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Death from a tooth infection – a sad story

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After repeated questions from people who were tempted to just nurse along a dental infection and not get it fully treated, I decided to research to find out about people who have died from dental infections. A study published in the Journal of Endodontics about ten years ago reported 66 deaths from tooth infections during 2000-2008. That works out to about five to ten deaths per year in the United States from dental infections.

Then I also found a story from 2017 that is particularly instructive of the danger of just taking antibiotics to tamp down the infection without getting the needed treatment of a root canal or an extraction. I’ll share that below.


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This story was reported by the Sacramento Bee, and then also by Fox News and some others.

Vadim Kondratyuk Anatoliyevich, age 26, was a father of two little girls and a long haul truck driver from Antelope, California. He took off for New York with a hauling job in the middle of January, 2017. His wife said his tooth was hurting when he left. It got worse, so he stopped in Oklahoma and saw a dentist. The dentist prescribed antibiotics and sent him on his way. The pain got better but then got worse, and the side of his face swelled up. He made his delivery, but it got so bad that he couldn’t make the drive home. So his brother flew to New York to drive him home. On the way, Vadim’s condition worsened. His breathing became labored and he grew pale, so his brother took him to a hospital in Utah where he was placed on oxygen and then flown to a larger facility in Salt Lake City.

His condition was life-threatening because the infection had spread to his blood and lungs. Doctors in Salt Lake City prescribed stronger antibiotics and put him on dialysis. But they soon determined that they wouldn’t be able to save him. They notified his wife that he kept getting worse and nothing they did was working. She was able to fly in and say goodbye before he died.

My Comments:

The important point I want to get across here is that it is dangerous to treat a tooth infection by just giving antibiotics. The source of the infection is dead tissue inside the tooth. Since there is no blood circulation there, there is no way for antibiotics to get in and eradicate the infection. Therefore, you end up helping to breed antibiotic-resistant bacteria. Vadim, while he was otherwise healthy, was diabetic, which made him more vulnerable to infections. It’s hard to be too critical of the dentist in Oklahoma, because he was dealing with a transient who wouldn’t be around to complete the treatment, and some family practice dentists don’t do any root canals. But what he should have done, in retrospect, was at least begin root canal treatment and maybe sealed a disinfectant inside the tooth.

And what Vadim should have done was address his toothache when he first felt it.

Anyway, here is a listing of some of my earlier blog posts that warn about trying to treat a tooth infection with just antibiotics:

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

An infected tooth, and no money

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Hello Dr. Hall
My face is swollen on my right side and the teeth inside have cavities. It’s been swollen about a month. I ate something yesterday that made it hurt and it has swollen a lot more and hurts now. I understand I need a dentist but I can’t afford one as I just got laid off my job. Any advice for me on how to care for this issue at home? I live in Orangeburg, South Carolina and I have no car or no help to a dentist but I’ve heard from friends none of the dentists around my city will work with payment. So what do I do?? My credit ain’t worth a crap either so I’m screwed but I feel something is really wrong. Really worried. Please help me somehow. Thanks. I clean for a living. I can clean anything from top to bottom. Any advice please help.
– April from Orangeburg, SC

(see Dr. Hall’s answer below)


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April,
I get questions like this from time to time and I’ve told people to call around and ask dental offices where their local charity dental clinic is. But, from the lack of response I get, I’m thinking people, maybe for shyness, don’t want to do that, or maybe they just don’t believe me. I decided to take this a step further with you and do the research to find such a clinic, because I’m worried about you. A dental infection that is starting to cause facial swelling is nothing to sit back and just watch. Five to ten people each year die from dental infections. Some people think that they can just take antibiotics. While that works for most infections, the source of a dental infection like this is

photo of the building entrance to Family Health Centers

Family Health Centers in Orangeburg, SC

usually a tooth where the pulp tissue has died. Since your blood can’t reach the inside of a dead tooth, what you do with just antibiotics is cultivate an antibiotic-resistant infection, and it will most certainly come back and then be much more dangerous.

