Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Swollen Face and No Money for Dentist

by

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

by

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

by

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?

by

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.

Dental Emergency During Pregnancy

by

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

by

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?

by

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

by

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.

Root Canal Gone Wrong!

by

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.

Can a Toothache Cause Chest Pain?

by

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.