Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

September 9, 2017

Swelling after a tooth extraction


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Dr. Hall
The tooth right beside my lower left wisdom tooth was extracted last Wednesday. There was swelling already on my jaw before the extraction. After extraction, the dentist prescribed amoxicillin for the infection. After 3 days, the swelling has worsened and pain killers are no longer helpful. The swelling below my jaw hardened and is larger than half of a golf ball.
– Jem from the Philippines

Jem,
It sounds like your infection is getting worse, even with the antibiotics. You need to report this to your dentist and he or she should switch antibiotics. I don’t think your dentist has done anything wrong here—amoxicillin is a good first choice for an infection from a tooth. But there are many infections that won’t respond to amoxicillin, sometimes because the bacterial strain has developed amoxicillin resistance.

These infections in the jaw can become quite serious, so I wouldn’t mess around with this but work with your dentist to find an antibiotic that will get this infection under control.
– 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 29, 2016

Just a filling, but it’s getting really complicated now


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Dr. Hall
I am 34, never had a cavity, and had been with the same dentist for 10 years. Our insurance changed so I had to change dentists about 2.5 years ago.

At the first appointment with the new dentist she said I had a cavity needing filled. I was shocked, had had no symptoms, but due to childcare complications had her fill it right then. It hurt for weeks, she adjusted and it continued to hurt.

I waited out the year and switched insurance back to my old dentist, He said I had had that shadow on my x-rays for 10 years with no change and it was likely I didn’t need the filling. He adjusted it and within days the pain stopped! However, the filling kept tearing floss and pocketing food under my gums. He recommended I have it fixed so the pocketing food wouldn’t cause an issue.

He did the repair in January. As soon as the numbness wore off, I had pain where the numbing medication had been injected and my tooth was very sore. This remained and then progressed to heat and cold sensitivity over the next few hours. I called him a week later and he had me come in. He gave me options and we decided to try steroids orally for any inflammation. I have had bad reactions to steroids in the past, but thought I would be okay to try.

It really isn’t any better, and now I am scared to go back. He said worst case scenario is removing the tooth. I am devastated but also in almost continual pain for 6 months now, especially to anything not body temperature. My appointment is tomorrow to try to brave him fixing it again. I don’t know what to do or even if I can trust him anymore. HELP ME PLEASE.

– Erin from Texas

Erin,
Boy, there’s a lot to say about your saga with this tooth.

I’d love to be able to see your tooth and see exactly what happened here. Not seeing that, I have to make some assumptions. I will tell you that it doesn’t sound to me like either of these dentists is doing good for you, but there are more problems and more serious problems with your current dentist than with the one who originally did the filling.
Let me address several of the points you bring up:

1. One dentist seeing a cavity or feeling like a tooth needs to be filled and another dentist disagreeing with that–we see that kind of professional disagreement often and there is no ill intent with either dentist. My inclination is to be more partial to the dentist who called it a cavity. As an additional point, your dentist’s explanation seems suspect to me. A shadow on your x-rays for 10 years and he never even told you about it? That sounds to me like an excuse. A dentist doing one filling–because of the overhead involved there is little to no profit in that and it is more an annoyance to the dentist, so I don’t think there was any dishonesty in the dentist who filled it. It’s more likely there was sloppiness in the dentist who let it go for ten years.

2. The tooth becoming sensitive to hot and cold after repairing the filling–that’s bad. I would assume (because the problem was the filling catching floss and catching food and because of the post-operative sensitivity) that the “repair” involved replacing the filling. For it to become sensitive to hot and cold after a simple filling replacement something had to go wrong that he didn’t tell you about. Especially since the sensitivity wasn’t immediate. Temperature sensitivity after a new filling isn’t uncommon and doesn’t mean that anything went wrong. But this wasn’t a new filling. To simply take a filling out and replace it shouldn’t be that irritating to a tooth, and based on the problems you were having, he wouldn’t have even needed to replace the entire filling.

3. Steroids? Really? Wrong treatment! The hot and cold sensitivity in your tooth indicates a possible low-grade infection in the tooth. Steroids would make that worse. Steroids block your body’s response to inflammation, but also block its response to infection. Not good.

