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Antibiotics for a Tooth Infection

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I have a tooth that is hurting me. It’s possible it is infected. I had a root canal treatment but the whole appointment was so distressing that I didn’t have the stomach to go back for the crown part. That is the tooth that is hurting. Is there an antibiotic I can take this time, instead of having to do the whole root canal thing again?

Bruce

Dear Bruce,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

I am sorry for the experience you had. Those type of traumatic dental procedures are what lead to patients developing a dental anxiety. It sounds like that is where you are right now. The bad news is that taking an antibiotic does not heal a tooth infection. What it can do is keep it from spreading further while you take it. However, once the antibiotic finishes, the infection will begin to spread again.

The only way to properly deal with a tooth infection is to physically remove the infected pulp. This can be done through a root canal treatment or a tooth extraction. There is good news, though!

Your next appointment can be done in a way that is both relaxing and pain-free. What you will need though is a sedation dentist. Specifically, look for someone who offers oral conscious sedation (OCR). This is sometimes called sleep dentistry because patients are often so relaxed that they will sleep through the entire appointment. Be aware, it is strong enough that you will need someone to drive you to and from your dental appointment. You will be way too relaxed to drive.

When a root canal treatment fails, the chances of a successful re-treatment go down with each attempt. Because of that, you may be better off seeing a root canal specialist. They are called endodontists. The exception to that would be if you are talking about a front tooth. Very few endodontists care about the aesthetics and even fewer have invested in any significant cosmetic training. If it is a front tooth, you’ll want to see an AACD accredited dentist. These are the best cosmetic dentists in the country. You want someone who can create a beautiful porcelain crown that will blend in perfectly with your adjacent teeth. That is tricky on a front tooth.

Regardless of what type of dentist you choose, make sure they offer oral conscious sedation so you do not have a repeat of your last appointment.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

 

Root Canal on a Canine Tooth

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I have a canine tooth that recently had a root canal treatment. The appointment was awful and reinforced all the reasons I avoid the dentist to begin with. A friend told me I am going to need to go back and get a dental crown put on it or the tooth will fracture. I don’t think I can go back. Is this completely necessary?

Pamela

Dear Pamela,

woman smiling with a dentist behind her

I’m going to address the fear you are experiencing first and then we’ll go into the canine tooth with a root canal treatment. You are not alone in feeling uncomfortable at the dentist. Many people struggle with dental anxiety. So I understand your desire to stay away. However, doing so will make things harder for you. May I suggest something that could change your life and allow you to sit in the dental chair without anxiety?

I am going to suggest you see a dentist who offers sedation options. The option I’d like you to try is oral conscious sedation. it is administered with a simple pill. It is so strong that, if you want to, you can even sleep through your appointment. The only inconvenience is the sedation is so strong you will need someone to drive you to and from your appointment.  On the flip side of that, you can get much more work done in one sitting which will allow you to catch up on needed dental work much sooner.

Root Canals on Canine Teeth

If a back tooth has a root canal treatment, a dental crown is necessary to protect it from fracture because of the biting stress. Front teeth, however, have completely different biting stresses. Because of that, a dental crown will actually weaken the tooth. It can even cause it to break off at the gumline.

The only reason for a crown on a front tooth would be if a significant amount of the tooth was gone because of decay. In that case, a crown would be a necessity even if not ideal.

Another reason some people will put a crown on a front tooth that doesn’t need one is for aesthetic reasons. A tooth with a root canal will turn dark. However, you can avoid a crown if your dentist follows the following procedure.

First, they’ll need to clean out the inside of the entire crown of the tooth. They shouldn’t leave any root canal filling materials or cement. Believe it or not, that material is a large part of the darkening. Then, your dentist will need to place a white fiberglass post deep into the root of the tooth. This will help strengthen the tooth and add resistance against biting stresses. Finally, fill the remainder of the space with a white composite material.

This method prevents darkening for several years. When it does begin turning dark, I’d recommend a porcelain veneer done by a skilled cosmetic dentist.

This blog is brought to you by Grosse Pointe Cosmetic Dentist Dr. Theodore Hadgis.

Does Premium Home Whitening Work?

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I received an offer in the mail for a Premium Home Whitening Kit. Do they work?

Callie

Dear Callie,

teeth whitening trays

Looking at this product I’ve got a positive and some potential negatives. First, the positive. The active ingredient is 35% carbamide peroxide. This whitening agent will work. That is quite a positive!  The blue light they offer doesn’t really have any value, though it won’t hurt anything.

Any over-the-counter kit is going to have a tray that doesn’t fit your teeth as well as what you would get with a custom fit tray you’d get with your dentist. That looseness can cause some negatives:

  • Leakage of the gel:  This will weaken the effectiveness of the gel. In turn, this will require you to need more gel to get the level of the whitening you desire, costing you more money with additional kits.
  • Vulnerability to your teeth: Just as your gel can get out, there will be things that can get in and pool there. This could be your drink or some food and bacteria. Sitting there will cause it to eat away and weaken the enamel of your teeth.
  • Irritation: A secondary problem with the leakage is that you risk irritation to your gums. In some cases, there can be more serious consequences such as one patient I know of, who needed a root canal treatment as a result of whitening her teeth outside of her dentist’s care.

