Dr. Noah's Dentistry Blog

Questions About Dentistry Answered

Am I Too Old to Have My Wisdom Teeth Extracted?

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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.

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Tooth Replacements for Hockey Players

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My son is on a hockey team. They just finished their season. However, in the last game he took a direct hit and lost a tooth. We were planning on getting it replaced with a dental implant because I wanted him to have something permanent. However, one of his teammates said that a dental implant is a bad idea in case he gets hit again. What do you recommend? His appointment is coming up soon and I want to make sure he’s getting the right treatment.

Katherine

Dear Katherine,

Dental Implant Diagram

I’m glad you wrote. First, in normal circumstances, dental implants are the absolute best tooth replacement available, so you choose well. I was thinking about his teammate’s comments and believe I have a solution. Go forward with his appointment to have the dental implant placed. Having that implant in there will prevent him from having bone loss in that area.

The part I want you to put off is having the dental crown attached to the implant. If he were to get hit in that area again and the crown was secured to the implant it could cause some bone damage as the implant is ripped out.

Instead, what he needs is a temporary replacement to fit in the space above the implant. You could do a removable partial denture, or even a dental flipper. Either one of those will be inexpensive and provide him with a tooth until he can have a permanent crown safely placed when he’s done with his hockey career.

Thank you for writing about such an interesting problem.
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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.

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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.

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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.

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Invisalign and Missing Teeth

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If I have missing teeth, can I still get Invisalign? I’ve seen an orthodontist for a consultation and he said Invisalign only works on the most ideal cases, but my dentist thinks I can still get Invisalign if I want to. I’m not sure which is right. They both have “motive” to get my money. Hahaha. As I live in a completely different state from you and you can’t get any of my money, do you think Invisalign is possible for me?

Elinore

Dear Elinore,

Upper Invisalign Aligner

I like your style. It is always a good idea to ask for your advice from someone who cannot benefit from the answer given. While it used to be in its early days that Invisalign only worked on the easiest cases, there have been quite a few advancements in the technology and it is now on the opposite ends of the spectrum where it works on all but the most complicated cases.

Invisalign does fine working around missing teeth, so you shouldn’t have any problems with Invisalign if that is the most complicated thing about your case. So, you may be wondering why your orthodontist was saying it cannot. I don’t think it was a completely financial answer. Orthodontists were trained to work with braces. They have more confidence in working with that procedure. He’s telling you what HE can do the best job with.

If you decide to get Invisalign, you should know there is one other hidden benefit to Invisalign. The clear aligners they use can also double as teeth whitening trays. This means, if you want to, you can straighten and whiten your teeth at the same time. It is like getting a mini smile makeover for a fraction of the cost.

I would consult with the Invisalign dentist you choose about replacing the teeth. In some cases, the teeth can just be shifted, depending on the placement of the teeth, without it having a negative impact on your smile. However, in some cases, your dentist will need to open up space for you to replace those teeth. In that case, you can replace the teeth once your case is done. The best tooth replacement is a dental implant. However, one step at a time.

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Smile Club or Professional Orthodontics

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I’ve been trying to do save up for orthodontics for a long time. I’m getting close, but just read something about Smile Care Club. It’s a lot less expensive than the orthodontics. Is it okay for me to use that and then save the rest of the money for something else?

Lisa A.

Dear Lisa,

The best thing about the Smile Club is the cost savings. I just want you to think about it ahead of time. They have you send x-rays, but there are some things, such as gum disease, which is very hard to discern by x-rays alone. It usually takes a physical exam as well.

Gum disease is serious and can creep up on you silently. If you get this type of orthodontics while having gum disease, it will make the situation significantly worse. That puts you at risk of losing your teeth. In that case, instead of spending a little extra money up front, you’ll end up spending thousands to replace lost teeth.

The other thing to bear in mind is things which can go wrong during the treatment. Sometimes, as teeth are brought together, there needs to be some mild shaving to ensure they come together well. In that case you’d need to see a dentist. You’d want it to be a dentist invested in your case, but you won’t have one of those.

Smile Club keeps up with you by photos and phone. I feel one on one monitoring in person is the safest way to go, especially for the patient. This is designed to be a mail order substitute for Invisalign. You’d be better served getting actual Invisalign and the personal attention you both need and deserve during your treatment.

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