Orangeburg has a population of only about 14,000 and it is the county seat of Orangeburg county which has about 84,000 people. But still I found a clinic that does charity dental work. It’s a non-profit called Family Health Centers, and they provide a variety of health-related services, including dentistry.

Dentists tend to be people who wanted a profession where they could help people, and many dentists will volunteer time at these clinics. In larger cities where they have a dental school, dental students will volunteer there to get more experience. They won’t do elaborate treatments like root canals or crowns, but they will place temporary fillings, maybe even some permanent fillings, and do extractions. Getting treatment for an infection like this that is starting to invade your body could save your life.

Here’s a post I wrote about a tragic death from an incompletely treated tooth infection.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

Photo of the Family Health Centers bus that serves as their mobile dental clinic

They even provide a mobile dental clinic, which I imagine will travel throughout the county.

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.

Does this root canal need to be re-done?

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Hello Dr. Hall,
I had a root canal on my upper right canine. The temporary filling came out and an abscess developed on my gum. I returned to my dentist’s office. He said I needed a second root canal to address the abscess. The abscess is not painful unless I press on the affected area. Is the abscess “toxic” and would antibiotics work or just the 2nd root canal?

Thank you for your attention,
-Mark Mesi

(See Dr. Hall’s answer below.)


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Mark,
Yes, you absolutely need to have this root canal treatment re-done.

Let me start by explaining what I believe happened. I’m going to read between the lines here since you didn’t give me all the details. You said the temporary filling came out. I want to explain why this causes a problem.

When a dentist does a root canal treatment on an infected tooth, the infection is cleaned out of the inside of the tooth and the root is then sealed with a filling material and cement. The seal needs to be protected or bacteria will get back into the tooth and the infection will return. To protect the tooth, a temporary filling will be placed at the end of your root canal appointment. If the root canal filling isn’t protected from saliva, it won’t take long for the saliva to seep into the filling and break the seal. So the temporary filling is placed and you should then be scheduled for final restoration of the tooth—usually a crown, or sometimes just a filling may do.

So it looks like someone didn’t follow through here and the temporary filling, being just temporary, came out. These temporary fillings are purposely made so that they are very easy to take out. Now your root canal treatment was exposed to saliva. Over a period of several days, the saliva will break down the seal of the root canal and the infection will return.

About the Antibiotics

You asked if you could just treat this with antibiotics and avoid re-treatment. Here’s why that won’t work. When you take antibiotics, they get into your bloodstream to fight the infection. However, there is no blood circulation inside your tooth, so antibiotics cannot get there to remove the infection. They can temporarily eliminate the abscess in your gum and bone, but as soon as you stop taking them the abscess will return. To complicate things, by taking the antibiotics you will be helping breed antibiotic-resistant bacteria, which is a very risky thing.

Since this doesn’t hurt, can you just leave it alone? Infections in your jawbone, particularly in the upper jaw, are risky in that they can spread to your eye or your brain. I wouldn’t mess with that. There is a famous story of a boy in Maryland who died from a tooth infection about 15 years ago.

Furthermore, with oral bacteria having an undisturbed existence inside your tooth, decay will begin to grow there from the inside out and, in time, your tooth will be unrestorable.

Just get it fixed.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

I can’t afford implants. Can someone help me?

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Dr. Hall,
Like so many other people, I need but can’t afford implants. My only option is dentures and I’m just not ready for that. If I was older I wouldn’t care but I’m 33, look better than ever (aside from my teeth) and have more confidence than I’ve ever had. Until I smile. The depression is unreal. I’ve trained myself to be less happy, to laugh less, just to avoid showing my teeth. I’ve been searching for some kind of miracle online in the form of assistance in the cost but I’ve found nothing. I see videos of people getting implants and I just wonder if they had to pay for them because they use the video for advertising. And if that is something that would be free if I signed a contract that allows for it to be used in advertising for the company because I would do it in a heartbeat. I can’t even go get a consultation without crying my eyes out so I’m at the point I just want to give up. Is there any way to apply for something like that? To receive assistance or have it covered if I allow it all to be used for media and advertising? Is there any way to get that help without just luck of the draw? I can’t take this depression much longer. My son deserves to see his mom smile.
– Mika from Oklahoma

(See Dr. Hall’s answer below.)


