Is a Tooth Infection Dangerous?

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I have been taking an antibiotic for a problem with what I think is my tooth, but it does not seem to be getting any better. A little over a week ago, I broke a molar. I thought it would be okay but I have been having a lot of pain in the jaw area. Then, it started to hurt in my cheek. Today, it started hurting in my sinuses. I don’t understand why this antibiotic is not working. Is this dangerous or should I just keep taking the antibiotic?

George

Dear George,

Man grabbing his cheek in pain

Yes, this is dangerous and I believe your tooth is infected and the infection is spreading. At this point, I would consider it a dental emergency because this seems to be spreading faster than I would expect. You do not want it to reach your brain.

I’m curious as to who prescribed you the antibiotic. If it was a dentist, he or she should have also made sure that you knew there would be a follow up appointment needed. Antibiotics alone do not cure a tooth infection. It is only truly dealt with when a dentist gets in there and removes the infected pulp.

This is done one of two ways. The first is with a root canal treatment. The second is by extracting the tooth. It is ideal if you can save the tooth by having a root canal treatment.

Please do not put this off. If for some reason your tooth cannot be saved and you have to extract it, it will also be important that you replace that tooth. Otherwise, the other teeth will drift or tip into the empty space. This will throw off your bite, which will lead to pain and possibly TMJ disorder.

The best tooth replacement is a dental implant. Hopefully, it will not come to that.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Can I Put Off A Root Canal Treatment

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I don’t have a lot of money at the moment and it is even worse with the holidays at the moment. I know it is important to treat it and I will. I’m just hoping that I can put it off until maybe March, when my tax refund comes in.

Bernard

Dear Bernard,

Man grabbing his cheek in pain

It will be really hard to diangose this without seeing you. However, I can give you some basic principles that may help you navigate this. The first thing to remember is that if it is hurting you need to see a dentist right away. That’s important even if it stopped hurting but is hurting again. This is a sign of an active infection which is considered a dental emergency. You won’t need to go in today, but will want to get in fairly soon. An Active infection grows and can become life threating. Another sign of an active infection is if there is a pimple on your gums.

If it is not hurting, you may be able to wait. I could not tell you how long because each infection is different. I know of a patient who had an arrested infection for about eight years. She didn’t even realize it. Once we did the root canal treatment, she felt better. She had no idea that the unexplained achiness and general malaise she had been feeling was due to an infected tooth.

There is an additional risk to waiting that you should be aware of. In some cases, there is external resorption where the infection slowly eats away at the root of the tooth. This makes the tooth unsaveable. The only option you’ll have then is a tooth extraction and replacement.

If you are in a situation with an active infection, I suggest that you call around to some local dentists and see if they’d be willing to work with you on payments. This way you can get the treatment you need, but pay it out slowly until your refund come in.

This blog is brought to you Marietta Dentist Dr. Cristi Cheek.

Antibiotics for a Tooth Infection

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I need some advice on what to do about my tooth. I went to the dentist last week because my tooth was infected. The swelling went all the way up to my eye. He gave me some pretty strong antibiotics, which I’ve taken religiously. Everything started to get better. However, since the medicine ran out things have gotten bad again, including the swelling. Do I call to get a refill or does this mean that I was on the wrong antibiotic?

Andy

Dear Andy,

Man grabbing his cheek in pain

I am hoping that there has been some miscommunication between you and your dentist. Otherwise, it means your dentist has a profound misunderstanding of how tooth infections work. That is not a good quality to have in your dentist. Antibiotics alone will not cure a tooth infection. The infected pulp has to be physically removed by the dentist. This is typically done by either a root canal treatment or a tooth extraction. A root canal treatment is preferable because it saves the root of your tooth. However, sometimes the tooth is not saveable. In that case, an extraction is necessary. You would also need to replace the tooth so you don’t end up with tipping or shifting that throws off your bite. Leaving it open could lead to painful TMJ Disorder. 

In your case, he probably prescribed the antibiotics in order to get your infection under control. That would not have been the treatment. Instead, they would schedule an additional appointment for you to have the root canal treatment. Hopefully, it is not too late and your tooth can still be saved.

In your place, I suggest that you call your dentist and schedule an emergency visit. If he just gives you more antibiotics, make sure that the appointment to treat the tooth is on the books for BEFORE your medication runs out. If they don’t do that, it means you need a new dentist. 

