Should I see a doctor or a dentist first for this lymph node pain?

May 27, 2018 9:45 AM

YNMDoD. I've had pain in the lymph node on the left side of my throat for a month now, and it hasn't gone away. Should I see my doctor or a dentist to check it out?

At the end of April, I caught what felt like a bad cold from my 4 year old. I was running a low grade fever, general malaise, exhaustion, painful sore throat, and a ton of sinus pain. I was generally functional on cold medicine. In the middle of this, my lymph node on the left side of my throat under my jaw swelled up. It was painful whenever turning my head or opening my mouth. After three weeks of this--culminating with a few days where I cried to my husband that I was so tired that I wish I could just stop existing--I went to the doctor, who looked in my throat, confirmed that it was red, and prescribed a Z-pack (I am allergic to most antibiotics). He didn't swab my throat or even feel my lymph nodes.

I started to feel better on the antibiotics. The sore throat went away. The lymph node pain improved a little, but once I finished the course of antibiotics, it seemed to come back. However, it was generally getting better on a daily basis. It no longer hurt if I turned my head, only if I both turned my head to that side and open my jaw wide. It's like a brief stabbing pain in my throat, and is worse in the morning first thing when waking. Occasionally while sleeping I have these weird jolt pains toward my ear.

However, the pain is also located very close to a molar that has now had two root canals on it, most recently six months ago. There is a small bump on my gumline that has never gone away. Compounding this is that I have been unhappy with my dentist for a bunch of reasons I won't go into here, so I would have to find and see a new dentist. I had made both a dentist and doctor's appointment about ten days ago--and then I had a few days where things seemed to be feeling better, so I canceled them. Regretting that now. The pain isn't reduced by painkillers, but it's not severe. Is still there, though.

I want to make an appointment to figure out what's going on, but I'm not sure if I should go to a dentist first or my doctor. Based on my symptoms, either something like mono or a tooth problem seems equally likely. I am generally anxious about adulting and medical professionals and making mistakes with my health so I've been a bit paralyzed over this. Who should I call first?

posted by PhoBWanKenobi to Health & Fitness (10 answers total)

Call them both and make appointments -- call one, make appointment, hang up, call the other.
Then go to both appointments in the order they can fit you in. You need to see both.
(It's unlikely a new DDS will be able to see you as soon as your regular doctor can anyway. But make the appointment.)
posted by velveeta underground at 9:58 AM on May 27, 2018 [1 favorite]

I've had weird neck lymph node crap going on for a few years and it's almost exactly what you describe. Same experience with antibiotics; the bump reduces to almost nothing, then it comes back. Sometimes it hurts a bit, sometimes it's fine. I've had extensive bloodwork done, saw dentists and oral surgeons and endodontists and it wasn't until I saw an Ear Nose Throat surgeon that I got some answers. In my case, it's a stupid reactive lymph node. I get it biopsied every few months and it's always fine; it just got really bad once after a really screwed up infected root canal and now when I get a cold or allergies, it swells up again.

This may not be what's happening in your case, but I would definitely get to an ENT specialist because they see stuff like this a lot. And I would go straight to an endodontist, not a dentist.
posted by yes I said yes I will Yes at 10:01 AM on May 27, 2018

Response by poster: And I would go straight to an endodontist, not a dentist.

Would following up with the same endodontist who performed the last root canal make sense? (I realize I am probably overthinking this but, like I said, I'm super anxious about these things.)
posted by PhoBWanKenobi at 10:07 AM on May 27, 2018 [1 favorite]

This sounds like an ENT issue to me. But you know the saying "if all you have is a hammer, everything looks like a nail" - I've gone to specialists for things when I should've just gone to an internist because they ended up missing the easiest, most obvious solution and went straight to speciality care. I honestly would consider starting with a general practitioner and seeing what they recommend. You might be able to see them sooner than a specialist, too.
posted by AppleTurnover at 10:36 AM on May 27, 2018 [1 favorite]

Heck maybe get a new GP in the longer term too. Not feeling lymph nodes at that visit is a red flag for me.
posted by SaltySalticid at 10:51 AM on May 27, 2018

