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Using Antibiotics for a Tooth Infection

Almost two weeks ago I went to the dentist for an infected tooth. It was pretty bad and even my cheek was swelling. He gave me some antibiotics, which I took in full. The swelling was almost gone. A few days later it started back up again. Do I go back to the dentist or do I just need a refill on my antibiotics?

Peter


Dear Peter,

Man holding his jaw in need of an emergency dentist

I think there was a miscommunication with your dentist. The antibiotic should have been just to get your tooth infection under control and tide you over until the infection can be properly dealt with. It is not meant to, nor can it, heal your infected tooth. The only way to cure a tooth infection is for a dentist to physically remove the infected tooth pulp. There are two ways to properly do this. The first is by extracting the tooth completely. This should be a last resort because natural tooth structure is always best; plus tooth replacements, especially the good ones, are expensive. The second option is a root canal treatment.

Hopefully, it was just a matter of you not hearing your dentist say that you would need a follow up appointment to do the real treatment, though the front desk should have mentioned it when you were checking out. If your dentist did not plan on any follow up treatment, then you need a new dentist because this one does not understand tooth infections.

It is particularly concerning that this started to get better and has now blown up again. I would consider this a dental emergency. Call your dentist as soon as the office is open and tell them what is going on. If they don’t get you in that day, then call around to some other dentists and see who will given the situation.

This blog is brought to you by Moline Dentist Dr. Thomas Goebel.

Is a Cracked Crown a Dental Emergency?

I’ve had porcelain crowns for over ten years. They’ve served me well. One of them has always had a minor defect, which I am told is quite common. You could never see it with a normal glance, but there has been a change in the last couple of days. Now I can see it and feel it. There is a horizontal line on the crown. Does this mean that I am in danger of losing the crown? Would it be considered a dental emergency?

Katherine

Dear Katherine,

A porcelain crown being placed on a tooth

While I would not consider it a dental emergency, I would have it attended to soon. Your dentist was correct that crowns can have minor defects. They’re generally called craze lines. Usually, they are not an issue. Yours has obviously changed, though, if you can see and feel it. I do think it will eventually break.

You have a couple of options here. First, is to just replace the one defective crown. Your other is to replace all the crowns at the same time. Which you do will depend on the condition of the crowns and your budget. The benefit to doing them all at once is that you don’t have to replace them one at a time as they age. However, if they’re all still in good condition, you might not want to do that.

Beware of a dentist telling you that you have to change all of them at the same time in order to get them to match. That is not necessary and a dentist should be able to match a single crown. It may take a few try ins, but it can be done.

For now, just call your dentist and schedule an appointment to have the remainder of the crowns looked at. Then you can decide wether or not to replace just the one that had developed a problem or all of them at once. While I did say it is not an emergency, I wouldn’t wait too long. This one is going to fail.

This blog is brought to you by Moline Dentist Dr. Thomas Goebel.

Delayed Treatment for an Infected Wisdom Tooth

I had some minor pain in a back tooth and went to see my dentist. He told me a wisdom tooth is infected. He gave me some antibiotics and referred me to a specialist. The antibiotics were very helpful. When the specialist saw me, he recommended I remove all of my wisdom teeth but he cannot schedule me for about a month. Since then, the antibiotics have run out and I can feel the pain coming back. Will he be able to treat me if the infection is back?

MaryAnne

Dear MaryAnne,

Man grabbing his jaw in pain

While you cannot rely on antibiotics alone to solve a tooth infection, in your case, it will be okay to call the specialist and tell him you have run out and need enough to get you through until your procedure. Let him know that you can already tell the infection is returning. He should have no problem writing you a refill on your prescription.

Do not wait to get it refilled. These infections are serious. Generally, they require urgent dental care, but it is okay to keep the infection at bay in the short term with medication. As I mentioned before, it will not heal the infection. The only way to do that is to physically remove the infected pulp of the tooth. Without proper treatment, this can turn life threatening. Our jaws are quite close to our brains and throats. You don’t want the infection reaching either of those places.

To remove the infected pulp there are two treatments: a root canal treatment and a tooth exraction. Generally, a root canal treatment is preferred in order to save a tooth. It is unnecessary on a wisdom tooth, however. This is because you can remove a wisdom tooth without needing to replace it.

This blog is brought to you by Moline Dentist Dr. Thomas Goebel.

Misdiagnosis by an Emergency Dentist Caused a Lot of Pain

I had a tooth that was giving me pain and sensitivity to cold. I am new to the area so I do not have a regular dentist yet. I went to a dentist who advertised as a dental emergency specialist. I went in and he said my wisdom teeth are impacted. I told him that tooth 19 seemed to be the problem, but he said it is definitely the wisdom tooth and that one of them either needs to be extracted or filled. I opted for the filling. This made my pain even worse. I went back and he adjusted the tooth and wrote me a prescription pain medication. All that did was make me loopy. Once the prescription wore off I was in even worse shape. I called back and he said to have the tooth extracted. I told him the pain didn’t feel close to the wisdom tooth at all but he insisted that was the problem. I had the tooth extracted and was again prescribed painkillers along with antibiotics this time. I was okay for a bit while the medicines lasted. Once they ran out, though, I was in complete misery. I finally went to the ER and they did an x-ray and told me that I had an abscessed tooth. I got fed up with this dentist and went to see an oral surgeon out of pocket. He told me it was tooth 19 (shocker) and that it is now too late to save it, so I had that extracted too. I’m so frustrated because I had to do several unnecessary appointments, including the ER, and ended up losing two teeth. Do I have any recourse for this or do I just have to suck it up?

