Dear Dr. Hall,
I have had an excruciating toothache for the last 3 days. I got an appointment with my dentist. I go every 3 months, he checked my radiographs from last time as it was only 2 months ago. He said it may be an infection but he can’t see any crack in my filling where I have the pain. He gave me penicillin and said if the pain goes away I do not need to go back. Surely this isn’t correct. Yes antibiotics may stop the pain for now but what stops the same issue occurring again?
Thank you,
Devon from St. Helens, England
(See Dr. Hall’s answer below.)
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Devon,
With all the crazy questions I get and the dental incompetence I hear about, I am still stunned by the multiple levels of incompetence of your dentist. You really need to find a new dentist who knows what he or she is doing and who cares enough to find out.
The first issue is not taking a new radiograph. You had radiographs two months ago, you say. But two months ago you didn’t have a toothache. Clearly, something has changed, so you need a new x-ray. And I suspect that the x-rays from two months ago were just bitewings—x-rays that show just the crowns of the teeth. You need a good x-ray that shows the tip of the root of the tooth, which will reveal if the pulp of your tooth is infected.
Second, is he really saying that because there isn’t a crack in your filling there is nothing else to check? There are several other things to check:
- Is the pain aggravated by tapping on the tooth?
- Does cold make the pain worse?
- Does cold alleviate the pain?
- How about heat?
- There are also electrical tests to help determine if the pulp of the tooth is alive
Did he really not try any of these tests?
And finally, and probably worst of all, the treatment—a prescription for antibiotics with the advice to not go back if that makes the pain go away. That is the opposite of correct advice. If penicillin makes the pain go away, then there is an infection, and that infection needs to be treated.
I have written many times why antibiotics alone cannot cure a tooth infection. Antibiotics do not get inside your tooth—they only attack the infection that has spilled out into the bone. Yes, after you are done with them, the infection will return. And when it returns, it will be worse, because there is now a strong likelihood that the bacteria are now resistant to the antibiotic that was used. A couple of years ago I posted a story about a man where this had happened and he ended up dying from the tooth infection because the hospital was now unable to find an antibiotic that would work.
If what you are telling me is accurate, you need to find another dentist who cares enough and knows enough to solve your toothache.
– Dr. Hall
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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.
This is really concerning to read. I wouldn’t have known that antibiotics alone can actually make things worse over time. I’m definitely going to be more cautious about how tooth infections are handled in the future—thanks for explaining it so clearly.