Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

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.
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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.

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.

Dental Tourism is Not Always Cheap

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I needed a dental crown and wanted to save some money so I went to a dentist in Mexico. A couple of years ago, I had three crowns placed with them a few years ago. One of them was bothering me a little anyway so I thought I’d save even more money by having them look at that while I was there. When I got there, they said all three of the crowns are failing and it’s best I replaced them. That left me getting four dental crowns that trip. However, a week after I got back the new one fell off. I went back to Mexico. This is a 600 mile trip for me. He told me that that tooth actually needs a root canal. I questioned why he didn’t tell me that at first and he said they’re not always necessary and don’t always take so he doesn’t do them unless absolutely necessary. That sounded okay and like he was trying to save me money, so I agreed to the root canal treatment. A few weeks later and that tooth is killing me and is sensitive to hot and cold. I go back, now it is officially getting not cheaper. He tells me I cracked my tooth. How did I crack it? It had a crown on it? He wants me to extract it and get a dental implant. I’m not sure what to think anymore. Do you have a recommendation?

Carlton

Dear Carlton,

An adult male grimacing in pain has he holds his cheek

I’m very glad you wrote. This is a perfect example of the difference between cheap and affordable dental care. “Cheap” usually ends up costing more money. There are two reasons that dentists will have prices well below the norm.

First, they could lack the skill to do good work and the only way to keep their practice running is by being appealing to new patients with their pricing because they don’t get a lot of repeat business. Second, is they cut corners with cheaper materials. This is so they can keep their profits up while keeping their costs down. This latter one can happen just as a result of being in another country where legal and sanitary standards are different than what we have in the United States. For instance there are Central American countries where dentists are not required to sanitize their equipment between patient use. It’s just up to the dentist whether or not they do this.

I feel like your dentist has been a combination of those two main reasons. Obviously, he lacks skill with dental crowns or they wouldn’t need to be replaced so quickly, nor would the new one have fallen off. Then, you have an obvious failed root canal. If he had done the root canal properly, then you would not have had pain. There would have been no pulp left in the tooth to have any sensitivity to hot and cold. Finally, I don’t necessarily think a cracked tooth must be extracted. It depends on a number of factors.

A dental implant is one of the most advanced procedures in dentistry. I highly recommend you do not let this dentist anywhere near your teeth any more. He has fallen well below the standard of care multiple times. You could ask for a refund, but because it is Mexico I don’t know how likely you are to get one.

Either way, I’d get a second opinion on this tooth. I recommend you use someone closer to home.

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.

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.

Dentist Damaged Daughter’s Tooth Removing Her Retainer

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My daughter had her retainer removed several weeks ago. In the process, her dentist damaged one of her teeth. It is now gray in color and receded from the rest of her teeth. He did an x-ray and said he could not tell anything for certain but then did a cold test that she failed. He believes the tooth may need a root canal treatment and is sending us to an endodontist. I have a couple of concerns. First, is there any way this will heal without a root canal treatment? Two, the endodontist he recommended does not use the Gentle Wave technology and I would prefer that if a root canal is necessary that is used. Am I within my rights to request a different endodontist who does use the technology?

Camryn

Dear Camryn,

Mother and Daughter

I am a bit concerned about the diagnostic skills of your dentist. Either a tooth needs a root canal treatment or it doesn’t. There really is not a “may” need a root canal treatment. That kind of wording leaves patients (or their parents, like you) in a quandary, wondering if they would be undergoing an unnecessary procedure.

The fact that the tooth underwent trauma, is turning grey, and has sensitivity to cold is enough to diagnose this tooth as dead or dying. In that case, it will need a root canal treatment.

I’m not sure how he managed to damage her tooth while removing her retainer. I am assuming this was some type of permanent bonded retainer that was bonded. Either way, he should have been able to remove the retainer without damaging the tooth if he knew even a minimal amount about orthodontics and bonding procedures. Obviously, he messed up and, in my opinion, is liable for the cost of the repair. Additionally, you do not have to stick with the endodontist he chose. You have the right to choose any endodontist you want, even segregating them by whether or not they use the GentleWave technology. GentleWave is getting good peer reviews in the dental literature. I think it is a good choice to use for your daughter.

This blog is brought to you by Tulsa Dentist Dr. Ryan Noah.
Click her to learn about how to straighten your teeth Invisalign, which means no metal wires or brackets.

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.