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Can I Save My Teeth?

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I have a filling on two teeth which are adjacent to each other. I started having pain with those teeth. Eventually, the pain got so bad that I went to see a dentist. I will admit to not liking to go unless it is necessary. I do get one cleaning a year, but that’s about all I can handle. The dentist did an x-ray and told me that there is an abscess and the teeth will need to be pulled. I’m sort of a wreck over this. I don’t like the idea of not having those teeth. Is there any way to save them?

Kelly

Dear Kelly,

woman grabbing her jaw in pain

I am sorry you are in so much pain. What I would like you to do is get a second opinion on these teeth. Just because you have an abscessed tooth does not mean that the tooth has to be extracted. Unless the tooth is too far gone to be saved, the typical solution is to do a root canal treatment. This cleans out the infected pulp of the tooth. In most cases, you will also need a dental crown but this allows you to save your tooth.

I’m having some doubts that your teeth are as far gone as to necessitate an extraction. If they were that bad I do not think an x-ray would even have been necessary. To be honest, some dentists are just more willing to put in the work to save teeth than others.

You mentioned that you do not like going to the dentist. That is usually a sign of dental anxiety and is more common than people realize. When you get your second opinion, I would like you to see a sedation dentist. They can provide you with some medication which will allow you to feel completely relaxed in the dental chair.

If it does turn out that you need your teeth extracted, you will want to replace them as soon as possible. If you don’t, the adjacent teeth will drift and tip into the empty space, which can lead to painful TMJ Disorder. If it comes to that, the best tooth replacement is a dental implant.

Don’t put off getting this double checked. You do not want it to turn into a dental emergency.
This blog is brought to you by Marietta Dentist Dr. Cristi Cheek.
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Solution for My Ugly Tooth

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I have a bit of a problem. I got hit with a pool cue right in the front tooth at full force. Don’t ask. It’s been a while and since then the tooth turned an ugly brown. I went to my dentist and he told me most of the root was gone so I would need a dental implant. He also told me I had three back teeth that needed fillings. I can’t afford to have all of that done and fix my ugly tooth. Do you know of anything that will help me?

Penelope

Dear Penelope,

illustration of a dental implant

I am going to suggest that you change dentists for a couple of reasons. One is the root resorption. If your dentist had treated your tooth when it first experienced the trauma, he could have saved the root, which would in turn have saved your tooth. He should have done a root canal treatment. Unfortunately, now that you have no root left, there really isn’t anything that can be done to save the tooth.

This does not necessarily mean you will need to have an expensive dental implant if you cannot afford it. There are other tooth replacement options. This leads me to the second reason to get rid of your current dentist. He or she is legally obligated to give you all your treatment options, even if he prefers other options.

Some possibilities for you include:

  • A dental bridge: This is a false tooth suspended between two dental crowns
  • A removable partial denture: This is just like it sounds. It will clip to your adjacent teeth.
  • A dental flipper: This is your least expensive option. It’s like a cheaper version of the denture.

Find another dentist who has the integrity to look after your oral health and give you all your options. Then, ask him or her to triage the needs so you can start with the most urgent. This can make it easier to deal with financially.

This blog is brought to you by Marietta Dentist Dr. Cristi Cheek.

 

Premium Home Whitening

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I keep seeing advertisements for something called Premium Home Whitening. If you are familiar with this product, would you mind letting me know what you think of it? I don’t want to waste my money, but I am interested in whitening my teeth. My dentist doesn’t do any cosmetic work, but I’ve been with him for years and would feel bad leaving.

Lorraine

Dear Lorraine,

tooth bleaching trays

Teeth whitening trays

 

I looked at this kit. Here’s what I found. First, the whitening ingredient is 35% carbamide peroxide. That is a good teeth whitening ingredient. That’s a real plus and better than I see in most over-the-counter whitening kits. There are some things that lessen its value to you, though.

One of the biggest issues is the tray. The trays you see in the image above are custom-fitted by a dentist. This ensures that the teeth whitening gel stays in the trays and your saliva stays out. The trays with Premium Home Whitening are DIY, that means you’ll bite down to create the fit of the trays. These will not be custom fit. You’ll find that your saliva will get into the trays, which will dilute the whitening gel, making it less effective. In addition, your gel will leak out, not only will that not whiten your teeth, but it will put your gums at risk. There have been cases of someone needing a root canal treatment because of over-the-counter teeth whitening.