4. Removing the tooth? Bad again. I would be scared, too, if my dentist started talking to me about extraction at this point. Things are cascading out of control quickly here. There is quite a list of steps, every one of which has to go wrong, before he should be talking about extraction.

Bottom line–I think you should find a new dentist. Between the two you’ve seen, I think you would be better off in the hands of the dentist who did the filling. Though she didn’t do great for you, you just had the one mishap, not this series of problems. But the better thing would be to get a different dentist entirely.

I don’t know what the deal is with your insurance, but I wouldn’t let your insurance hold you hostage here and prevent you from getting adequate care. Losing this tooth over this simple cavity that was apparently just a slight shadow on your x-ray, that’s too much.

I’m wondering how you ended up with two dentists, neither of which has done very well for you. Maybe the problem is that you have really cheap insurance and no really good dentists want to participate in that plan. That occurs to me. If that is the case then maybe, to get this done right, you need to go outside your insurance company’s list of “preferred providers.” From the point of view of the patient, if your insurance company is using that term, “preferred provider,” I would translate that as “cheap dentist.” That’s what insurance companies mean by preferred.

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.

August 29, 2013

There are a lot of things that can look like decay on the x-ray under a filling. Be careful here.

I have had a filling in the back of my lateral incisor (#7) since childhood that has been replaced several times over the past 10 years due to leaky margins, etc. The last time it was filled was in January of this year when my then dentist placed a pulp cap to avoid a root canal. There was minimal bleeding and he used a caries detector with dye to remove any caries by hand to avoid drilling too close to the pulp and then filled it.

I did not have any discomfort to hot or cold or any pain afterward. I still do not have any pain in this tooth on tapping or when eating and it feels fine but it was discovered at my new dentist that there is what looks like some decay under the filling on x-rays during my last exam in June with my current dentist and she says I have to have a root canal and a crown placed.

My question would be; if there is no sensitivity/discomfort in this tooth, would it be possible to remove the filling, clean out the decay and then place another filling or do I have to accept the root canal/crown diagnosis? I have already researched and contacted Dr. Hurley in Bedminster for the crown after finding her on your provider list for New Jersey, but would of course like to postpone the “bigger” treatment if possible. Thank you so much in advance for your attention and advice and I love your very informative website.
– Kathryn from New Jersey

Kathryn,
I’ll go a step further even beyond your suggestion of waiting to have this root canal done. And I’ll be direct. No, I would not have this new dentist do a root canal and crown on this tooth. It sounds to me like they are a little too eager to do something quite aggressive here. Have another dentist look at this.

It’s interesting how you put the diagnosis – “It was discovered that there is what looks like some decay under the filling on x-rays during my last exam.” There are a lot of things that can “look like decay” on an x-ray. An empty space, a radiolucent glass ionomer base, or any of a number of radiolucent filling materials can “look like decay.” If the filling looks intact and isn’t leaking, after a close visual exam, I would leave it alone. If the tooth is infected, it would show up on an x-ray of the ROOT of the tooth.

A tooth that becomes infected will almost always hurt at some point, though there are exceptions. It will start by being sensitive to cold and ordinarily that will blossom into a full-fledged spontaneous toothache. The toothache, if untreated, will go away, and the tooth will die, after which it will usually become sensitive to biting on it. But that may not happen. It is uncommon for a tooth to die quietly, with no symptoms, but it does happen. The way to diagnose that is not by seeing something that “looks like decay under the filling,” but by seeing signs of infection around the end of the root of the tooth on the x-ray.

Finally, this idea of doing a crown on a lateral incisor after a root canal – I would not let them do that, even if it DOES need a root canal. A lateral incisor is a very thin and delicate tooth. To prepare a lateral incisor for a crown, most of the tooth structure has to be removed, leaving it very weak and vulnerable to breaking off. The average lateral incisor is going to have a diameter at the neck of the tooth of about 5 millimeters. To do a crown, at least a millimeter has to be ground off all the way around, leaving it with a diameter now of about 3 millimeters – which represents a decrease in resistance to lateral fracture of more than 60%. So, even though a back tooth with a root canal treatment needs a crown to keep it from fracturing, a front tooth is a completely different situation.

