Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

December 20, 2013

Taking antibiotics for an infected tooth

Filed under: Infected teeth — Tags: , , , — mesasmiles @ 12:53 pm

Dr. Hall,
My tooth became infected about 11 days ago. I saw the dentist Friday. I have been taking Keflex 500 mg three times a day, and since Friday, also Flagyl 250 mg three times a day. The swelling was almost gone, but 2 days ago, it swelled up again. My gums are red and swollen, and painful sometimes. Initially, the swelling was all of the way up to my eye and down to my chin. There has also been a yellow spot there, and I can taste the bacteria in my mouth. Now what?
– Susan from Indiana

Susan,
I”m hoping that you are either not understanding what your dentist is doing or you aren’t communicating it to me clearly enough, because if I’m getting an accurate picture of what is going on here, your dentist doesn’t understand tooth infections.

Antibiotics are not a proper treatment for a tooth infection – they are only an aid to treatment. The reason is that when a tooth becomes infected, the living tissue inside it dies. Therefore, there can be no circulation inside your tooth and there is no way for any antibiotics or other defenses to get into the tooth to eradicate the infection. The dead tissue has to be removed by one of two methods. The tooth can be opened up, the tooth cleaned out, and then sealed so bacteria can’t get back in. This is called a root canal treatment. The other option is to remove the entire tooth which, of course, also removes the dead, infected tissue.

There are cases where, if a tooth is infected and you are swollen, that you would start by taking antibiotics and then commence treatment after the infection is under control somewhat. If the tooth is an upper tooth and the plan is to extract it, the infection will interfere with the ability to get the tooth numb, so it would have to be controlled first, and then the tooth extracted. But in most cases, the best emergency treatment is to begin getting rid of the source of the infection. If the tooth is opened up, often that will provide drainage for the infection through the tooth. In some cases, the act of opening the tooth will provide immediate relief from pain, also. Your infection sounds pretty serious, and why nothing was done clinically is troubling, so I’m hoping I don’t have the full story. The yellow spot is probably a point of drainage of the infection, which would give you that taste in your mouth.

If the dentist prescribes antibiotics, he or she should explain clearly what the action plan is, and the treatment should be scheduled promptly. If you simply take the antibiotics without getting rid of the source of the infection, you will be cultivating antibiotic-resistant bacteria and complicating later treatment. So I’m hoping your dentist made this clear to you and scheduled your follow-up. If not, I would find a new dentist who is more competent and caring.

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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 29, 2012

Can Ali trust this dentist?

Hi and thank you for taking my question!

For about 2 weeks I have been having jaw and tooth pain that comes and goes and seemed to move. I went to the dentist who I have not seen before. He did X-ray and found a large cavity in a tooth that already had a filling. He said he feels there is only a 10% chance he can save the tooth because there won’t be enough actual tooth to work with and it is probably going to be extracted the same day after he cleans it out and finds how deep it is. Then he suggests an implant or bridge but leans toward a implant and bone grafting.

I strongly dislike any dental work and am petrified of all this. The tooth is 4 from the back on my right side which still has wisdom teeth. Does this sound correct to you or should I seek a second opinion? He said there was no infection he saw at this time but put me on amoxicillin for precaution since I had some pain. I have the worst fear of having some type of allergic reaction to the local anesthesia or something going totally wrong and I am having constant anxiety over this. Thanks for any advice!
– Ali from Maryland

Ali,
I can’t say for certain without seeing your tooth, but I am skeptical of what you are saying your dentist is telling you, for a couple of reasons.

First, if this is the first time you have had a toothache in this tooth, then the tooth has just recently become infected. I am having a hard time believing that this tooth is as far gone as your dentist is saying, if that is the situation. A hopeless tooth would have most likely begun hurting months ago.

Second, a tooth that has been so extensively destroyed that it isn’t savable, this would not require an x-ray to see it. It would have an obvious, big, gaping hole in it, and the filling would have fallen out long ago. Usually.

So yes, a second opinion would be smart.

A word of advice about getting a second opinion – make sure it is a BLIND second opinion. Don’t let the second dentist know what the first dentist said. You are entitled too be able to get a copy of the x-ray to take to the second dentist, but you need to conceal the diagnosis because that knowledge can possibly prejudice the second opinion.

And another point. You say you are having a lot of anxiety about facing this work and are worried you may be allergic to the anesthetic. In all my years of practice and the thousands of people I treated, I never had a genuine case of allergic reaction to any local anesthetic. I had people claim they were allergic, but upon administering the anesthetic, there was no allergic reaction. But I saw a lot of anxiety like yours. In fact, I myself am an anxious patient. You need to find a dentist who practices sedation dentistry who can give you something to take care of your anxiety. For me, if I just have nitrous oxide, that works and I’m fine. For others, they may need conscious sedation. When you have a certain level of anxiety, your body actually fights off the local anesthetic and it may be impossible to get you completely numb. And that just perpetuates this vicious cycle.

So, yes, get your second opinion, and I would recommend finding a dentist who could offer you sedation.

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.