While this will whiten your teeth, I think in the long run it will cost you more to get equal results than you could from a dentist. I do realize your dentist does not do teeth whitening. You don’t have to leave him to get your teeth professionally bleached, though. You could go to your dentist for your general dental care and another for your cosmetic work. It is a common practice and your dentist would not be offended at all. If he wanted your teeth whitening business, he’d offer the service.

This blog is brought to you by East Cobb Dentist Dr. Kristi Cheek.

Will a Root Canal Treatment Damage My Porcelain Veneer?

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I just had eight porcelain veneers done and now I found out one of them needs a root canal treatment. I’ve read that a root canal treatment can turn a tooth dark and I don’t want that to ruin my veneer. I really like them. I can’t imagine why I’d need a porcelain veneer. I’ve been so careful taking care of them because I’m happy I finally have a smile I like and I don’t want it ruined. What do you recommend?

Lisa

Dear Lisa,

I’m concerned about why you needed the root canal treatment to begin with. I hope this wasn’t the result of your dentist being too aggressive. When teeth are being prepared for porcelain veneers, it doesn’t take much. At the most, your dentist should remove about half a millimeter.

photo of tooth preparation for porcelain veneers

The photo directly above shows a depth limiting diamond bur being used to prepare some teeth for porcelain veneers. Using a tool like this helps protect the tooth from the dentist going too deep in the preparation. Some dentists get carried away and will reach the dentin. Others will actually do porcelain crowns and just call them porcelain veneers. When doing a crown the dentist has to grind the teeth down to nubs.

Protecting the Beauty of Porcelain Veneers with a Root Canal

There is a way to help prevent the darkening of the tooth which needs the root canal treatment. Most of the darkening comes from the root canal filling material itself. This can be significantly reduced by following the procedure I’m about to outline.

1. Have your dentist clean out all the material from the crown of the tooth.
2. He or she should then place a white fiberglass post into the root.
3. Fill the remainder of the space with a light/white colored composite material.

Doing this will delay any darkening for quite a few years.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Are Steriods the Right Option After a Root Canal?

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I had a root canal treatment which seemed fine at first, but then I started to have tooth pain several weeks later. I went to see the endodontist, who then prescribed me a course of antibiotics. That helped and she said I’d be fine now. However, a few weeks later the pain returned. She’s since placed me on a course of steroids, but I’ve gotten worse instead of better. I’m not sure what to do.

Adrian

Dear Adrian,

a woman holding her jaw from TMJ pain

While we do sometimes prescribe steroids with a root canal treatment, it seems like your endodontist doesn’t understand the science behind it. Steroids are an anti-inflammatory. There are times this is an appropriate treatment. Generally, with a root canal treatment, there can be some irritation at the end of the tooth root. This can happen for several reasons. The file could poke through the end of the root or some materials, such as the infected pulp, the disinfection solution, or the filling material itself can make their way out. This causes a vicious cycle of pain and inflammation, but there is not necessarily an infection.

The inflammation causes swelling of the tissues around the end of the tooth, This, in turn, pushes the tooth up causing traumatic occlusion (how the teeth meet together). That then aggravates the inflammation, causing more swelling, starting the cycle over again. Prescribing steroids, in this case, can help stabilize the body’s response.

Because sometimes there could be infected tissue being pushed through, a brief course of antibiotics is generally prescribed along with the steroids.

However, this isn’t your problem. The best dentists will find the cause before prescribing a treatment. In your case, it was the wrong treatment. We were dealing with an obvious infection here. In that case, prescribing steroids is the WRONG treatment. Steroids are an anti-inflammatory. However, that inflammatory response is necessary in the case of infection. It brings necessary white blood cells and antibodies necessary to fight the infection. By prescribing steroids your dentist actually hindered your ability to heal.

Root Canal Treatment Failure

Your situation sounds more a case of root canal treatment failure. This doesn’t mean your endodontist did the root canal incorrectly. While I’ve been harsh on her diagnostic and follow up treatment skills, you can do everything right in a root canal and it will still fail.

The canal system inside a tooth is complex. It is easy to miss a small canal. Plus, some shoot off at a 90-degree angle and there is no way for the tool to reach everything. When a tooth flares up weeks after the treatment, it means there is an infection present and the root canal didn’t succeed. This is why your antibiotic treatment she gave you after the first flare-up made your tooth feel better. It brought the infection under control.

