Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Is Nerve Damage a Dental Emergency

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I had four wisdom teeth removed. I believe there was some nerve damage done to the lower right, which my dentist did not warn me about. The lower right jaw is pretty numb. As a result, I am having trouble eating, chewing, and brushing my teeth. Is this a dental emergency? I don’t know what the treatment is in this case.

Anna

Dear Anna,

blonde woman holding the side of her jaw in need of an emergency dentist

This is not a dental emergency for reasons I’ll explain in a moment. Your surgeon should have given you a risk assesment before you agreed to the surgery. In most cases. the nerve is far enough away from the root of the lower wisdom tooth that there is hardly any risk. However, a few can run quite close to the root. In those cases, dentists tend to overstate the risk. I don’t understand why your dentist did not mention this at all.

Unfortunately, there is nothing you can do but wait this out. There are three groups of severity when it comes to nerve damage.

  • Bruised – In this case, the numbness will last for about a month, after which feeling will return.
  • Crushed – A crushed nerve has to grow new nerve fibers. I would expect that to take about a year.
  • Severed – If your dentist severed the nerve, it won’t re-grow and the injury will be permanent.

Getting an x-ray should give you an idea of where you stand with this.

This blog is brought to you by Glenpool Dentist Dr. Ryan Noah.

Can’t Afford to Remove Broken Tooth

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I have a back wisdom tooth that is broken. Shortly after it broke, the pieces began falling off. All I have left now is one small piece in the back. The pulp is disappearing, however, the tooth is super sensitive. Will it eventually fall out by itself or do I HAVE to see a dentist? I don’t have much money at the moment so even though I’m in pain, I want to avoid the dentist, if possible.

James

Dear James,

An adult male grimacing in pain has he holds his cheek

I am glad you wrote. I feel compassion for what you are going through. To be in so much pain and still not want to see the dentist means you are completely broke. Yes, eventually, your decaying tooth will fall out. That being said, there is a chance that an infection will get into the bone and cause serious problems. The way to avoid that is to have the tooth taken out.

I’m having a hard time grasping the entirety of your situation because I haven’t seen it. I’m not sure what you mean by the pulp disappearing. Because of that, combined with my sympathies for your financial situation, I am going to suggest that unless your jaw starts to swell you should be okay to wait it out. However, if the jaw starts to swell, you have a serious dental emergency on your hands. In that case, you have to see someone and have this dealt with, or else it can become life threatening.

Here is some advice if you want to try and take care of this now. First, I’d call around and see if there is a free dental clinic for emergencies. If not, you could also call around to see if there is a dentist who will allow you to get the treatment you need and then pay it out. I would start by looking for dentists who advertise themselves as affordable dentists in that case.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Do I Have to Tell My Dentist About a Toothache Before My Trip?

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I have been on a waiting list to go on a trip with a charity group for over three years. It’s designed to help poverty stricken nations in third-world countries. I have been looking forward to this for so long and I finally got called up to go. I have to jump through quite a few hoops including getting a check-up from my doctor and dentist and receiving letters saying my body and teeth are fit and healthy. The thing that worries me is that I have had this tooth that has been aching me on and off for a couple of months. Do I have to tell the dentist about it? I’m worried it will blow my chance of going and then I’ll have to go back on the waiting list, possibly for years.

Veronica

Dear Veronica,

Woman grabbing her cheek in pain.

It is admirable that you are trying to do such challenging charitable work. The truth of the matter is, if something is wrong with your tooth, even if you didn’t tell your dentist about it, he would probably find out about the issue during your check up. Even if he somehow missed it, it is much better, to be honest in situations such as this. The last thing you want is for the tooth to blow up into a dental emergency while you are out there. Not only would that put you at risk, but it will put a serious hamper on what you are able to do for the nation you are trying to help.

There is good news here. If you explain the situation to your dentist, he could get you in right away and you could get that angsty tooth taken care of in plenty of time to get the okay for your trip. Most of the time, these things can be handled quite easily, especially if you get in right away.

Best of luck to you!
This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Dental Emergency During Pregnancy

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I am 14 weeks pregnant and just had a dental filling fall out. I haven’t gone to the dentist since getting pregnant. I’ve heard you are supposed to avoid dental care while pregnant. Is it safe for me to go in? Should I just tough this out? The tooth is pretty sensitive and I’m worried, but don’t want to do anything that could hurt my baby.

