Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

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.

Affordable Dentist in an Emergency for Unemployed

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I need to find an affordable dentist for my dad. He is 63 and has a terrible toothache, but he’s also unemployed and on state insurance, which doesn’t provide dental coverage. Obviously, with the unemployment, he can’t really afford to have the tooth fixed, which is terrible. He keeps trying to live with it, thinking he’ll just fix it when he gets back on his feet again, but I’m really worried that it’s infected and that it’s getting worse. How do I find an affordable dentist who will help him?

Jim

Dear Jim,

There are a lot of ways you can find an affordable dentist and it sounds like your dad needs to get in as soon as possible. Anytime there’s extreme pain, it is a dental emergency. If it’s an infection, it will get worse and spread, so it’s good that you’re looking into options. I’m not trying to scare you, but people still die from tooth infections. I’m only saying that so you’ll have an understanding that it cannot be ignored.

The fastest way to get him treatment is to call around and see who offers payment plans. Some offices will provide in-house financing, but a lot of them are offering things like Care Credit, which is financing through a company that only helps people with medical bills. They usually have a deal where, if you pay off the balance in six months or less, you don’t even have to pay interest on it. If you find an office that does either one of these things, any office can instantly become an affordable dentist and he can get treatment right away.

Depending on the severity of the pain and how long it has been going on, you could look into dental insurance plans as well. When you do self-pay on the policy, it may kick in right away, but be sure that the plan doesn’t have any kinds of waiting periods. These are clauses that some insurance companies stick in there that say the insured party cannot have a specific kind of treatment for a certain number of months after signing up with a policy. You might see waiting periods of 6-12 months or more on “major” services, which generally include extractions and root canals.  Always read the fine print, but you can find him a policy that only runs $30 a month or so and may cut the fees he pays in half or even more, depending on what he needs to have done.

If he’s in a real bind, have him visit his primary care physician. Although a doctor won’t treat dental needs, he can assess it and determine if he thinks it’s infected. If it is, he’ll be able to prescribe antibiotics, which should be covered under his state medical care. This won’t fix the problem, but it will buy him a little bit of time to work out which affordable dentist he’s going to see and how he’ll cover the expenses.

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