Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

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.

Can’t Afford to Treat My Infected Wisdom Tooth

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I have a massively infected wisdom tooth. I’m furloughed during the quarantine and my unemployment hasn’t kicked in yet. I don’t have the money to get this treated yet. Is it possible to just take antibiotics until the money kicks in or should I just go to the ER to have this treated?

Kelly

Dear Kelly,

A man holding the side of his jaw like he needs an emergency dentist

Antibiotics won’t solve a tooth infection

Tooth infections aren’t something to mess with. In fact, they are considered dental emergencies. Unlike other infections which can be solved by antibiotics, a tooth infection has to be physically removed by a dentist, either by a root canal treatment or a tooth extraction. Without that, it will continue to spread. The most an antibiotic will do is hold it at bay for a short time. Then, when the antibiotics run out, it will begin to spread again. If you think about how close your jaw is to your lungs, heart, and brain, you realize how people still die from tooth infections.

I’ve found most dentists to be compassionate. That will be especially true during this time of the COVID-19 pandemic. I would simply call around to dentists in your area and explain your situation. I’m positive you will be able to find one who will work with you financially until your unemployment payments kick in.

Start by looking for a dentist who advertises as an “affordable dentist“. They pretty much offer payment plans even when there isn’t a world wide health emergency. I’m positive they will in your situation now. You can just get the wisdom tooth extracted and you’ll be back to normal in no time.

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

Can a Toothache Cause Chest Pain?

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I want to know if chest pain can be caused by a toothache. My mother is 75 and is a tad stubborn. She periodically has toothaches I have to try to convince her to get checked, but this morning she mentioned chest pain too. I started to panic but she says it has happened before and it ended up being nothing. I wanted to take her to the hospital but she said no. Now, I’ve been fretting about it all day. Could that just be referred pain from her tooth or should I have taken her to the hospital?

Karen

Dear Karen,

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

ANY time someone has chest pain it is important to get them to the hospital!

Heart attacks can have multiple symptoms and often vary by person. Orofacial pain happens in about 10% of heart attacks. However, it isn’t generally localized to a single tooth, but radiates across the jaw. That doesn’t mean your mother shouldn’t get checked out because as mentioned earlier, everyone manifests a heart attack slightly differently. This is especially true of women.

Toothaches Should be Taken Seriously

Even if her heart is fine, a toothache needs to be taken seriously. Often, they are a sign of a tooth infection. These should be considered a dental emergency. When the infection is not physically removed by a dentist in a procedure known as a root canal treatment, the infection will spread. Antibiotics alone won’t help. Even in the 21st century, people still die from tooth infections.

The Link Between Bodily Health and Oral Health

There are increasing studies that show dental health has a direct link to someone’s general health. This is especially true with gum disease. Patients with gum disease have an increased chance of heart attacks, diabetes, high blood pressure, and stroke. Helping your mother get in front of her dental issues will have an overall positive impact on her health.

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

Sinus Infection after Extraction

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I had a dental emergency a couple of weeks ago and the tooth is beyond repair. The dentist did an extraction. In the process my sinus was perforated. I’ve done some research and this seems to be something that can happen without it being the dentist’s fault. He told me about it after the extraction, cleaned the area, closed it up and then gave me a prescription for antibiotics. I was feeling better and had finished my antibiotics. Today there is drainage and pressure in my sinuses. Could I have developed an infection at the extraction site?

Miranda

Dear Miranda,

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

I’m glad you know that a sinus perforation doesn’t necessarily mean your dentist made a mistake. Some roots of teeth are so close to your sinus cavities the only thing separating them is a thin membrane, which will be perforated during an extraction when they’re that close.

It sounds like your dentist followed correct protocol when that happened as well. You’ve got a responsible caregiver and that is something to be grateful for. I can think of three possibilities going on here.

The first is that you just needed to be on your prescribed antibiotic a little longer than you were. Some infections need a little extra oomph to help your body fight it. This may be the case with yours.

A second possibility is you need to be on a different antibiotic. You didn’t mention which antibiotic your dentist prescribed. A good one for this type of situation is clindamycin.

A third possibility is there is some bone in the sinus cavity. This will blow up into an infection and can cause another dental emergency, plus a host of other problems.

I want you to call your dentist and schedule an appointment to be seen again. He’ll likely put you on more of the antibiotic or a different one. He may do an x-ray to see if there is some bone trapped there. If he doesn’t don’t panic. Try the antibiotics. If they don’t work, then it will be time to see an ENT and have this investigated further.

You are doing a good job staying on top of this. I don’t know if you and your dentist have started talking about what you will replace the extracted tooth with, but once you have this infection settled, I’d like you to discuss getting a dental implant with him.

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

Emergency Dentist for Gum Injury

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We don’t yet have a dentist in this area. We’ve been busy relocating and haven’t had the time. My husband recently complained about an injury to his gums that is swollen. He can’t remember when he did it or what happened, but it looks to me like it resembles a giant swollen pimple. Of course, I know we don’t get pimples on our gums so it must be inflamed from an injury. Will this go away on its own or does he need an emergency dental appointment?

Karen

Dear Karen,

Tulsa emergency dentist

Relocation is stressful, so I completely understand you not getting to finding a new dentist. However, what you described on your husban’s gums doesn’t sound like a gum injury. Instead, I think he has an abscessed tooth. This manifests in what looks like a pimple on the gums.

This is considered a dental emergency, so he will need to see a dentist right away. It means his tooth is infected. These infections can blow up quickly and become life-threatening.

I know you don’t have a dentist right now, but there are dentists who will treat non-established patients in cases of emergencies like yours. You can do an internet search using the term “emergency dentist“.

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. Eventually, the tooth may stop hurting, but that is because the pulp of the tooth will die, That won’t stop the infection from spreading though.

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.



Dentist Won’t Fix Crown

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I don’t know what to do. I’ve had massive trouble with a dental crown I had placed less than xix months ago. My dentist adjusted them three times. Nothing he did helped. The crown still hurt like mad every single time I bit down. Now he’s saying there’s nothing wrong. Well, last night I was eating at a restaurant and it broke. I called him and he feels he’s done enough and says I must have done something. He said he’s willing to make a new one, but I’ll have to pay for it. Even if I felt that was fair, I don’t trust him to get it right any better than he did last time. What do you recommend?

Marla

Dear Marla,

Tulsa Emergency Dentist

You have been through the ringer with this, not to mention your dentist is being unfair. It will be fairly easy for you to get a refund for this crown regardless of how your dentist feels. He hasn’t met even the minimum standard for the lifetime of a dental crown.

However, you’ve got to get this problem taken care of. Because you can’t trust your dentist and you’ve been handed a time sensitive situation, I’m going to recommend you look up dentists who treat emergencies in your area. It shouldn’t be too hard to find one. Many of them will use the search term “emergency dentist”.

The Possible Problem with Your Dental Crown

When your crown gives you pain upon biting down there is usually one of two reasons.

The first possibility is a lingering infection. While most of the time an infection is dealt with by a root canal treatment, there are some tricky canals in there and it’s possible one was missed. An x-ray should reveal that. If your dentist didn’t do an x-ray, the emergency dentist will as a standard procedure.

Another possibility is the crown is seated too high. You said he tried adjusting it three times. While that’s good, when it wasn’t making a difference he should have kept investigating the problem.

I think this is the most likely issue with your crown. The reason I say that is it broke when you bit down.

While our biting forces are quite hard, they’re usually spread over all out back teeth. If you have a crown seated too high, your bite will hit that and only that with its full force. That type of force on a single crown will make it vulnerable to breaking.

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