Now, if you don’t do a crown on a front tooth after a root canal, it will be susceptible to discoloration. But that susceptibility can be decreased and postponed by several years by careful handling of the tooth after the root canal. If all the root canal filling material is cleaned out of the part of the tooth that shows – carefully cleaned out inside down to the root of the tooth. Then, a translucent post can be placed in the root canal space to reinforce the strength of the tooth. If that is done, it could be five or ten years before the tooth shows any signs of discoloration, and you could do a crown then.

And furthermore, if you are going to have a single porcelain crown done on a front tooth, you definitely want a dentist with good artistic ability, such as Dr. Hurley, to do it.

– Dr. Hall
follow up: The next day, Kathryn sends an x-ray of the tooth, and I offer my opinion. It appears that this tooth does not need a root canal treatment. There is a dark area next to the tooth, but it doesn’t extend near the pulp, and there are definite signs that the root is healthy.

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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 4, 2013

If the antibiotics don’t work, my dentist says he wants to pull the tooth.

Dr. Hall,
I have been trying to find information about calcification/mineralization of a tooth. (I was told by my dentist that, on x-ray, he does not see any remaining canal in one of my molars. It is one that already has a crown. After a round with antibiotics, if I still have discomfort in the tooth he says it may need to be pulled. Without a tooth canal present, he said he cannot do a root canal. I would rather keep all my teeth. Is there an on-line site with information about this subject so that I can read and be educated?) Thank you.
– Mikala from Wisconsin

Mikala,
I’m not comfortable with what you say your dentist is telling you.

First of all, this idea that if you’re not comfortable after the round of antibiotics you need to have this tooth pulled. Antibiotics alone in treating a toothache doesn’t solve anything. Sometimes antibiotics are used as a diagnostic tool – if the antibiotics solves the tooth pain, then we know your pain is caused by a tooth infection. That would be an indication that the tooth needs a root canal treatment or an extraction. But once you stop taking the antibiotics, if the pain has indeed gone away, it will return sooner or later, because you haven’t addressed the source of the infection.

But if the antibiotics don’t solve your tooth pain, then that would be an indication that the pain is NOT caused by a tooth infection, and the dentist should be looking for some other explanation for the pain. It could be from nerve irritation or who knows what. In that situation, he doesn’t have a diagnosis, so proceeding with treatment would NOT be the next step. It’s like he has this backwards.

And I have a problem with the notion that because the dentist can’t see a canal in the tooth, it doesn’t have one. Especially in an upper molar tooth where there is a lot of bone around it, it can make the root canal hard to see.

If you want to try to save this, I would get a second opinion. Look up endodontists in your area. Those are root canal specialists. Or just tell your dentist that you want a referral to an endodontist. If it were me, I would look up an endodontist on my own for fear that the dentist would send me to a buddy who would simply parrot what the dentist has said.

And to explain calcification, here’s what happens. As we get older, the canals in our teeth tend to shrink. This is a natural process that can be aggravated if there is irritation in the tooth, the tooth builds up more dentin on the inside of the pulp chamber and the canals of the tooth, making them narrower and possibly harder to find. It can make root canal treatment more difficult and sometimes, in extreme cases, can block the canal. But root canal specialists should have special tools to navigate through these calcified canals.

Good luck. If you want to save this tooth, go for it.

– 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.

March 9, 2012

Several ways for a dentist to screw up a root canal treatment

My husband fell on 11/29/11, while coaching my son’s basketball team. He suffered concussion, chin laceration with sutures and his front two teeth fractured. He was treated same day in dentist and ER. Dentist did not want to do any treatment for 2 weeks. In 2 weeks, tooth #8 (right front tooth) started to discolor without pain-she felt only dried blood and no treatment at that time.He was fitted for temp crowns and placed within 3 weeks.

Two months later, he had severe pain and an emergency root canal began with amoxicillin for 5 days. There was slight relief of pain for 24 hrs and then severe pain up to his nose with a cold sensation. Root canal finished one week later without pain relief.

Two weeks after that, the dentist root canaled tooth #9 (left front tooth) because she didn’t understand why there was still pain. Novocaine in place, still no relief and pain never by tooth #9?  Probable unneeded root canal.

