Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

If My Wisdom Tooth is Completely Rotted Do I Need to Go to the Dentist?

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I have a wisdom tooth that rotted completely out. The part you can normally see is completely gone. Even below the gumline I’m not seeing a lot. Do I need to be worried or can I just move on with things? It doesn’t hurt.

Andy

Dear Andy,

An adult male grimacing in pain as he holds his cheek

It sounds to me that, at least for now, you are okay. Once the tooth is gone, there is not much risk of any infection getting into the bone. That is because the tooth is completely open. Without any enamel left, the decay will go quickly.

You actually got pretty lucky. Normally, when your tooth is infected and untreated the infection spreads. Once it breaks out of the tooth, it can cause serious, even life-threatening, problems. Between six to ten people die every year in the United States from untreated tooth infections.

My guess is that you haven’t been to the dentist in a while. There are usually two reasons for that. First, is affordability. The second is dental anxiety. If you fall in the first category, you can look for dentists who advertise as affordable dentists. If you’re in the second category, look for a dentist who offers some type of sedation.

It’s very likely you have other teeth with decay which are about to blow up into a tooth infection. I would at least get a check up to see where your teeth stand. You don’t want to end up with a dental emergency.

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

Tooth Infection and No Money

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I need some advice. I’ve already had a few teeth in the back of my mouth sort of come out on their own. Now I have one that is infected. It’s gotten pretty bad and my right cheek is swollen. I look a bit like that guy from the Godfather. I do have some antibiotics that my ex-wife left here. She never took them because she went through a phase where she didn’t believe in “western” medicine. It’s a z-pack. Will that work for my tooth?

Bradley

Dear Bradley,

An adult male grimacing in pain as he holds his cheek

I’m sorry you are going through so many difficulties at once. That is hard. Be aware that while a z-pack can temporarily hold your infection at bay, it will NOT take care of it. In fact, unless you get the proper treatment in a timely manner, you can actually end up in a worse situation than you were in before.

In order to properly treat an infected tooth a dentist has to physically remove the infected pulp. There are two ways to properly do this. The first is with a root canal treatment. This is the ideal because it will save your tooth. The second is by extracting the tooth.

Because your cheek is swollen, I would consider this a dental emergency. It has spread out of your tooth. You don’t want it to reach your brain or heart because then it will become a life-threatening situation.

This blog is brought to you by a compassionate dentist in Tulsa, Dr. Ryan Noah.

Swollen Face and No Money for Dentist

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I need some help and advice. I have a few teeth that have problems, especially on one side of my mouth. I am unemployed and pretty broke so I haven’t really taken care of it. In fact, I pretty much can’t. Not if I want enough money to pay my electric bill. I’ve taken to donating plasma to get some extra cash. My big problem is that the side of my face has swollen up. I’m guessing this is a bad sign. I have tried calling around my area in Little Rock and all the dentists want payment up front. None seemed willing to work with me because I wasn’t an “established patient.” I don’t know what to do. Is there a way for me to treat this at home?

Alan

Dear Alan,

An adult male grimacing in pain has he holds his cheek

I am sorry you are going through this. You are correct that your face being swollen is a bad sign. This means that it is more than a tooth infection, it is a tooth infection that has spread outside of your jaw. It will continue to keep spreading as well until you get the appropriate treatment. I would consider this a dental emergency.

You will need some antibiotics to get the infection under control, but that will not solve the problem. The infected pulp has to be removed from the tooth. You are in a tough spot. While it is true that most dentists prefer an established patient in order to work with them, I have found that dentists are compassionate.

Start by looking for dentists who advertise as an affordable dentist. They are generally more willing to work with patients. Be certain to explain what is going on so that they know how serious this is. If no one is willing to help you, I took the liberty of looking up some charity clinics in your area. Here is a link for you. I would call them.

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

Dealing with Gross Incompetence

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I need some advice. I am new to my area and had some sensitivity to tooth #19 to cold food and drink. Because I didn’t have a dentist yet, I went to one who advertised as an emergency dentist. I told him about the tooth that was bothering me. He did an exam and said that I have impacted wisdom teeth with half of them partially erupted. He suggested that the problem could be solved if I have fillings placed on the partially erupted teeth. If not, he’d want to extract them. I was puzzled because it wasn’t my wisdom teeth that were hurting, but he blew that off. I had the fillings, but that didn’t help and a couple of days later my mouth felt worse. He gave me some antibiotics. Those worked until they ran out. I went back to the dentist and he suggested that I have the teeth extracted. I pointed out that the pain wasn’t near my wisdom teeth and he replied that “I asked for his expertise and he gave it.” So, I had the wisdom teeth extracted. That helped until the antibiotics ran out… again. So, he gave me more antibiotics. When I was in pain again, I went back to the ER. They said that I had an abscessed infected tooth and guess which one it was? Yep, #19. I told my dentist, he recommended an endodontist, but that dentist couldn’t see me for almost a month. So, I found my own and paid out of pocket. He agreed it was infected and said he wished I’d been diagnosed sooner because now it is not saveable and it has to be removed and replace. I’m so mad and want my money back for the work he did now that I’m going to have to pay for all this new work. Is that a possibility?