June 3, 2011

Can a tooth infection spread to a salivary gland?

Filed under: Infected teeth,Root canals — Tags: , , — mesasmiles @ 6:23 pm

Dr. Hall,
Is it possible for root canal packing to “leak” and infect a salivary gland? My daughter has had two unilateral salivary gland infections within 6 months. Hospital CT showed nothing and dental x-rays showed nothing. We have no other ideas on what could cause these recurrent infections. (She’s had two root canals with crowns done on her lower jaw above the infected gland.) Thank you!
– Jeff from Chicago

Jeff,
I guess it would be possible for infection from a tooth to spread to a salivary gland, but the tooth would have to be infected first. And a tooth with a root canal treatment would not be infected if it has healed properly. And if it hasn’t healed properly, it would show on the x-ray.

So the answer, in your case, would be no. Given what you say that the dental x-ray shows nothing, then, no, there is no root canal failure, and no infection of the tooth, so nothing that could spread to the salivary gland.
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.

May 25, 2011

This dentist isn’t handling this infection correctly.

Hi Dr. Hall,
So I had my root canal done a few years ago (3 or so) and just started hurting hard a week and a half ago. I saw a dentist on Tuesday last week, who saw infection on an x-ray and did root canal re-treatment and sent me home with Penicillin 500mg and Vicodin. Pain wasn’t going away after these meds so I was using 400mg ibuprofen too to get a minor relief until Saturday when I did get an hour or two no pain but everything still highly sensitive. And pain keeps coming back hard! Sleepless nights all this time!

Sunday to Tuesday it kept hurting. I feel pressure in my jaw and my tooth is kinda hurting, numb pain, constant feeling that I am trying to ignore most of the day. Not to mention headaches during the whole week and also earache Saturday thru Monday!

I saw the same dentist again to consult, and he said that some people have a longer recovery and since pain is less – it is going to be better. And if still hurts after two weeks, we can do another dose of antibiotics. I am still up at night (it’s the 9th night since he did re-treatment!!!) and taking 400mg ibuprofen and waiting for pain to stop!

I want to know is it really that my course of recovery is so long or is something else? Thanks much!!!
– Kate from New York

Kate,
I think you should see a root canal specialist. This infection should be resolving by now if the penicillin were working. I have a couple of points for you.

When you have a root canal that fails, generally a root canal re-treatment will be successful somewhere between half the time and three quarters of the time. So there is a reasonable chance that this root canal re-treatment won’t be successful.

Also, penicillin would not generally be the first choice of antibiotic for a root canal infection, especially for a situation of root canal failure, so I question your dentist’s judgment on that. And I question his judgment further if he hasn’t offered to change the antibiotic when this has been going on for a week. Penicillin resistance of infections is very common. He should have switched you to clindamycin or another strong antibiotic when you had gone a few days and weren’t seeing any significant improvement.

Also, if I am understanding what you are saying, the pain did get better but then got worse again. That’s a particularly bad sign. Clearly this isn’t working.

Ask him for a referral to a root canal specialist (endodontist), and if you get any delays, find one on your own.
– Dr. Hall

Response from Kate:
Thanks so much! I didn’t have anyone to tell me that this is not normal or that meds he gave don’t work. I really knew that something is wrong and all he said was to wait for 14 days! horrible.

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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?

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 and complicate breathing.  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.

April 7, 2011

She wants two teeth out but the surgeon only wants to take out one

Filed under: Infected teeth,Wisdom teeth — Tags: , , — mesasmiles @ 9:05 pm

Dr. Hall,
I have been having all sorts of dental work done, two root canals on the top left one which was a retreat. I also have an inpacted wisdom tooth on the bottom left which has been inflammed and the root canals still does not feel quit normal. I was wondering if the inpacted bottom wisdom tooth could have something to do with that. Any advise would be greatly appreciated.

I have been having ear pain and neck pain which the oral surgon said is normal with impacted wisdom teeth. I have not had it pulled because i want to haveboth bottom teeth taking out at the same time and he wont do it for some reason.
– Christine from Maryland

Christine,
I’m not sure why you’re not following the advice of your oral surgeon and asking me. I can’t see the x-rays and can’t examine you, so I can just guess, but I’m guessing that your oral surgeon doesn’t want to take out the root canal tooth because there’s nothing wrong with it. I can’t think of another reason. I’m sure he would charge money to take it out, so he would gain financially from having it out. He sounds to me like a man of integrity and I would follow his advice.

You’re playing with fire to leave that infected wisdom tooth in your mouth. The ear pain and neck pain are warning signs – your body is trying to tell you to get this taken care of.  Those infections can flare up and can, on rare occasions, become life-threatening.

Dr. Hall

Links: Infected teeth.

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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.

December 7, 2010

Can an infected tooth cause a fever?

Filed under: Infected teeth — Tags: , — mesasmiles @ 3:06 pm

Dear Dr. Hall,
I was told by my children’s dentist that an infection in the mouth in general (gums, teeth, etc.) can’t cause a fever. Correct me if I’m wrong but I always thought it could cause a fever. Can you please let me know if it could or couldn’t cause a fever & why? They didn’t seem to want to take the time to explain.

