Will She Lose This Tooth?
A few years ago, I had an accident that broke off half my tooth and led to me needing a root canal treatment and dental crown of my lateral incisor (the one next to my front tooth). It was fine until recently, where I’ve had some pain on and off. I went to see my dentist who said he didn’t see anything wrong. I insisted there was, so he sent me to an endodontist. The endodontist said the pain is probably coming from the tooth next to it, but he doesn’t see anything on the x-ray. His theory is that I’ve probably been putting pressure on it while I sleep. I feel like no one is taking me seriously and am worried I’m going to lose the tooth. If I did, would a dental implant work for someone my age? I’m 32. If I do lose it, should the dentist pay for the replacement?
Angie
Dear Angie,
I’m glad you wrote. I don’t know why your dentist and endodontist found this challenging. You had serious tooth trauma a few years ago. It is highly unlikely that the adjacent teeth were not impacted by that. If you had a root canal treatment, then the crowned tooth would not be having the pain. On a back tooth there can be tricky canals, etc., but a lateral incisor would not be complicated. Because of that, the endodontist’s idea about it being referred pain from another tooth makes sense. However, I don’t agree with the pressure thing.
It is more likely that the tooth was damaged at the time of the original accident and is just now showing the signs. This is actually quite common, so that is what puzzles me about your care givers not considering that possibility.
If they don’t see anything on the x-rays at the moment, then I don’t think this is a dental emergency and would not stress about it. Instead, just have some x-rays done every couple of appointments to keep an eye on it. The most likely scenario is that at some point this adjacent tooth will also need a root canal treatment.
Nothing you’ve described makes me think that you are in danger of losing your tooth. But, if you ever do lose a tooth, then, yes, a dental implant would be an excellent tooth replacement. In fact, it is the best tooth replacement.
This blog is brought to you by Moline Dentist Dr. Thomas Goebel.
Infected Tooth and No Money
I’m missing one back tooth and have another that has had some decay for a while. Now I am pretty sure that it is infected. My problem is that I do not have dental insurance but I do have health insurance. Is there a way I can use my health insurance to get an antibiotic for a dental problem? My jaw is becoming quite swollen.
Abraham
Dear Abraham,
I am glad you wrote. What you don’t want to do is use antibiotics as a solution for this. Even if your medical insurance would cover a dental issue, which it will not, an antibiotic will only be a very temporary solution. Then, once the antibiotics are done, your infection will blow up even worse with no way to keep it under control.
The only way to really get rid of a tooth infection is by a dentist getting in there and physically removing the infected pulp of the tooth. Ideally, this would be done with a root canal treatment because it would save your tooth. If that is no longer possible, the other treatment option is to extract the tooth. The downside to the extraction option is that you will need to replace the tooth. Otherwise the adjacent teeth will shift or tip into the empty space. This will throw off your bite and could lead to headaches, jaw pain, and TMJ Disorder.
The best tooth replacement is a dental implant, but that is also the most expensive. There are several other options. If you do need an extraction your dentist is ethically obligated to give you all of them.
With the swelling you have in your jaw, that signals to me that your infection has spread. I would consider this a dental emergency and get in right away. I know you don’t have dental insurance, but if you call around and explain your situation, I feel like you should be able to find a dentist who would be willing to allow you to pay it out and get the treatment you need.
This blog is brought to you by Moline Dentist Dr. Thomas Goebel.
Do I REALLY Need to Replace This Dental Bridge?
I have a dental bridge on my lower right to replace a lost tooth. I initially thought about getting a dental implant but my dentist suggested the bridge would be less expensive. Now he is saying the one of the teeth holding the bridge is broken and I need to replace the entire unit. If I have no pain and no symptoms, do I really need to replace this? Is there another option?
Jeremy
Dear Jeremy,
You’ve brought up one of the many benefits of dental implants over a dental bridge. If an adjacent tooth to the replacement is damaged it has no impact on the dental implant. With a bridge, that is not the case. The only reason I can think of that he steered you toward a bridge instead is that he doesn’t have dental implant training and did not want you going somewhere else.
That being said, I am a bit sceptical of your dentist’s diagnosis here. You have no pain. If a tooth was broken, you would be very likely to have some pain, especially when you bite down. Generally, the solution to a broken or fractured tooth that can be saved is a dental crown, so why is this one suddenly damaged when it already has that protection. Plus, replacing the bridge would only be necessary if the tooth had to be extracted, which means you would now need a longer bridge. That is another crown on a healthy tooth, with even more strain on it.
I would not consider this a dental emergency especially since you do not have any symptoms. My recommendation is for you to get a second opinion before following through with this. Don’t tell Dentist B who Dentist A is or what he said. They may know each other and you don’t want Dentist B feeling pressured to not contradict his pal. Instead, just go and say, I am seeking a second opinion on the lower right side of my mouth. If he asks you what the previous diagnosis was or who the dentist was, just explain you don’t want to prejudice his diagnosis in any way and just want a blind second opinion. He or she should not have a problem with that.