Robin

Dear Robin,

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

Not only is that a possibility, but I think you are not asking for enough. Instead, I would ask him to pay for the unnecessary visits to the oral surgeon that removed your wisdom teeth, your ER visit, as well as the extraction and replacement of tooth #19. My suggestion is that you replace it with a dental implant.

Based on what you described, your dentist is definitely guilty of gross negligence and I believe you have a malpractice suit on your hands if he does not cooperate.

Pain to the tooth with cold is a sign the tooth needs a root canal treatment. To give you an antibiotic after the treatment would mean that he suspected there was in infection there, or else he doesn’t know what antibiotics do. By your third appointment, there should have been no way that the inflammation would not have been noticeable on an x-ray. Then he just kept giving you antibiotics which he should have known would not solve the problem. Finally, he sends you to an endodontist that could not see you for a month while you have a festering infection which would be considered a dental emergency! No.

I’m sorry this happened to you.
This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.

Dentist Messed Up My Crowns

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I have two front teeth which have always been crooked. I asked my dentist about options to fix them and he suggested I get two dental crowns that can make the teeth look straight. I agreed. He did the crowns and the teeth certainly did look straight, which is good, but I was having a lot of sensitivity to both hot and cold. I called the office and they said that was normal for the first month or so. I’d never had a crown before so just took them at their word. A few days later, I developed pain. Then the area to the right of my nose all the way up to my eye swelled up. I went to see my doctor with an urgent care appointment. He said that it looked like a dental problem to him and suggested an emergency dentist that is a friend of his. They got me in that day and told me that I have an abscess and need a root canal treatment and new crowns because mine have open margins. She showed me the x-rays and the margins are huge. I’ve scheduled an appointment with her to have this done. In the meantime, she gave me some antibiotics to get the spread of the infection under control.

I called my other dentist in order to get a refund because I’m going to have to redo all their work, plus get some extra work done. I was floored when their receptionist told me that once they do the work, I am responsible for the care of the crowns and will be receiving no refund. I asked “Even if the problem was the dentist’s fault?” But she insisted it wasn’t and that he does great work. Is there anything I can do to get a refund?

Jane

Dear Jane,

A man holding his jaw in pain.

I’m sorry you had to experience this. You may have realized this already but sensitivity to hot and cold is not normal after a crown. Indeed, they can be a very good sign that there is a tooth infection. Your first priority is to get the root canal treatment done. This is important. Some people put that off when the antibiotics kick in and they’re in less pain. However, those antibiotics will run out and the infection will blow back up.

Once you have the treatment you need it will be time to get tough with your other dentist. The good news is that you have x-rays that show the open margins on the crowns. Leaving those violates the standard of care. Your original dentist should have run an explorer around the margins to make sure this would not be an issue. Either they neglected that or did not want to deal with re-doing the crowns.

Here are a few things you can do to encourage your dentist to do the right thing. First, tell them you will be speaking to the dental board. No dentist wants that to happen. Make sure you let them know that you have diagnostic proof of them doing the crowns incorrectly. You can also tell them that you will be writing a very thorough review of their lack of both skill and ethics in their work and posting it everywhere. But, if they are willing to do what is right and return your fee you will let people know that they made it right. If none of that works, then I would get a lawyer to write them a threatening letter with their official letterhead on the document. This will make the dentist worry that you’re willing to go to court and almost always works.

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

Am I Too Old to Have My Wisdom Teeth Extracted?

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When I was in my early twenties, I had an impacted tooth that developed an infection and had it removed. He told me the other teeth didn’t have an infection so I didn’t need to worry about them. Now, ten years later, another one of them is infected. I’ve heard there are age limits on these type of things. What do I do if I am too old?

Adeline

Dear Adeline,

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

I’m glad you wrote. To put your mind at ease, I will say right off the bat that, no, you are not too old to have your wisdom teeth removed. That being said, it would be important for you to remove the tooth either way. An infected tooth is a dental emergency. When left untreated, they will spread out of your jaw and can become life threatening.

You did not ask about this, but I think you should remove the remainder of your impacted wisdom teeth when you have this infected one removed. It would have been better for you if you’d had them all removed ten years ago.

The ideal age to have wisdom teeth removed is between the ages of 18-25. However, I don’t get very nervous until someone is over forty years old. If you don’t remove them now and they bother you after forty your risk of complications go up dramatically.

You do not need to replace wisdom teeth when they are removed. However, if any of your other molars have problems, those would need to be replaced. In that case, I would look into dental implants. They are the top of the line tooth replacements and the closest thing to having a healthy natural tooth in your mouth.

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

Worried About My Tooth

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I had an bit of a fall that resulted in losing about 1/3 of a front tooth. Even the nerve was exposed. I was visiting a friend in a different state at the time. She took me to her dentist who did a root canal treatment. When I got home my dentist checked out the work and said that everything looked good and he put a crown on the tooth, which the last dentist did not do.

