I redid a filling for the tooth #3.  It did not work.  Then root canal was done with crown.  The pain returned.  Finally apicoectomy was done.  A few days after the surgery she returned to my office with swollen and blue face. If I had had been by Yellow River, I would have jumped into it.  We also placed an implant for the tooth #30.   She disappeared for 8 months.  We thought that she must hate us.  But her son still returned for cleaning.  Finally early this month, she returned for temporary bridge (around #30 implant) cementation.  She gladly told every one of us in the office that the pain associated with #3 has never come back again.  She is too busy to return for implant further treatment now. 

Xiao Pan, compared to the patient I just mentioned, you are much more fortunate.  I am sure that you will be alright sooner or later.  If I could not comfort you enough, you may need a long nice vacation, trying to forgetting the root tip surgery. Anyway, we do not have to do anything now.  Just watch.

Xin Wei, DDS, PhD, MS 1st edition 03/08/2011, last revision 03/08/2011