This blog is brought to you by Moline Dentist Dr. Thomas 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.,
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.
How Long Can I Delay Root Canal or Tooth Removal?
A crown on my upper left first molar broke. My dentist said that the tooth had died, and if he could not remove all the decay, he would refer me to an oral surgeon to remove the tooth. Then, he would place a dental bridge. I asked my dentist to refer me to an endodontist, and I have an appointment in two weeks. I read online that a dental implant is better than a bridge. Is there any reason I should have the tooth removed right away? How long can I wait before this becomes a bigger problem? – Thank you. Selina from Allegheny, PA
Selina,
Thank you for your question. Dr. Goebel would need to examine your teeth and x-rays. But we can offer some insight.
Removing vs. Saving a Tooth
If a tooth is healthy enough to save and will not negatively affect your oral health, it is best to save it. Although dental implants are a highly effective tooth replacement, healthy natural teeth are better. We recommend that you keep your appointment with the endodontist (root canal specialist) for a second opinion.
How Long Can You Wait Before a Root Canal?
You did not mention if your tooth hurts, but the specialist will need to check for the extent of the infection. Without treatment, infection will continue to spread. So, the condition of your teeth and your oral health will continue to decline without root canal treatment.
Also, if the tooth requires removal, leaving the space without a dental implant will allow other teeth to drift into the area. Tooth misalignment can lead to other issues like jaw pain or the need for orthodontic treatment.
Get a Second Opinion
Your dentist seems uncomfortable replacing your tooth with a dental implant and crown. Even if your dentist would refer you to an oral surgeon for implant placement, we are concerned about his experience with implant crowns and crowns in general. After your appointment with the root canal specialist, we recommend scheduling an appointment with an experienced dentist to discuss your options after root canal treatment or extraction.
Moline, Illinois dentist, Dr. Thomas Goebel, sponsors this post.
Dental Implant Delayed Due to a Sinus Infection
Can you tell me why my dentist can’t clear my sinus infection after tooth extraction? This issue prevents me from getting a dental implant. After removing my upper left tooth, my dentist prescribed clindamycin antibiotics for a week, but the infection isn’t gone. I finished the antibiotics, but I still feel pressure in my face and nose. I have tried nose spray and decongestant. Before I call the office back, can you give me an idea of what my dentist should recommend?
Also, if his recommendation does not match yours, should I ask for another round of clindamycin? Is this a routine problem that my dentist should have known about? I am afraid it will not heal, and I cannot get an implant. Thank you. Jeremiah from Columbia, SC
Jeremiah,
Dr. Goebel would need to examine your tooth and review your x-ray for an accurate diagnosis. But from your description, your dentist is not negligent.
Upper molar tooth roots are often located close to the sinus. So, when your dentist removes a tooth, the sinus can rupture. Sometimes only a thin membrane separates tooth roots and the sinus.
A dentist may treat the issue with these steps:
- Close the perforation
- Use a surgical gelatin sponge or bone grafting if you need a dental implant
- Stich the opening closed
- Prescribed antibiotics if you have an infection
After finishing antibiotics, contact your dentist if the infection does not clear. Although you may need another course of antibiotics, your dentist may need to switch you from clindamycin. Sometimes bacteria become antibiotic resistant.
Afterward, if the infection persists, your dentist may need to refer you to an otolaryngologist (or ear, nose, and throat specialist). The specialist will coordinate your care with your dentist to ensure the infection is gone before dental implant surgery.
You can expect about four months of bone graft healing before you get a dental implant. And after implant surgery, it takes three to four months for your jawbone and implant to fuse. Then, your dentist can complete the implant with a dental crown.
Cosmetic dentist Thomas J. Goebel, DDS of Moline, Illinois, sponsors this post.
What is this weird sensation I feel with my new dental crown?
Darren,
When a dentist places your crown correctly, it should feel like a healthy natural tooth. You not notice that you have a crown. Sometimes, even bite adjustments are not enough to resolve the discomfort because the problem lies beneath the crown.
Uncomfortable New Dental Crown
If discomfort in your crown lingers, get a second opinion, and ask for an x-ray. Sometimes, decay beneath a crown can cause lingering discomfort. If the problem tooth previously had root canal treatment, you would not feel pain or have a toothache. Your symptoms might be vague and difficult to describe.
What Causes Tooth Decay Beneath Crowns?
Tooth decay beneath a crown can occur in these instances:
- Bacteria or plaque gets trapped beneath the crown
- Root canal failure
- Lingering decay or infection that a dentist covers with a crown
Depending on the condition of your tooth and how much tooth structure is left, the second opinion dentist may recommend
- Adjusting the crown
- Remaking the crown
- Extraction, replacing the tooth with a dental implant, a new implant crown
After retreatment, your tooth and bite should be comfortable.
Thomas J. Goebel, DDS, of Moline, IL, sponsors this post.