Rose

Dear Rose,

pregnant woman at the dentist

First things first, congratulations on your new baby! That is a wonderful blessing. Second, I am sorry for the dental emergency in the middle of all this. you have enough stress on you. Third, I just wanted to say that I can already tell that you are going to be a great mother. You were willing to suffer rather than do anything that could harm your child. The good news is you do not have to suffer.

Dental Care During Pregnancy

The ideal time for dental work is in the second trimester. You’ve gotten past the dangerous, vulnerable stage of the first trimester and haven’t gotten to the uncomfortable stage of the third trimester. In this instance, you are in the perfect window for dental care. However, in the case of a dental emergency, you would need to go in no matter what stage of the pregnancy you were in. There is more danger to your baby in ignoring a dental infection, which can be passed on. It’s even been associated with low birth rate.

Your dentist will take precautions to ensure that you and your baby are perfectly safe. They should only do enough diagnostics to get to the root of the problem. Most dental x-rays these days are digital which have hardly any radiation. Even so, make sure they give you a lead covering in order to keep any and all radiation away from your baby.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Something Is Wrong With This Dentist’s Advice

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I have a tooth that has been aching me on and off for a couple of weeks. It will be fine for a long while and then hurt for about ten minutes or so. I finally got worried enough about it to go and schedule an appointment with a dentist who does same-day appointments for urgent dental care. He examined me and then said it was hard to tell so he did an x-ray. That told him that there was an infected tooth where there was already a dental filling. He said it was so far gone that only 10% of the tooth was viable. He recommends I have the tooth extracted and then schedule a follow up appointment for a dental implant. He wanted to extract the tooth right then, which sort of freaked me out. I told him I’d let him know. Is this really necessary? Is there no way to save a tooth that is infected?

Cathy

Dear Cathy,

blonde woman holding the side of her jaw in need of an emergency dentist

I am glad you wrote. There are some things that make me suspicious of this dentist’s advice. First, if the tooth were really that far gone not only would you have been in serious pain for a long time, but your dentist would not have needed an x-ray to tell. In fact, the filling would have fallen into the tooth.

Thankfully, you didn’t go through with the tooth extraction. My suggestion is that you get a second opinion from another dentist. When you do that, make it a blind second opinion. By that, I mean don’t tell them who gave you the first diagnosis or what it was. Many dentists know one another and you wouldn’t want them feeling torn about saying a colleague was wrong. If they don’t know who it was, they are free to give their unbiased opinion.

As for your question as to whether an infected tooth can be saved, the answer is generally ‘yes’. A root canal treatment can save a tooth that is still viable. If that turns out to be not possible for you and the tooth does need to be extracted, then a dental implant is a great tooth replacement. Just make sure the dentist has post-doctoral training in implants. It is an advanced procedure that is not adequately taught in dental school.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Are There Options for Infected Teeth?

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I have two back teeth with fillings that have been hurting me for a while. When the pain got to the point of distraction, I broke down and went to the dentist. He said the teeth are infected and will need to be extracted. I’m really feeling awkward about missing teeth. I know they are in the back, but I feel sort of like I’ll turn into a hillbilly or something. Are there consequences to this? Do I have any other options?

Merrill

Dear Merrill,

blonde woman holding the side of her jaw in need of an emergency dentist

I am glad you wrote. Your dentist is under a legal obligation to give you all of your treatment options. I am surprised that he only gave you the possibility of extraction. Is it possible you are on government insurance? That could be an explanation. On government-funded insurance, you aren’t really given an option. They tell you what treatment you can have, unless you want to pay out of pocket.

Options for a Tooth Infection

Your best option in this case, is to get a root canal treatment. This will remove the infected pulp, while still saving your tooth. It is always better to have natural tooth structure. Without that, you have to replace the teeth. If you don’t replace them, the adjacent teeth will begin to shift into the empty spots. This will throw off your bite, but it could also lead to painful TMJ Disorder.

Any tooth replacement will keep the teeth in place. However, you will begin losing some bone structure where those teeth were if you do not have prosthetic roots placed there with dental implants. However, those are very expensive.

The first priority is to try and save the teeth, if possible, with a root canal. The faster you deal with a tooth infection the better. This will also save you the money of getting tooth replacements.