Thank You so much for your time & your blog!
Sincerely, Roseann from New Hampshire

Dear Roseann,
There must be some miscommunication. Yes, an infection in the mouth can cause a fever. An infection anywhere in the body will bring in your body defenses, and have the potential to cause a fever.

Maybe what they were trying to say is that most dental infections don’t cause any significant fever. Most of the time it doesn’t. Often, an infection is confined just within a tooth, and often the body contains the infection, keeping it so well controlled that there is no noticeable infection. So fevers aren’t usually present when there is a tooth or gum infection. But that isn’t always the case.

Actually, sometimes a tooth infection can cause a run-down feeling, also. I saw that in several patients.  And a child can sometimes run a fever because of cutting teeth.
– Dr. Hall

Click here to ask Dr. Hall a question.

We thank our advertisers who help fund this site.

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.

November 10, 2010

I can’t afford to have my infected wisdom tooth removed.

Filed under: Infected teeth,Wisdom teeth — Tags: — mesasmiles @ 2:25 pm

Dr. Hall,
Have a rotting and decaying wisdom tooth, that is causing sever throbbing and pain. the Surrounding teeth are also starting to decay, some already have holes in them. Ive started to get a minor pressure just to the side and below of my eyebrow, right along my left cheek bone closer to my ear. Should I rush to the ER or just get antibiotics and have it handled by a dentist when its affordable?
– Eric from Alberta

Eric,
A very bad idea to try to get by or to try to just take some antibiotics.

I just read that Queen Elizabeth I of England died of a tooth abscess. I wouldn’t trifle with an infected wisdom tooth. It’s swelling around your eye now. What if this infection spreads to your brain? What will you do then?

Scrape together the money and get this wisdom tooth extracted. If you try to get by with antibiotics, there is no way to heal an abscessed tooth with antibiotics because they can’t reach the source of the infection. So what ends up happening is you tamp down the infection for a short period, and then it comes back, and this time the bacteria are resistant to the antibiotic. It can really make a mess of things. You’ll probably need some antibiotics to get the infection somewhat under control, and then get the tooth extracted while you are in the middle of the antibiotic treatment. That will usually cure you.

Dr. Hall

We thank our advertisers who help fund this site.

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 30, 2010

Should I take antibiotics for my tooth infection?

Filed under: Infected teeth — mesasmiles @ 2:04 pm

Dr. Hall,
i had a root canal about 4 years ago. then i lost my job and never had the cap or filling put in so i have been using store bought filling all this time well i let it go fwith out the filling for a few days and now i thinl i have some kind of infection. what anti biotics do i need to get rid of the infection. before i go to the dentist and get the tooth exstracted
Rich in Arizona

Rich,
Don’t take any antibiotics until you see the dentist. You may or may not need antibiotics for your tooth infection.

When a tooth is extracted, that usually removes the entire source of the infection and it will just go away.

Antibiotics are very helpful, but when used excessively they will breed bacteria that are resistant to the antibiotics and so they can complicate treatment if not used properly.
Dr. Hall

We thank our advertisers who help fund this site.

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.

June 5, 2009

I have an infected tooth and no money

Filed under: Infected teeth — mesasmiles @ 4:15 pm

I am missing some teeth in the back part of my mouth. I now have an infection so bad and my cheek is swollen so much that I look like I have a golf ball in my mouth. I do not have medical or dental  insurance and I do not have a job so I wanted to know what I can do to treat the infection. Thank you for any help you can give.
– Rachel from Michigan

Rachel,
You’re in kind of a tough spot. But before I tell you what to do, let me tell you what NOT to do. Don’t take antibiotics to try to get rid of the infection unless you also have the tooth treated. And here is why. The infection you have is inside some tooth. Antibiotics cannot get to the inside of a tooth. So what happens if you try to get rid of the infection with antibiotics alone is that you attack the infection, but there is no way you can get rid of it, so you are helping the bacteria that survive develop resistance to the antibiotic. Then, when it comes back, you could be facing a situation where NOTHING will get rid of the infection–potentially a very serious situation.

Tooth infections are nothing to fool around with. They can spread to your brain and cause a brain infection, or they can spread to your throat and swell and choke you. So you need to get this fixed. A root canal would be good, but if you can’t afford that, at least have the tooth extracted. Depending on where the tooth is and its condition, you may need to take antibiotics for a few days before it is extracted. Be sure you follow through, because if you just take the antibiotics and leave it untreated, the infection always comes back and is always more resistant to antibiotics to some degree or another.

Many communities have clinics or programs where people who don’t have any money can get basic dental care in emergencies. Call your local dental society and ask about such a program or clinic. Or just start calling dentists. When I was in practice, I would always try to help someone in an emergency situation like yours, and I would take whatever payment they could afford. But they would need to call and let me know their situation.

And don’t delay. The infection can get much worse. It can also break through somewhere and drain and then start to feel better, but you can’t count on that.
– Dr. Hall

We thank our advertisers who help fund this site.

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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