Chiming in with recommending that an ENT is the specialist you want to see for this. Also getting a dental xray, whether at a General Dentist or an Endodontist, although I'd personally go see an endodontist. (I work in General Dentistry, and really all we would do is take an xray, usually see something suspicious and refer you to the specialist anyway. So save your time and go directly to the endodontist you've already seen.) It's possible you have a failing root canal, or a cracked root which keeps a low grade infection going, which calms down for a little bit with antibiotics and then flairs up periodically.
posted by Jazz Hands at 11:47 AM on May 27, 2018

I am a dentist, but not your dentist. I would go back to the endodontist who saw you, or possibly a different endodontist if they can't get you in ASAP. To me, the bigger warning sign that something is not right with the root canal is the "small bump" on your gumline. If I see a patient that may need a root canal in the future, I usually tell them to look out for a "pimple" on the gums. Is there occasional pus coming out of it or is it squishy? Then I think the root canal either failed or the tooth is cracked. I would recommend getting a CBCT of the tooth (basically a 3D scan) instead of just a conventional radiograph if at all possible.

That being said, when I see a failing existing root canal, the patient is usually unaware it's failing because they are not having any pain with it because the vast majority of the nerve is dead. A fractured root usually (but not always) results in immediate pain for a few days, then it usually doesn't hurt. So I would heed the previous advice of making appointments with both a dentist (endodontist) and a doctor, but I would try to see the endodontist first because usually a second root canal doesn't have the greatest prognosis and my gut is telling me that's the origin of your problems.
posted by catsarethebest at 12:12 PM on May 27, 2018 [1 favorite]

I had almost the exact same thing happen. I had a root canal that just didn't feel right, and it sort of ached for a few years. Then it would get infected, with an abcess on the gum. Early on I could get it to go away with antiseptic mouthwash, like the original Listerine, but even that quit working. I knew I had to get it checked, and my own dentist told me it may be fractured and I could lose the tooth.

Happy outcome: it was a perforation in the tooth, a result of using the brushes a little harshly in the original root canal. It was open to the gum and would get infected, and bleed and all that crappy stuff. The old endodontist had retired (YAY) and the new one is--I hate to say it but he is young and better educated and has super cool tools, like a microscope they use these days to look into the tooth and really can see what is going on. I took Amoxicillin for a week, had the tooth cleaned out and repacked, and my tooth is saved. I cannot communicate how happy this has made me.

The other thing is that I feel so much better and I look a lot better too. It seemed funny to me at first but when you think of that kind of an infection in your mouth it really is serious and can be awful. Go see an endodontist, and good luck.
posted by chocolatetiara at 4:23 PM on May 27, 2018

Response by poster: I called my endodontist today and he got me in first thing. The regular x-ray looked good, but the 3d xray showed that there is still a spot of infection there despite the fact that things are generally progressing toward healing. He said that I have three options--to wait and see if it continues to heal (which may happen slowly or not at all, especially, he says, since I have had lyme disease and anecdotally he's seen that interfere with healing), perform an apicoectomy, or have the tooth pulled. I called my old dentist for advice, since my issue wasn't with his care but with other things, and he recommended against the apicoectomy. Both thought that it "couldn't hurt" to call my PCP to see if there might be something else going on, though they said the lymph node swelling is likely from this. So I guess we'll see what's up. Frustrated that it's not something more clear cut, I guess.
posted by PhoBWanKenobi at 2:53 PM on May 29, 2018

Response by poster: It only took another month to get a resolution on this: I went back to my doctor in early June when my lymph node was still swollen and he basically shrugged and was super dismissive. At this point I was also getting weird headaches and joint pain which felt pretty similar to how I felt in the past when I had undiagnosed lyme disease. But I was frustrated enough with my primary care doc that I visited a local midwife, who also does primary care, cried a bunch in her office, and asked her to run bloodwork for me.

Today I got the results that I'm positive for both Epstein-Barr and Lyme disease. Fun stuff. Will be spending the remainder of the summer on antibiotics.
posted by PhoBWanKenobi at 8:05 AM on June 27, 2018