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Mika,
I wish I had a better answer for you, but the reality is that to get dental implants you’re going to have to pay for them. I’ll explain why. But I also have some suggestions for making them more affordable.

On the idea of getting the implants in exchange for being an advertising subject, the reason that doesn’t happen is that dentists have no trouble getting endorsements from their paying patients.

But here are some ideas for making this treatment be more affordable:

  • You could be a teaching subject for a dental implants course. Dental schools that teach implant dentistry need patients to be subjects, and they will offer a discounted fee in return for your being willing to put up with the inconvenience of being treated by students.
  • There are a couple of affordable implant options, such as a snap-on denture that uses only two implants, or the use of mini implants that are much easier to place.
  • You could get the removable denture now and begin saving up to later have it supported by implants. Spacing it out like that could maybe help you fit the treatment into your budget.

There is a lot of charity dentistry that goes on. Many cities have charity clinics that cater to people who can’t afford regular dental care. However, if you have no teeth, they will want to give you a removable denture and won’t get into any dental implants treatment. The thinking is that up until about 30 years ago removable dentures were the standard of care and that should be good enough.

I wish I had better answers for you. See if any of these options make it easier for you.
– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

What if a Tooth Breaks During an Extraction

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Dr. Hall
I had tooth #17 (lower left wisdom tooth) extracted about 6 weeks ago. I wanted to see it after the dentist took it out, but he wouldn’t let me touch it or have it. The gum took about 3 weeks to fully close back up. I started having pain on the left side of my face, in my ear and in the back of my left eye. The pain has subsided but not in the back of my eye. I’m suspicious that my dentist was trying to hide the tooth from me because he didn’t get all of it out. Could the pain I continue to have be because of an infection from a piece of the tooth being left behind?
– Leslie from the Bahamas

(See Dr. Hall’s answer below.)


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Leslie,
It does sound suspicious. It is possible to have a post-operative infection after taking out a wisdom tooth, but that generally only happens in the case of an impaction where the gum is sutured closed again after the surgery. When the tooth wasn’t impacted and there is an open socket, which is what you are hinting happened with you, any infection will drain out through the opening and it should heal without complication.

But if a significant piece of the tooth were left in the socket, such as entire root, yes, the gum could heal over it, leaving this root embedded in your jaw and susceptible to a post-operative infection.

I would find another dentist and have them take an x-ray of your wisdom tooth area to see if this is the case. It would be best to go to an oral surgeon who could handle finishing the extraction if that turns out to be necessary. If there is still a root there and the bone hasn’t healed over it, you could have the root removed without a lot of trouble. If there is a root that was left, I would be inclined to ask for a refund from your dentist.

What Should a Dentist Do When a Tooth Breaks During an Extraction

Unforeseen complications can easily happen during an extraction. Especially in older patients, sometimes roots will have extra cementum deposited so that the end of the root is fatter, which can cause the root to break off when the tooth is extracted. I wouldn’t blame the dentist for this.

If it’s just a small root tip that breaks off, it can be best just to leave it. If the root tip is near a nerve or close to the sinus, it can be risky to go after it. But the dentist should tell you when this happens. And it should heal with no complications.

If a large piece of the root breaks off, it should be removed. Doing so will generally require removing some bone around the root. If the dentist has the skills to do that, he or she can complete the extraction. If they don’t, they should refer you to an oral surgeon to complete the procedure. In either case, you should be informed of the complication.

Also, it isn’t uncommon for a patient to want to take the extracted tooth home and some dentists will routinely give that to the patient. If you asked and he didn’t let you see it, yes, I would be suspicious.
– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

All-on-4 Implants from ClearChoice leave her bite off

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I received All-on-4 implants in June 2023. They teeth are too big and don’t align. My bite is off. It’s hard to chew and swallow. ClearChoice said they are fine the front teeth set on top of each other. I feel like the back teeth are taller on the right then the left. I don’t know what to do.