However, without getting in there and ridding the tooth of the infection completely it will rear its ugly head again. This is what you’re experiencing now. In this case, steroids are a hindrance rather than a help. You have some options here. The first is to have another root canal treatment done to try to completely get the infection. You should be aware the risk of failure increases with each root canal re-treatment. That doesn’t mean it is a waste of time to try, just be aware of the statistics. Two other options are root canal surgery or having the tooth extracted.

If you do end up extracting the tooth, don’t wait too long to replace it. There are more than esthetics to factor in. Your other teeth will begin to shift into the empty space. You can ask your dentist about tooth replacement options, including dental implants. Then decide which is best for your situation.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

Whitening Your Teeth with Clorox Bleach

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I have a friend who bleaches her teeth with Clorox. I was worried when I heard about this. Is she going to damage her health from this, or is it okay?

A worried friend

Dear Worried,

teeth whitening trays

You sound like a good friend who is trying to do everything you can to keep your friend safe. The good news is, unless she’s swallowing it, she’s not likely to die. I have a cosmetic dentist friend who had a patient who did this too. He joked that, although he couldn’t recommend it, for reasons I’ll elucidate in a moment, he wasn’t that concerned.

Here are some of the issues to consider when it comes to using something like Clorox bleach. This chemical is a base, which makes it very corrosive and can burn living tissue. Additionally, if it mixes with certain other types of chemicals it can react and turn into toxic chlorine gas. But if she is swishing with it quickly, she may be avoiding any tissue damage.

When is it Safe?

Almost all dentists were taught in dental school to use bleach to dissolve the dead organic debris and disinfect the canals in a root canal treatment.

According to PubMed, it is also safe to do periodically as an oral rinse, but only diluted. They recommend a 1:20 ratio in the dilution.

Get Teeth Whitened in One Appointment

The Clorox is a slow process that has to be repeated over and over. While it may get her teeth a bit whiter, it is also likely causing tissue damage. Instead, she can get her teeth as white as they can get in just one appointment with Zoom Whitening. It’s fast and safe. That may appeal to her.

Avoid the Bleaching Police with Professional Teeth Whitening

According to a label on Clorox Bleach, “It is a violation of federal law to use this product in a manner inconsistent with its labeling.” If she doesn’t listen to the fact that it can burn the tissue in her mouth, maybe you can tell her about the bleaching police.

Suggesting she get her teeth whitened safely with a dentist is a good thing. Maybe she’ll listen. Then again, she may live on the wild side and already be a federal fugitive by ripping off the tag on her mattress.

I’m sure she’ll appreciate how much you care about her.
This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.

How Long Until a Dental Implant Can Be Placed?

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I’m trying to make some big decisions about a tooth. I had a dental crown done months ago which my dentist now thinks probably should have had a root canal treatment done, but now that there’s a crown it can’t be. He’s suggesting pulling the tooth and doing a dental bridge. I’m getting a second opinion to see if there is another option. I think if I do have to lose the tooth, I’d rather get a dental implant. However, I’ve just now gotten dental insurance and all procedures require a one year waiting period. Will my teeth start to shift in that long of a time period?

Kevin

Dear Kevin,

An image of a dental implant crown being placed in three stages

I’m a little concerned about the dentist you’re seeing. If you need a root canal treatment, you need one. It doesn’t matter if you have a crown. Saving the tooth is the priority. I’m glad you’re getting a second opinion. If at all possible, a tooth should be saved.

I also agree that a dental implant is a better option than a dental bridge, especially for a single tooth. To get a bridge would require both adjacent teeth be ground down for dental crowns. This is a waste of healthy tooth structure.

I’m not sure your dentist is looking out for your best interest as much as what is most convenient for him.

Getting a Dental Implant

Worst case scenario, your tooth has to be extracted. With a waiting period, my suggestion is you get a temporary replacement, like a dental flipper, until the waiting period passes. Even if you were to get the dental implant surgery right away, there is still a waiting period while the surgical site heals and the bone has time to integrate around the dental implant.

Once the healing is done, your dentist will place a dental crown on the implant. It’s like having a healthy, natural tooth again.

Dentists will place something there to hold the space open, just like you can do while you wait on your insurance.

This blog is brought to you by East Cobb Dentist Dr. Cristi Cheek.