Oral Surgery Expert Opines on Excessive Bleeding Following Root Canal

This case involves a woman in Texas who had a root canal performed in order to treat an infected tooth. Several days after the procedure, the woman presented to the emergency room with complaints of puss and swelling indicative of a probable infection. The infected tissue was drained, and the decision was made to keep the woman in the hospital due to the apparent severity of the infection. After several days in the hospital, the woman began to bleed profusely from her mouth. Doctors were initially unable to locate the source of the bleeding, however after the patient was taken to interventional radiology it was discovered that there was a perforation of one of her facial arteries. The bleeding was eventually stopped, however the woman was forced to endure a lengthy hospital stay.

Question(s) For Expert Witness

1. What are the common complications that can occur during root canal requiring oral surgery?

Expert Witness Response E-133573

There can be numerous potential complications during root canal therapy that require oral surgery. The first is nerve damage, which can occur during an injection or through overinstrumentation. The second is through extravasation of sodium hypochlorite during irrigation of the root canal. Other complications can include the separation of an endodontic file, or persistent infection requiring drainage. I manage patients with severe infections in the facial region on a daily basis in my private practice. During my residency, I saw and treated a wide variety of facial infections, including the placement of Penrose drains. I continue to teach for the past 12 years at a major university medical center, including endodontics and oral surgery, and have over 33 years of experience in providing each of those services. Generally speaking, there may have been overinstrumentaion of root canal files into a pre-existing infection. This may have helped precipitate the infection into the spaces. Typically, a dentist would manage the infection properly, either by opening it for drainage or by creating an incision that would allow for drainage. This is normally sufficient to establish a point of drainage for the infection to start improving. It sounds like that may not have happened.