I decided to get oral surgeon second opinion, who suggested Augmentin TID for 7 days with medrol dosepak. 5 days into meds, cold sensation resolved and tooth #9 RC completed by general dentist who then removed filling from tooth#8 and my husband felt pain free for 1st time in 3 months! However, it returned at 50% within 24 hours, but cold sensation gone. I am a NP and I spoke with a pharmacist friend who said you will often see rebound pain with medrol dosepak quick tapers? He recommended a 2 week taper of prednisone with abt in place now that canal is open and can drain possibly? What would be recommended next step? My neighbor thought maybe tooth fractured at gum line? The dentist says she sees black spot on x-ray, but thinks it is nothing? My husband has been tortured for months without any pain control offered and is a teacher and is suffering. Do you think this tooth should have been root canalled immediately when it turned dark or 2 months later? Would that have saved the tooth and torture he is living? Do you think tooth could be saved? Should he need extraction, would you recommend implant next to permanent crown or bridge?
– Kathleen in New Jersey

Kathleen,

When tooth #8 (your husband’s right central incisor) started to discolor two weeks after the traumatic injury to the tooth, it clearly needed a root canal treatment. The nice thing about doing the root canal treatment at that time is that there is less chance of post-operative complications since infection would not have settled in yet – it would be just a matter of cleaning out the dead tissue, maybe leaving the tooth open for a couple of days as a precaution against flare-up, and then sealing it. I cannot for the life of me understand what your dentist thought was going on inside this tooth. Dried blood?? If there is dried blood in the tooth, isn’t it pretty clear that the tissue inside the tooth is dead?

And I don’t understand why there was a prescription for amoxicillin and for only 5 days. So if I am understanding this treatment sequence correctly, the tooth was opened and the amoxicillin started. I can’t tell from what you are saying whether the tooth was left open during this time or not. But then the amoxicillin ran out, and AFTER that, the root canal was completed – in other words sealed. Doing it this way, there would be a fairly substantial risk of flare-up. Once a root canal tooth is sealed, there is no longer any pathway for drainage for any infection that may be there. And a five-day course of amoxicillin would not be enough to completely wipe out the infection. In fact, amoxicillin would not be a first-choice antibiotic anyway for this type of tooth infection.

My recommended next step? See an endodontist (root canal specialist). An oral surgeon would not be a good choice of specialist to see here. And a pharmacist doesn’t have the correct training either. There is something to be said about getting a professional involved who has the specific training for this type of problem. I can’t tell by just e-mails what is happening here. But I can tell you I disagree with some of the treatment choices made by your general dentist, and the flare-up is not surprising to me at all. Doing a root canal on the other front tooth appears to me to have been a stab in the dark, and it also doesn’t surprise me that it didn’t help. And the prednisone would also be the wrong treatment if the infection isn’t resolved. And what is this about your dentist seeing a “black spot” on the x-ray but thinks it is nothing? That sounds almost grade school. Is there a continuous, intact lamina dura around the tooth? Is there a widened periodontal ligament space? You need an endodontist to look at this x-ray and read it, not someone who will try to take wild guesses at what is going on.

There should be no need to extract this tooth. None of what has happened is any indication that the root canal was not sealed properly. And even if there was that type of error here, there are several options for correcting that, short of extraction. You need the correct choice of antibiotic therapy – probably clindamycin at this point – which in most circumstances should get this to settle down in a couple of days. However, if there is a root fracture, that is a different story.

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.

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.

March 15, 2011

Will my decayed wisdom teeth fall out on their own?

Filed under: Wisdom teeth — Tags: , — mesasmiles @ 7:27 pm

Dear Dr. Hall,
I read with interest your comments regarding wisdom tooth extraction. I have had my wisdom teeth for my whole life (I am 34 now), as they did not cause me any problems growing in. Unfortunately, I did not care for them properly and, although the rest of my teeth are in pretty good shape, my wisdom teeth have all started to decay, to the point that they are basically about half gone. For some reason, the process of this decay has not caused me very much pain or discomfort.

