The Cosmetic Dentistry Blog

May 4, 2013

If the antibiotics don’t work, my dentist says he wants to pull the tooth.

Dr. Hall,
I have been trying to find information about calcification/mineralization of a tooth. (I was told by my dentist that, on x-ray, he does not see any remaining canal in one of my molars. It is one that already has a crown. After a round with antibiotics, if I still have discomfort in the tooth he says it may need to be pulled. Without a tooth canal present, he said he cannot do a root canal. I would rather keep all my teeth. Is there an on-line site with information about this subject so that I can read and be educated?) Thank you.
- Mikala from Wisconsin

Mikala,
I’m not comfortable with what you say your dentist is telling you.

First of all, this idea that if you’re not comfortable after the round of antibiotics you need to have this tooth pulled. Antibiotics alone in treating a toothache doesn’t solve anything. Sometimes antibiotics are used as a diagnostic tool – if the antibiotics solves the tooth pain, then we know your pain is caused by a tooth infection. That would be an indication that the tooth needs a root canal treatment or an extraction. But once you stop taking the antibiotics, if the pain has indeed gone away, it will return sooner or later, because you haven’t addressed the source of the infection.

But if the antibiotics don’t solve your tooth pain, then that would be an indication that the pain is NOT caused by a tooth infection, and the dentist should be looking for some other explanation for the pain. It could be from nerve irritation or who knows what. In that situation, he doesn’t have a diagnosis, so proceeding with treatment would NOT be the next step. It’s like he has this backwards.

And I have a problem with the notion that because the dentist can’t see a canal in the tooth, it doesn’t have one. Especially in an upper molar tooth where there is a lot of bone around it, it can make the root canal hard to see.

If you want to try to save this, I would get a second opinion. Look up endodontists in your area. Those are root canal specialists. Or just tell your dentist that you want a referral to an endodontist. If it were me, I would look up an endodontist on my own for fear that the dentist would send me to a buddy who would simply parrot what the dentist has said.

And to explain calcification, here’s what happens. As we get older, the canals in our teeth tend to shrink. This is a natural process that can be aggravated if there is irritation in the tooth, the tooth builds up more dentin on the inside of the pulp chamber and the canals of the tooth, making them narrower and possibly harder to find. It can make root canal treatment more difficult and sometimes, in extreme cases, can block the canal. But root canal specialists should have special tools to navigate through these calcified canals.

Good luck. If you want to save this tooth, go for it.

- Dr. hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

April 29, 2011

Will a tooth infection spread to my brain?

Filed under: Infected teeth — Tags: , , — mesasmiles @ 2:31 am

i went to the dentist two days ago and was told that i have a small tooth infection and i was given a proscription for antibiotics but was told to not take it until a week before i come back to have the procedure done but i dont go back to have it done until two weeks into july i asked if i would be ok until then and i was told that the infection is so small that its little to none o i will be ok until then is there a such thing as that i just want to make sure because i know that tooth infection can spread to your brain and kill you so do you think i will be ok?
- Edwina from Maryland

Edwina,
Yes, there is a such a thing as a tooth infection being so small that you don’t need to worry about it affecting your general health. Usually that’s the case.

Yes, a tooth infection can get out of hand and then you’re right, it can spread to your brain. If it’s in the lower jaw, the swelling can also spread down your throat.  But before it did that it would become painful and would swell up quite a bit.
Dr. Hall

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

December 10, 2010

Healing after root canal apicoectomy.

Filed under: Root canals — Tags: , , — mesasmiles @ 9:52 am

6 weeks ago I had an “apico” done to remove infection from tooth that had both a crown and root canal. Check up this morning revealed bone was starting to rebuild, xray looked clear of infection but small pus sac on gum looked like it may have some residual infection. They gave antibiotic to take for week. Is there anything that I can do to further get rid of this residual infection?
- Ruth from Illinois

Ruth,
With any root canal treatment, including an apicoectomy like you have had, or any other apical surgery, if the dead tissue from the tooth is removed and if there is a good seal at the end of the root of the tooth, the tooth will heal and the infectiion will eventually go away. Antibiotics can speed the healing, but they key to eventual success of the case has nothing to do with antibiotics – it’s all about removing the source of the infection.

From what you’re telling me, it sounds like the bone around the tooth is healing. That would tend to indicate that the source of the infection has indeed been removed and the tooth is adequately sealed. If that is the case, the residual infection will go away eventually. The antibiotics you are taking will speed that along. There’s nothing else to do, really, but wait.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 23, 2010

So many things wrong – where do I start? Find another dentist!

Filed under: Pain in teeth — Tags: , , , , , , — mesasmiles @ 5:11 pm

Dr. Hall,
I had a toothache.. Went to the dentist… He said that my filling in my 2nd to last molar is cracked… he also said the last molar needed to be fixed. So they did a deep cleaning… Drilled out the old fillings and capped both teeth with a single temporary cap… The next night I was in sooo much pain and my face swelled up… My throat and under my tongue was swollen… They put me on pain killers and antibiotics… After a week the told me that the tooth 2nd to last tooth died and it needed to be pulled… So they pulled it… this was all done on 9/18/10… But some friends told me that the dentist should have lanced my gums to let the infection drain… I’m still on pain killers and antibiotics.. There are still some swelling under and on my jaw on my throat and under my tongue… So what should I do???? I don’t want to be hospitalized for this or die after everything I have been reading… Can you please inform me of what to to????
- Joyce from California

Joyce,
Either I’m not getting the full story or there is something wrong with your dental care. I’ve got a lot of questions about what was done for you.

But first, pulling the infected tooth without lancing the gums is usually okay. The idea is to get the infection to drain, and with the tooth removed, the infection will usually drain just fine through the empty socket. But since you have swelling in your throat, hopefully you are still taking the antibiotics. If you’re not on antibiotics, I would find an excellent dentist and get another prescription.

But the way you’re telling about what happened in your dental care makes it sound like other parts of your treatment weren’t done right.

First, if you had a toothache and then putting the temporary cap or crown on made the tooth start to hurt as much as you’re saying, that means that this tooth was already infected before anything was done. I’m not sure why your dentist couldn’t tell that. It appears that the tooth was already abscessed, and that should have been visible on the x-ray that they hopefully took.

Second, I question doing the deep cleaning and fixing the teeth at the same time, as a treatment for your toothache. What was going on here? Couldn’t the dentist figure out what was the cause of the pain – is that why you got this scatter-gun-style treatment of trying everything? Was he or she hoping that one of the treatments would work? Usually when there is a toothache, you do a careful diagnosis and figure out the cause of the pain, and then get you out of pain. Deep cleaning is a great treatment for gum disease, but it carries a risk of causing an infection to flare up temporarily.

And I don’t understand why you were on antibiotics for a week before the dentist could tell that the tooth had died. That doesn’t make sense to me.

And you didn’t say anything about any suggestion the dentist made about saving this tooth. The tooth is dead so you have to extract it? Am I just being given a shortened version of this story? There are options that should have been mentioned to you.

If all of this was done and I’m just missing those parts of the story, then I would go back to this dentist and make sure that you are being given an antibiotic that is actually effective against this particular infection. If I am hearing this story right, then I wouldn’t have confidence that this dentist would give you the right prescription. I would recommend you find another dentist to get you the right prescription for the right antibiotic and get you healed.

Dr. Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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