Fast forward a year and the crowned tooth became very sensitive to both hot and cold. After a few months, the tooth gradually calmed down, but was still a little sensitive for cold. I’d finally saved up enough to go in and the dentist did an x-ray and exam but could not find anything wrong with the tooth. He decided I needed to see a specialist and sent me to an endodontist.

This specialist did not see anything wrong with the tooth either and thought maybe the problem was me clenching my teeth which could cause pain. He felt I was feeling pain on the tooth next to it. Nothing is being done and I’m worried I can lose this tooth. Have you heard of a situation like this?

Evelyn

Dear Evelyn,

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

I’m more puzzled with why neither your dentist or specialist can figure this out than I am about your tooth. First, if I understand what you said correctly, then you had a root canal treatment on a front tooth that removed the nerve. It was also checked by another dentist. In that case, that tooth cannot be the one having sensitivity to hot or cold because it should not have feeling. That doesn’t mean you are not feeling pain, just that it is referred pain, which means coming from a different tooth.

Second, not seeing anything on the x-ray does not surprise me because it would be inflamed. Until it blows up into an infection, there would not be anything to see.

Third, you had a traumatic injury to a front tooth that was rather significant. It is very unlikely that the tooth next to it was not impacted even though it did not lose any structure. Often when a tooth experiences trauma, the damage from that is slow to become obvious. It is not uncommon at all for it to be fine for a few years and then blow up.

I do not think you have a dental emergency on your hands. Because you are not having pain now it either means the tooth has recovered or the adjacent tooth is dying. My suggestion is that you leave it, but have an x-ray at your next check up and then every few years after that. If the tissue does die, then it will mean another root canal treatment on the adjacent tooth.

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

How Long Can You Put Off a Root Canal Treatment?

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I have a tooth which is in need of a root canal treatment. I am in a bit of a bind financially at the moment. Do you have an estimate of how long a root canal treatment can be put off before it becomes a problem?

Jack

Dear Jack,

A man holding his jaw in pain.

I am sorry that you are having to deal with so much right now. First, the financial bind and then the infected tooth. I’m sure this is adding more stress. It would be hard to tell you how long you can wait without examining your tooth. However, I can give you some guidelines.

If the tooth is not hurting and has not been hurting for a bit you can likely put it off without much of a problem. I know of a patient who put off a root canal treatment for several years but there were no problems. When they did finally get the root canal treatment, they did mention they felt better in their general health, which surprised them. Most people do not realize that their general health is impacted by their oral health. One thing to be aware of is that waiting for a long period of time puts you at risk for external resorption. This is where the root of the tooth is slowly eaten away and the tooth can no longer be saved.

If there is any pain with the tooth, even just a little, then you have an active infection and you should not put this off. It will continue to spread. Another sign of an active infection is a pimple on your gums. Again, don’t put off treatment in that case. Believe it or not, people still die from tooth infections. This is because your teeth are very close to your heart, lungs, and brain. If an infection reaches there, then an infected tooth becomes life threatening. I say this to make sure you understand an active infection must be dealt with. I would consider this a dental emergency.

The good news is that there are affordable dentists who would be willing to work with you on payments in the situation where you need urgent dental care. I would do an internet search using the term affordable dentist, then call them and explain your situation. One of them should be willing to help you.

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

Is A Cracked Crown A Dental Emergency?

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I had six dental crowns placed quite a few years ago for a smile makeover. They’ve served me well. One of them has always had a small defect but it was not a problem. My dentist said these type of defects are common and harmless. You couldn’t really see it but my dentist was scrupulously honest (a trait I value) and told me about it. Since that time, she has retired and I am with a new dentist. I’m not quite as familiar with his character and have developed a dilemma of sorts. The dental crown that has the defect has changed somewhat. I can now see a line and feel it with my tongue. It’s a bit like a crack. I’m not opposed to replacing it, I just wanted to know if this would be an emergency appointment or if it can wait.

Regina

Dear Regina,

An image of a porcelain crown being placed on a tooth

It is a wonderful thing when you have a caregiver you truly trust. Hopefully, your new dentist will have the same integrity. I would not call the crack in your crown a dental emergency, but you will want to replace it at your earliest convenience. You mentioned that you had six porcelain crowns made at the same time. I am not certain how old they are. However, if they are getting up in years you have a couple of options.

First, you can just replace them as they are needing to be replaced one at a time. That could result in quite a few trips to the dentist. Another option is to replace them all at once. This is initially more expensive but you will save time.

I don’t actually recommend this if they are still in good shape. If they are, they could serve you well for many years. Have your new dentist assess them. Once their condition is determined you can decide what is the best option for you.

I will mention if you had any plans to whiten your teeth in the near future, make certain you do that before you have your crowns replaced. You can match dental crowns to the color of your natural teeth, but the crowns will not whiten after they are completed.

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

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.