Taking antibiotics for an infected tooth

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.