– Kimberly from Visalia, CA


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Kimberly,
I’d start with a second opinion from another dentist with some expertise in dental implants. If ClearChoice did something wrong here, another dentist would be able to let you know that and put some pressure on ClearChoice to make this right for you.
– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Do I really need to have this bridge replaced?

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Dr. Hall,
I have a bridge on my upper right side and my dentist said I need to replace the bridge because one of the teeth holding the bridge is cracked below. I have no pain or symptoms, and replacing the bridge and crowns will be very costly.
Is there another way?
– Meredith from Newport Beach, CA

(See Dr. Hall’s answer below.)


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Meredith,
Thanks for your question.The first thing that occurs to me about your situation is that your case is a great illustration of one of the chief advantages to replacing a missing tooth with an implant rather than a bridge. While a bridge may be less expensive up front, if anything goes wrong with any tooth that is part of the bridge, you will probably need to replace the entire bridge. With a dental implant, if anything goes wrong later with an adjacent tooth, it won’t affect the implant. (See my page on dental implant vs bridge for a discussion of these advantages.)

So, assuming that one of the abutment teeth in your bridge is cracked, that tooth would need to be extracted and you would need a new, longer bridge that is now replacing two teeth.

a drawing of a dental bridge replacing a missing lower first molar.

A dental bridge

Having said that, I am skeptical of this diagnosis for a couple of reasons.

First, you aren’t having any symptoms. If this tooth is cracked, it would be the root that is cracked, and there would ordinarily be some sharp pain when you bite anything hard.

Second, it would be very unusual for a tooth that has a crown on it to crack. When a tooth is weak or cracked and in danger of splitting, the proper treatment is to place a crown, which will prevent the crack from growing and destroying the tooth. I have had patients with a strong bite that is sometimes called a gorilla bite who have broken off teeth at the gumline, but I have never seen a tooth with a crown on it develop a crack in the root.

To emphasize the preservative nature of a crown on a cracked tooth, I published research a number of years ago showing that even if a tooth is completely fractured through the root, under proper conditions the pieces can be forced back together, the tooth crowned, and the tooth can be saved.

Anyway, I’d recommend getting a second opinion before you do anything. But be careful of how you do this. Don’t go to Dr. Jones and say, “Dr. Smith said one of the teeth in my bridge is cracked and I need a new bridge. What do you think?” No, don’t identify your dentist because he or she may be friends with the other dentist. Also, give as little information as possible about what you were told, so that the opinion given will be completely independent. Don’t put the idea in their head that another dentist said the tooth is cracked. If the second dentist asks, just tell them you don’t want to say until they give their opinion. Go and say, “Dr. Jones, I want a second opinion. Do you see anything wrong on my upper right?”

If your dentist’s diagnosis comes from an x-ray, you could even send me a copy of the x-ray and I’ll tell you what I think.

– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

Is this a cyst or just an abscess?

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Dr. Hall,
I have had a swelling on my top right premolar for about 3 years now. It doesn’t pain me – just a bit tender. My dentist has always said we can leave it or take it out and have always said it is a chronic abscess. My dentist sent me to and I have now seen a specialist in hope of doing root canal which he has given a 70 per cent success rate but he said there is a possibility there may be a cyst, but no way of knowing. I would have thought an X-ray would show it up. All I know is that there is a dark area (shadow) there. I am so confused what to do – a root canal or extraction. I just want this lump gone now. I don’t really want to lose the tooth but my biggest worry is what if it is a cyst and it has been there all this time what it’s doing to me. Surely there’s a way of telling, and also if I choose root canal will the lump go away? Both my dentist and the specialist have mentioned a gum procedure to cut the gum, peel it back, and go into the bone to trim the tip of the root, remove whatever is under there, if it doesn’t heal after extraction or after root canal. I look forward to hearing from you as I am really confused and it is making me ill with worry.
Many thanks
– Susan from Kingswinford, UK

(See Dr. Hall’s answer below.)