My question relates to the fact that I would prefer to just let them decay on their own until they are gone, rather than risk the complications inherent to wisdom tooth removal at my age. I assume the surgery would be all the more complicated by the fact that there are bits and pieces of the teeth for the surgeon to pull on rather than the full teeth. What are the potential consequences of simply allowing them to decay on their own? Is it possible for this to happen without experiencing infection or complications? Would it be less dangerous than the surgery? Keep in mind that, thus far, one of them seems to be almost completely gone (although there are a few pieces still there), and the other three are half gone. So far, no sign of infection or pain. Thank you so much for your time and insight. I really enjoy perusing your web site.
– Jeremiah from California

Jeremiah,
You raise some interesting questions. Yes, decayed teeth do eventually crumble and go away. There is some risk in letting that happen, though. Let me help you understand that risk, and then you can figure out what you want to do.

If a tooth appears to be intact but yet has deep decay, that decay will reach the living pulp tissue of the tooth, cause it to become infected, and that infection will spread through the end of the tooth, through the root, and deep into the jawbone. When these infections are encased either in bone or in a relatively intact tooth, that causes pressure to build up and pain. If the infection breaks through the bone and starts to drain, that relieves the pressure and thus relieves the pain. That will also tend to slow the advance of the infection in the bone, because the infection has an outlet. If the infection doesn’t find an outlet, though, it can get very nasty. For example, infections of lower teeth can cause swelling on the inside of the mouth. This swelling can move down the throat and threaten to close off your windpipe. Also, upper molars are not that far from the brain and there are blood vessels present that can carry the infection to the brain. So this isn’t something to mess with.

If a tooth breaks off, it does two things that help make the infection less serious. First, it creates a wide open situation where the infected, inner portion of the tooth becomes exposed, which gives the infection an outlet and helps prevent its spread down into the bone. Second, every tooth has slight eruption forces that are always operating. These forces tend to push the tooth further out into the mouth until it meets an obstacle, which is usually the opposing tooth in the opposite jaw. When the tooth breaks off, it no longer has contact with its opposing tooth, and those forces will tend to push the tooth out of the jaw a little. If it keeps decaying, then little pieces will continue to break off. Eventually, the tooth could be completely pushed out.

But be careful about judging just by what you see. Sometimes you can just see a small portion of the root, and it looks like nothing important is happening, but an x-ray will show that this root is quite long and goes down deep into the bone.

Another problem is that if you have one badly decayed tooth, you can have decay bacteria spreading over all your teeth and accelerating decay everywhere in your mouth.

As far as comparing the risk of letting your wisdom teeth fall out on their own versus extracting the wisdom teeth, I believe having them extracted would be less risk, no matter what the condition of the teeth. If they have started to push themselves out, making it so there is less risk for the infection getting deep into the bone, that also makes for fewer complications if you have them removed. But then extracting them is a whole lot more expensive than letting them fall out.

Dr. Hall

Other links: Read more about tooth infection, and antibiotics for 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 10, 2010

Healing after root canal apicoectomy.

Filed under: Root canals — Tags: , , — mesasmiles @ 9:52 am

6 weeks ago I had an “apico” done to remove infection from tooth that had both a crown and root canal. Check up this morning revealed bone was starting to rebuild, xray looked clear of infection but small pus sac on gum looked like it may have some residual infection. They gave antibiotic to take for week. Is there anything that I can do to further get rid of this residual infection?
– Ruth from Illinois

Ruth,
With any root canal treatment, including an apicoectomy like you have had, or any other apical surgery, if the dead tissue from the tooth is removed and if there is a good seal at the end of the root of the tooth, the tooth will heal and the infectiion will eventually go away. Antibiotics can speed the healing, but they key to eventual success of the case has nothing to do with antibiotics – it’s all about removing the source of the infection.

From what you’re telling me, it sounds like the bone around the tooth is healing. That would tend to indicate that the source of the infection has indeed been removed and the tooth is adequately sealed. If that is the case, the residual infection will go away eventually. The antibiotics you are taking will speed that along. There’s nothing else to do, really, but wait.

Dr. Hall

Links: Read more about dental implants.

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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 6, 2010

Old root canal tooth re-infected.

