Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

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.

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.