Dr. Hall,
Many years ago, I had a gold crown put on tooth #14. In 2001, I had a root canal treatment done on that tooth. Recently, I developed an infection on the gum of tooth #14. My dentist gave me penicillin tablets and told me to go to the endodontist. The endodontist had a surgical microscope and said the tooth was cracked; and, therefore, the prognosis for redoing the root canal was poor. He suggested pulling the tooth.
There is no infection on the gum of the tooth now because of the penicillin. I am reluctant to have the tooth extracted. I am considering doing nothing now, and having the tooth pulled at some future date when it becomes infected again. I this a reasonable strategy? Are there any negatives to such a plan?
– Jim from California
Jim,
This is a bad plan, to wait until the tooth hurts again before you do anything, and I’ll explain why.
The infection is still there. The penicillin is only keeping it under control, it hasn’t healed you. Once you quit taking the penicillin and wait a few days, it will be swelling up again. It’s inevitable–you’re not going to get out of this. And then, with the infection in full force and you go to have this tooth out, the infection is going to neutralize the novocain, and won’t that be fun!
So your dentist will probably want to put you back on the antibiotics to get the tooth infection under control before taking the tooth out. And then the pain will be gone and you’ll be thinking again, “why not put this off.” So you’ll get into an endless loop, which will end when your infection develops resistance to penicillin, which will eventually happen, and you’ll be forced to act.
Plus, if you have a choice, it’s better not to have a tooth extracted with a full-blown infection. It’s always safer to get the infection under control first, then get the tooth out–because an extraction creates a large wound–a large surface area of exposed bone and tissue. And in the presence of pathogenic bacteria, this opens up a pathway for them to really invade your tissues and your bloodstream, which entails some risk. The risk is small, and usually the extraction of an infected tooth leads to immediate relief, but if you have the infection under control, it’s a more desirable situation.
So just do it. That’s my advice.
Dr. Hall
Read more about failed root canals, tooth abscesses, and cracked teeth.
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About David A. Hall
Dr. David A. 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 advanced internet marketing for dentists.
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