Filed under: Root canals — Tags: , , — mesasmiles @ 4:47 pm

i had a root cannal years ago, they put it a cap or whatever into the root. in january 2010 that crown or cap broke off inside the root leaving a hole/shell type thing. now i am having major pain inside the hole and there is some bleeding when i clean out the hole so i can just place the tooth back in place, held in by my splint which i wear all the time except when i eat. is this now an infection? i feel throbbing inside and outside on the gum, it also feels like it is starting to go up into my right cheek to my eye. what do i need to do? should i get into my dentist to get antibiotics right away? thank you for your time
– Brenda from Alberta

Brenda,
I’m having trouble visualizing what you are explaining here. But from your description of this pain and where it is coming from, it sounds like a tooth infection and you need to see your dentist as soon as you can.

When a root canal filling is exposed to saliva over a period of weeks, it can wash out the cement that holds it in place and open up the tooth to become infected again. That could be what has happened here. When you have the root canal treatment first done, the dentist usually puts a temporary filling material in the tooth to protect it. That’s important, that this temporary filling stays in place. Or, if you have a permanent filling or a crown put on over the root canal treatment and that breaks or comes off so that the root canal filling material is exposed to saliva, you need to get back to your dentist within a few days to get that fixed, or your tooth will get re-infected.

And pain and swelling in the upper jaw can easily travel to your eye or even your brain. That’s not something you want to mess with. And remember that antibiotics can be used to help bring the infection under control, but when you’re talking about an infected tooth, antibiotics will never cure the situation. The tooth needs to be fixed or the infection will come back and when it comes back it will possibly be resistant to the antibiotics. Get these infected teeth taken care of properly.

– 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.

September 3, 2010

Should I have my wisdom teeth out at age 42?

Filed under: Wisdom teeth — Tags: , , , — mesasmiles @ 11:56 am

Wisdom tooth removal.

I am 42 yrs old and have been told I need all 4 removed. My dentist said 1, the oral surgeon wants to remove all 4. Only one has come through the gum and has given me trouble. The other 3 don’t bother me at all. In your opinion, is it necessary to remove all 4? I am worried about complications and really only want the one removed in hopes to reduce risks of complication and recovery time.
– Mary from Texas

Mary,
I don’t know what your x-rays show as far as the potential for these wisdom teeth bothering you, but I can give you some general guidelines that hopefully will help.

If your wisdom teeth aren’t erupted at age 42, they should have been taken out when you were around 20. The chances for causing complications increase with increasing age. When you’re 20, they are fairly easy to remove. They are considerably harder now. They will be harder yet in 20 more years. I don’t know how long you’ve been going to your current dentist, but if this tooth has been poking through the gum, he should have recommended having it out as soon as he saw it.

Another principle is that it is usually best to take them all out at the same time. If there is any significant potential for them causing you trouble and they aren’t in a particularly risky position, I would advise having them all out. The amount of discomfort is only a little more and the healing time is the same. I can tell you from going through this experience with a number of patients that it is an awful pain to deal with four surgeries, one after the time that each tooth starts to bother you, instead of just one. And it’s much better to choose the time when you have them out rather than have the time thrust upon you. What if they start to bother you when you are having some medical crisis? It could be a really nasty time for you.

Another useful piece of information is that complications surrounding the extraction of upper wisdom teeth are minor and transitory. They are much easier to take out.

Hopefully you have a feeling of trust in your surgeon that you will get straight, honest answers. I would ask this question about the lower wisdom tooth that isn’t the current problem tooth. Is it totally impacted in the bone – totally underneath the surface of the bone – or is it poking through the bone and could be exposed by merely raising a soft tissue flap? If it is totally impacted in the bone, the chances for it causing you trouble later on are much less. If it is poking through the bone, there is a greater chance of infection getting in around the tooth. Often it’s just a matter of time before they become infected. In my practice, I always advised that patients have all their impacted wisdom teeth removed, except if they had reached the age of 40 without them causing any trouble and they were totally impacted in the bone. I reasoned that if they had gotten this far without them bothering the patient, and there was no easy path for infection to get to the teeth, that the risks of surgery began to outweigh the risks of leaving the teeth alone.

I hope this helps.

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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