This blog is brought to you by Glenpool Dentist Dr. Ryan Noah.

Antibiotic and Tooth Infections

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My tooth was infected. I went to see my dentist and he did an x-ray where he found an infected tooth. He provided me with an antibiotic. I took it faithfully. The swelling started to go down and I was even feeling better. Then, it started to get worse again. I guess what I need to know is if I need to get more of the same antibiotic or if I need to get a different one. I want to know what to ask for when I call the dentist again.

Lucy

Dear Lucy,

A woman holding her jaw in pain

I hope there has been a miscommunication between you and your dentist and not that he does not understand how dental infections work. While an antibiotic is useful for holding back a dental infection, it does not cure it. The only way to get rid of a dental infection is for the dentist to physically get in there and remove the infected pulp. There are two ways to do that.

The first is with a root canal treatment. This is the ideal solution because it will save your tooth. If the tooth is no longer salvageable, the next option is to have your tooth extracted. That is the last resort option because it is always better to keep your natural tooth structure.

The fact that your infection started to get better and then got worse again is a particularly bad sign. I think you need to schedule an emergency dental appointment. He may write you another antibiotic but this time make absolutely certain that a follow up appointment is scheduled for before the antibiotics will run out.

If the worst case scenario happens and the tooth cannot be saved you will want to replace it. If you don’t, the other teeth will either shift or tip into the open space. This not only will make your bite look off, but it can also lead to painful TMJ Disorder. There are a variety of tooth replacement options, some removable, like a partial denture, others permanent, like a dental implant.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Dealing With A Lingering Infection After An Extraction

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I had a root canal performed over a year and a half ago, and my endodontist said there were C-shaped roots and that she was hoping it worked. She gave me the standard antibiotic regimen and told me to follow up with my regular dentist. I followed her directions, and when I had my routine cleaning 6 weeks later, I mentioned to the hygienist that I was still dealing with some pain. They took an x-ray, but since my dentist wasn’t there that day, they said they would have him take a look and give me a call.

My dentist never called back, so I thought that meant everything was fine, but when I went back for the next routine cleaning, I told them that I still had pain. They took an x-ray and said it showed there was an infection, and I was told to call my endodontist for a follow-up. It was a holiday, so my dentist prescribed penicillin pills and scheduled an appointment for me later in the month.

About one month later, I ended up having the tooth pulled by an oral-maxillofacial surgeon, and I have since had improvements. However, I do still have pain in my jaw directly under where the tooth was extracted. The tooth socket has healed, and several symptoms have improved, but I am still concerned there may still be an infection in the jaw bone.

My faith and trust in my dentist have been shaken, and the dentist that pulled the tooth never even scheduled a follow-up with me. Is it possible that I still have an infection in my jaw? In your opinion, how should I proceed with this? I greatly appreciate your time. Thank you.

-Rylee from Arizona

Rylee,

A failed root canal can often be fixed with re-treatment or root canal surgery. However, extraction is sometimes necessary, as you have experienced.

It’s too bad that your dentist wasn’t more on top of this, but I wouldn’t fault the oral surgeon for not scheduling a follow-up after what he or she probably saw as a routine extraction. It is rare for there to be a lingering infection in the bone after a simple extraction of a tooth because the open socket leaves a clear path for drainage, so your body has no trouble getting rid of the infection. Occasionally, you can get a post-operative infection if the tooth is fully impacted and the tissue is sutured closed over the extraction site. From what you have explained, it sounds like your jaw healed normally.

But the lingering pain is a concern, so I would have it checked out. There are some cases where an infection can linger after an infected tooth is removed. Such a situation would require a strong dose of antibiotics. I would recommend that you go back to the oral surgeon and get evaluated. If you do still have an infection, I would imagine your surgeon would stay clear of penicillin since you already were on that. If you do happen to have a lingering infection, it is probably penicillin-resistant. I would try a strong antibiotic like clindamycin or some other antibiotic that isn’t penicillin.

 

This blog is brought to you by Tulsa emergency dentist Dr. Ryan Noah.

Root Canal Gone Wrong!

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My husband coaches my son’s basketball team, and while coaching, he fell, which caused his front two teeth to fracture. He went to the dentist and ER that day, but the dentist wanted to wait for 2 weeks before treating him. Within 2 weeks, his right front tooth was starting to discolor, but no pain. He wasn’t treated, just fitted for temporary crowns that were placed 3 weeks later.

