The Cosmetic Dentistry Blog

February 15, 2012

Options for treating an infected tooth

Hi Dr Hall, I’ve had a partial filing on my teeth #31 and #32. Today, after 2 months of constant pain (I was taking Ibuprofen) I went to the dentist. After a x-ray, he said we should extract those teeth because I have an abscess and an infection. I want to know if that’s the only solution and what could be the consequences? What do you think I should do? Thanks.
- Mel in Maryland

Mel,

Yes, there are other options available, unless, say, you are on a government funded health care plan. When the government funds it, such as with Medicaid programs, they tell you what option you have to choose, and it’s almost always the cheapest one. In that case you would probably not have a choice and have to have these teeth extracted.

But otherwise, the dentist is under ethical and also legal obligation to inform you of all your options. If this dentist didn’t give you any other choice, I’d get a second opinion. Plus I’m suspicious that the fillings may not have been done right which led to the teeth being infected. That may be why he just wants to take the teeth out without giving you any other choices, if he feels that he screwed up somehow.

Tooth #31 is your lower second molar. #32 is your lower wisdom tooth. When a tooth is infected, generally the best option is to have a root canal treatment. And if the tooth has abscessed, the tissue inside the tooth is dead, so there is no feeling in the tooth, which makes a root canal treatment much more comfortable than, say, an extraction. However, with a wisdom tooth, the root anatomy is often very complex and the access to the tooth is very difficult, so I personally would not recommend that tooth for a root canal treatment. But a second molar, yes. I have two root canal treatments on my own lower second molars.

If the lower second molar is extracted, the upper second molar will probably drift down into that space until it hits the lower gums. If that happens, you will eventually lose that tooth also. So that is a consequence. Since there are no teeth behind that tooth, you won’t have the usual extra complication of teeth drifting forward and tipping into that space, which completely disrupts your bite on that side.

I hope this is helpful.

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 12, 2011

Dr. Hall advises patient who is worried Army will pull his tooth. Can this toothache wait?

Filed under: Pain in teeth — Tags: , , , — mesasmiles @ 6:35 pm

Hello Dr. Hall,
I am in the Army National Guard and about 15 months ago during an exam, they decided I needed to have two fillings done in order to be deployable. This exam was done in the back of a tractor trailer by the way. I have received many fillings in my life, but the two I got that day have been horrible. The EXTREME sensitivity to hot and cold started that day. As well as not being able to chew on that side of my mouth.

At every opportunity I have expressed to the Army how much pain I am in because of these two fillings, each time I was basically told if they had to do anything about it, I wouldn’t be deployable. I sucked it up, and here I am in Afghanistan. The Forward Operating Base I am on doesn’t have any doctors or dentists, and recently the molar has started hurting 24/7. What is the reason for the discomfort? I am leary of them sending me to another FOB for treatment, because I don’t just want them to pull it (The Army’s favorite fix).

Is there another way to fix it? A root canal maybe? I am almost at my wit’s end with this and ready to knock it out myself. Oh and by the way, the dentist who did this to me, in the same day he extracted 4 wisdom teeth from another soldier, and stitched his gums to the inside of his cheek. I feel I was subject to the same skill.
- Ryan, in Afghanistan

Ryan,
I feel for you. I have had a toothache like you are experiencing, and they can be miserable.

It does sound almost for certain that you need a root canal treatment on this tooth.

Let’s give the army dentist the benefit of the doubt and say that these teeth already had cavities in them that were so deep that some bacteria had already entered the pulp. And let’s say that the teeth were filled with silver amalgam. I don’t know for sure what the Army uses for filling material, but I guess that it’s silver amalgam, since that is the cheapest filling material and the easiest to place. Amalgam conducts heat and cold readily. So that means that the tooth is going to get highly irritated right after the filling is placed, and if there are some bacteria in the pulp, that aggravates the infection and the tissue inside the tooth will then flare up into a dandy of a toothache.

The good news is that this process is self-limiting. Since a tooth is unable to recover from an infection inside the tooth, the tissue inside the tooth will end up dying, and the pain will go away. The time it takes for that to occur can vary a lot from one case to another, but usually it will be a matter of a few days. Then the infection spreads into the bone from the little opening at the apex of the tooth. While this can create a rapidly swelling abscess and a toothache also, it usually doesn’t, and your body ordinarily can wall off the infection and keep it from spreading.

Now keep in mind that I haven’t examined you or seen any x-rays, so my knowledge of your situation is limited and I don’t want you to take this advice without any question. But, based on what you have told me, here is what I would do, because, like you, I wouldn’t want them to pull this tooth, so I would take the risk of this really flaring up and try to avoid that. I would wait out this toothache. It will subside. Then I would cross my fingers and hope that it becomes a mild, well-controlled abscess and not a nasty one, and when I got to a place where I could have a private dentist look at this, I would get the root canal treatment done, and a crown put on the tooth.

It could be that your army dentist drilled too far and wasn’t careful in placing these fillings. It could be that an insulating base should have been put into the tooth under the amalgam filling material. Or, if this had been filled in a private dentist’s office, it could have been filled with a composite material that doesn’t conduct heat or cold. Or it could be that the decay was already so deep that there was nothing the dentist could do to avoid what happened.

I wish you well.

And I thank you, as a fellow American, for your service to our country.
- 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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