Trent

Dear Trent,

What a nightmare! You certainly have some recourse here. In short, what this dentist did is malpractice. First, I’m going to tell you what to require of him, then I will tell you what mistakes he made.

The first thing I would do is tell this dentist he needs to cover the expenses not only for your extra visits to the oral surgeon and ER, but also for the cost of an implant and a crown to replace your missing first molar, as well as any bone grafting that may be necessary with a dentist of your choosing. If he refuses, tell him you will contact a lawyer and add pain and suffering to the amount. I feel fairly certain his insurance company will tell him to settle quickly.

This “Emergency Dentist’s” Mistakes

Let’s start with the fact that there is no emergency dentist specialty. Any general dentist can schedule emergency appointments and treat patients. He misled you with that. Second, at your initial appointment with cold bringing pain to the tooth, he should have advised you that you would likely need a root canal treatment. I have no idea why he was bringing up your wisdom teeth with these types of symptoms. Then, with your second appointment when you are still having problems, he adjusts your bite? Really? The prescription for antibiotics tells me he either suspected an infection or was just throwing around treatment options willy-nilly. Plus, antibiotics never completely cure a tooth infection. The job of antibiotics is to hold the infection at bay while you are awaiting an appointment for your treatment. By the final appointment, there should have been no doubt. I don’t know how he passed his courses in dental school.

You may be wondering why I’m having you include the tooth replacement in there with what your dentist should cover. It is because if he would have treated this in a timely manner, there is a good possibility you could have saved the tooth. Now that it is out, it must be replaced. Otherwise, the remaining teeth will drift or tip into the space. This will throw off your bite and can lead to painful TMJ Disorder. A dental implant is the best replacement available.

This blog is brought to you by Moline Dentist Dr. Thomas Goebel.

Will an Emergency Dentist Remove Wisdom Teeth?

My 22-year-old son is out of town. We’d always meant to get his wisdom teeth removed but something always seemed to get in the way and they weren’t really bothering him. Of course, now that he is in a different state visiting relatives everything blows up. One of his wisdom teeth is giving him a lot of pain. It is inflamed as well as the gums behind it. He’s been taking ibuprofen but it only helps temporarily. If I sent him to an emergency dentist would they remove his wisdom teeth?

Carolyn

Dear Carolyn,

Man grabbing his jaw in pain

There is no worse feeling than when we can’t be near our children when they need us. I’m sorry this is happening to your son while he is out of town. As to whether an emergency dentist will remove his teeth, it depends. They will certainly see him because he is in pain. They can get him out of pain. Then,  if there is an infection they will likely schedule a follow-up to deal with that.

You didn’t mention if the tooth is erupted, partially erupted, or completely impacted. If it has not erupted, there is a possibility this is pericoronitis, which is just a fancy medical term for inflammation around the wisdom tooth. Sometimes when a tooth is partially erupted there is a flap of gums that traps food and bacteria and can inflame the gums and even lead to an infection. This flap can be removed, which lessens the likelihood of issues such as your son is facing.

Some dentists are comfortable and skilled at removing impacted wisdom teeth. Others will send him to an oral surgeon. Either way, when you are in pain from a tooth, it is always a good idea to get it checked out by a dentist to see how urgent the situation is and be advised on how to solve the problem.

This blog is brought to you by Moline Dentist Dr. Goebel.

Antibiotics for Tooth Infections

I have a toothache that has me so distracted I am having a hard time getting any work done. I am in the middle of a huge merger and DO NOT have time to see a dentist. I do have a doctor that will write me a prescription for just about anything. I just need to tell him what type of meds I need. Can you help me with that?

B.W.

Dear B.W.,

Man grabbing his jaw in pain

First, I’m just going to say what your doctor is doing is not only against medical ethics but super dangerous. While I am sure that it is handy to have a doctor willing to do that, I do worry. That being said, an antibiotic will not solve your problem. Instead, it will just be a temporary reprieve. Once the antibiotics run out, your tooth infection will come back with a vengeance.

The only way that you can stop a tooth infection is by having a dentist physically go in and remove the infected pulp. This is because a tooth infection kills the tooth and there is no longer blood flow to the tooth, which means the antibiotic will have no effect on the root of the infection.

You have two choices in truly dealing with a tooth infection. The first is to have a root canal treatment where the dentist goes in and removes the infected pulp. From there you are generally given a dental crown. The good news is that this saves your tooth. It is always better to have as much natural tooth structure as possible.

The second option is if the tooth cannot be saved and the decay and infection have gotten too far. When that happens, the tooth has to be extracted and you will need to replace the tooth. If that happens, I recommend you get a dental implant to replace it. That is the closest to having a healthy natural tooth in your mouth again.

I know you are short on time, but if you let this spread, it can turn from a dental emergency to a medical one. Think about how close your jaw is to your brain and heart. People still die from tooth infections because they allow the infection to spread. I know you are busy, but I really do not want you to put this off. You could call the dentist and ask him to prescribe you an antibiotic, but it will only buy you a short period of time.

This blog is brought to you by Moline Dentist Dr. Thomas Goebel.