He had an emergency root canal 2 months later because of his severe pain and was given amoxicillin for 5 days. This offered him some pain relief, but after 24 hours, the pain returned up to his nose with a cold sensation.

2 weeks later, he had a root canal on his left front tooth, which caused no pain relief and was most likely an unneeded root canal.

We went to an oral surgeon to get a second opinion, and he recommended Augmentin TID for 7 days with Medrol Dosepak. Within 5 days, the cold sensation had resolved, and he was pain-free for the first time in 3 months! However, within 24 hours, the pain returned at about 50%.

I am a Nurse Practitioner, and my pharmacist friend recommended a 2-week taper of prednisone and my neighbor thought maybe the tooth fractured at the gum line. The dentist did see a black spot on the x-ray but said it was nothing. My husband has been suffering from pain for months; what would be the recommended next step? Do you think it would’ve been better if the root canal had been performed right away? Could the tooth be saved, and should he need an extraction, would you recommend implant next to permanent crown or bridge?

– Jodi in Michigan

An adult male grimacing in pain has he holds his cheek

Jodi,

The nice thing about doing the root canal right away is that there is less chance of post-operative complications because infection wouldn’t have settled in yet. They would just need to clean out the dead tissue and leave the tooth open for a couple of days before sealing to ensure there aren’t any flare-ups. The dried blood would be an indication the tissue inside the tooth was dead.

I’m very confused on why they would prescribe Amoxicillin for only 5 days. Doing things the way you stated would leave a fairly substantial risk of a flare-up. Also, Amoxicillin would not typically be the first choice of antibiotic for this type of tooth infection, and a 5-day course would not be enough to clear up the infection.

My recommendation would be to see a root canal specialist; it is always good to see someone who has the specific training needed. There are many of your dentist’s treatment choices that I disagree with, and it sounds like a lot of his treatments were guesses. It’s important to have an endodontist look at the x-ray and figure out what is really going on.

Your husband shouldn’t need his tooth extracted as there are several options for correcting the root canal if it wasn’t sealed properly. I would also recommend Clindamycin for antibiotic therapy.

I hope your husband’s pain is resolved quickly! Take Care.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

What’s causing the pimple on my husband’s gums?

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My husband recently said that he has a little pimple on him gum on the upper left, above his molar. Is this something that needs an emergency dental appointment? Karen

Dear Karen,

Tulsa emergency dentist

There are a couple of possibilities for a pimple on the gums. If it is near the root tip of your husband’s molar, it is most likely from a tooth abscess. When a tooth gets infected, the pulp eventually dies and the infection festers inside the tooth, spilling out bacteria into the bone. The infection in the bone then looks for a place to escape, and it will often try to drain through the gums.

While this wouldn’t be considered a dental emergency, it would need attention. If untreated, the infection can spread into the surrounding bone. It can also begin to dissolve away the roots of that tooth. It is unlikely that the tooth will be hurting, for two reasons. First, the tissue inside the tooth is dead, so it has no feeling. Second, while an abscess around the end of a tooth can cause the tooth to be painful to biting, since this infection has found a pathway to drain, pressure isn’t building up. Though my guess is that your husband has some mild discomfort to biting on this tooth, assuming that it truly is an infection and not just some little growth on the gum.

It’s Important He Doesn’t Put This Off

The tendency for men is to “tough it out” and hope it goes away. This won’t go away. And while the tooth will need a root canal treatment, I would tell him not to worry about that. Since the tissue inside the tooth is dead, the dentist could probably do a root canal without any novocain, since there is no feeling in it. I expect it will be a completely painless procedure. The dentist may still want to make the tooth numb, and may put your husband on some antibiotics to get the infection completely under control before starting treatment and to help insure that there is no post-operative flare-up.

It’s always better to take care of these things sooner rather than later. Better a root canal treatment and dental crown than to need a tooth extraction and replacement.

If the Tooth Can’t be Saved

There’s always a chance, depending on how long this has gone that the tooth can’t be saved. In that case, you’ll need to look at tooth replacement options.

Two of the best are to get a dental implant or a dental bridge. A dental implant is the better treatment, but it is more costly than the bridge.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.