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Susan,
I think I can help you here.

First, about the cyst. We were taught a lot about cysts when I was in dental school and about the possible problems they could cause. But in my decades of dental practice I never saw a single cyst. It’s a common practice for some dentists to exaggerate risks to protect themselves in case something goes wrong. So yes, there is a chance that this could be a cyst, but the chances are going to be pretty small. Get rid of the infection by doing the root canal treatment and I’ll bet you’ll be just fine. I wouldn’t do the gum procedure they are suggesting. This is called an apicoectomy, and my opinion is that would be overkill.

Then I have a comment about your UK dental care. I guess your dentist and the specialist seem to be trying and well-intentioned, but I am surprised that your dentist was just watching this swelling for three years. This is an infection and you’ve been having bacteria spilling out of this abscess into your bloodstream for these three years. My guess is that when you get this root canal treatment done you will start to feel better. These infections in your body tend to sap your strength a little and it’s a good thing for your general health to get rid of them. And giving this procedure a 70 percent chance of success is really lowering expectations. Root canals in general have at least an 85 percent success rate and, in the hands of specialists who have the latest technology, the success rate is considerably higher than that. And if you do end up with a root canal failure, you can always have them later try the apicoectomy that they mentioned.

Best of luck,
Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

I now have nightmares about my ClearChoice experience

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Because I have a fear of dentists I expressed my concerns to ClearChoice and I was told I would be sedated and put to sleep. But instead I woke up in the middle of the procedure and when I tried to get up because it hurts so much they held my arms down with no additional painkiller.

When the procedure was finished I immediately noticed that my top teeth were too far forward preventing my lips to comfortably close and now I dribble saliva out of the corners of my mouth during the day and all night long. I was told by ClearChoice this is standard procedure. They never said that I would have terrible breath from now on and I do. Had to go back in to ClearChoice because something was sticking out of the side of my gum. They told me I cannot eat solid food and the food they told me I can eat gets caught inside the implant.

I’m still having excessive pain and the new procedures are not even completed. If I would have been told half of this would happen I would not have ever gone to ClearChoice. My wife and I have now spent a lot of money and I wish I would not have had this procedure done. Because they held me down now I have nightmares most nights and cannot sleep. Every morning I wake up saliva has been going down my cheeks all night long onto my pillow and the sheets creating a terrible odor.

I went to the ClearChoice in Metairie, LA
– Benson T. from Lafayette Louisiana


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Benson,
Thanks for sharing your experience. Since I have heard that ClearChoice has threatened patients who report adverse experiences at their clinics, I have used a pseudonym instead of your actual name.
It is not that rare that a patient can be more resistant to sedation. The sedation worked on you, but was apparently not quite deep enough and you woke up prematurely. What I would have done is give you more medication, though that would definitely disrupt the schedule. I’m assuming that you were getting oral sedation, since if you had had IV sedation, it would have been rather simple for them to give you additional medication and it would take effect immediately. Their resistance to doing that suggests to me that you had oral sedation, meaning it would have taken maybe half an hour for additional medication to take effect.
It is definitely difficult to do quality work on a patient who is uncomfortable. I imagine that you were moving your head while they were working on you. That may be their excuse. But this would have been solved had they taken the time to fully sedate you.
I hope this helps others.
– Dr. Hall

Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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.

An issue with ClearChoice Orlando

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Patricia visited the ClearChoice Dental Implants Center in Orlando, FL, and this is her comment:

My experience has been mixed, in the beginning they were very pleasant and worked with my schedule. Now I have had my temporary plates for more than 8 months, I’ve had several unnecessary appointments for which I have to take a day off work and drive almost 2 hours. I was told the lab is responsible for the delay, but the office employees are no longer pleasant and seem happy to pretend there is no problem. At this point I can do nothing other than wait for them to call when they have my permanent set and feel like placing them in my mouth. I have already paid $46,000 so they are not interested in me anymore. – Patricia


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Do you have a comment or anything else to add? We’d love to hear from you. Enter your comment below. Or click here to ask Dr. Hall a question.

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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