The gums around my upper left premolar have been swollen since the summer of 2022. The gum tissue is tender, but it doesn’t hurt. My dentist said I have a chronic abscess, and I would keep the tooth or get it extracted. During my last visit, I expressed concern about the lingering swelling, so my dentist referred me to an endodontist. The specialist said she could do a root canal with 70 percent success, but she is unsure whether I have a cyst. She took an x-ray, so I’m unsure why she couldn’t see a cyst. She showed me a dark shadow on the x-ray where my gums were sore.

My dentist and the specialist mentioned a procedure to access the tooth root through my gum tissue and bone. I could choose that procedure first and a root canal later if it doesn’t work. I understand how I went from my dentist saying that I could keep the tooth or get it extracted to cutting through my gums and bone to see if there is a cyst or an abscess. Are there questions that I need to ask my dentist? Thanks. Sarai

Sarai,

Although dental schools teach about cysts, they are rare, and the risks of having one are small. An infection causes swelling in the gum tissue around a tooth. Root canal treatment will remove the infection. Afterward, you will see and feel relief.

An apicoectomy is a dental procedure that involves cutting through your gums and bone to access a tooth’s root(s). The suggestion of an apicoectomy for your tooth sounds like over-treatment. Additionally, it concerns us that your dentist allowed the swelling to continue without investigation and treatment. An abscess can leak bacteria and affect neighboring teeth and your jawbone, even spreading into your bloodstream.

Like other infections, tooth infections can drain your energy and cause malaise. Root canal treatment has at least an 85 percent success rate. The skill of a root canal specialist (endodontist) decreases the risk of root canal failure. The specialist has the latest technology and understands which techniques work best, even in complex cases. Afterward, your dentist will protect your tooth with a custom dental crown.

We recommend treating the infection promptly. If you are uncomfortable with your dentist’s and endodontist’s recommendations, you can see another dentist or specialist for a third opinion.

Dr. Miranda Lacy, a Plano, Texas dentist, sponsors this post.