You are likely looking at this option because you feel it will save you money over the professional teeth whitening your dentist offers. While that is possible, a lot of that will depend on how much whitening you want. What your dentist can offer is stronger and more effective, so it will take fewer treatments.

If all you will need is one kit, then yes, you could save money this way. But, looking at the maximum results you can get from one kit, I find it unlikely that would be someone’s end goal. You would need several kits. At that point, you are equal, if not more, to what your dentist would charge, without the benefit of being under their care where they can monitor for the start of any complications. I would talk to your dentist. If finances are keeping you from moving forward, ask if he or she offers any payment plans which would allow you to get started.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Dentist Can’t Get Me Numb

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I am terrified of going back to the dentist but know I need to.  I had my first tooth infection. I went in to get the root canal treatment and was a bit nervous already. Then the dentist just couldn’t get me numb. He tried six times. By then, I was a mess of tears. He wrote me a prescription pain killer as well as an antibiotic and told me we’d try again in a week.  It’s almost time again and I’m not sure I can go through with this.  Have you seen this happen before? Is there anything that can help?

Marci

Dear Marci,

Woman asleep in dental chair from dental sedation

I am pretty sure I know what happened here. It is something not many dentists have been educated about so I am not surprised that your dentist wasn’t sure what to do, even though there has been at least one journal article on the topic.  It is interesting to me that you said you were a bit nervous to start.  When you have dental anxiety, it has the unfortunate effect of burning off your numbing medication. It’s a vicious circle because you end up in more afraid after that experience, which in turn makes it harder for you to get numb. Fortunately, there is a way to stop the cycle.

The Solution to Dental Anxiety

Depending on what your dentist has available, you may have to switch dentists for your root canal treatment. You need a dentist who offers dental sedation options. In your case, I am going to recommend oral conscious sedation. This will allow you to sleep through your appointment completely pain-free.  You won’t have to sleep if you do not want to, but you will have no anxiety and will feel no pain. It is quite strong so you will need someone to drive you to and from your appointment.

I am sorry you had this experience.  Using this additional tool will change this to a positive experience for you.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

 

Scared to Get My Tooth Pulled

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I had a fall which broke my tooth a bit. It feels fine but looks funny with that chip. My sister told me I could get that repaired. Yet, when I went to see the dentist he wants to pull the tooth and give me a partial denture. I’m opposed to this for a few reasons. First, it’s a front tooth. Second, I’m too young for dentures. Third, and this is just being honest, the idea of getting a tooth pulled terrifies me. I’ve never been comfortable in the dental chair though I try to force myself to go at least once every couple of years. Is this my only option? Money isn’t an issue.

Craig

Dear Craig,

before and after dental bonding

I want you to bear in mind that I haven’t examined your tooth, but am inclined to think you need to see a different dentist. From what I’m getting, your tooth is chipped and that is all, right? If that is the case, the solution would be a dental bonding procedure (pictured above). This is a fairly difficult (for the dentist) cosmetic procedure. It may just boil down to your dentist doesn’t know how to do it. However, there is always the alternative of getting a porcelain crown.

Even if there were some more serious underlying issue, such as the tooth suffering enough trauma for the pulp to die, in that case you’d do a root canal treatment with a dental crown. I don’t understand this rush to extract the tooth. However, let’s say for the sake of argument that there is no way for the tooth to be saved. Why then do a removable partial denture when there are much better options available? Did he mention a dental implant or even a dental bridge? The fact that he is suggesting a cheap denture is a sign to me you are not getting top-quality care. You said money wasn’t an issue, so it is not a matter of him knowing you need the cheapest solution.

What I’d like you to do is get a second opinion from one of the dentists listed on the mynewsmile.com website. They can not only handle all your cosmetic dentistry needs, but additionally, they have the cosmetic skills necessary to give you a gorgeous repair that will blend right in with your tooth.

If the Tooth Needs to Be Extracted

Let’s say the worst-case scenario is true and the tooth needs to be extracted. Don’t be embarrassed for being uncomfortable with that. Many patients aren’t exactly counting down the days with joyous anticipation for their next dental appointment. One thing I suggest to patients in situations such as yous is to have the tooth extracted with a dentist who offers oral conscious sedation. This is sometimes dubbed sleep dentistry because you will be so relaxed you can just sleep through the procedure you want. The only downside is you will need someone to drive you to and from your appointment as well as stay with you until you are lucid and steady on your feet again.

Then, when it is time to get your permanent tooth replacement. I highly recommend you get a dental implant. This is the closest thing to a healthy, natural tooth. It’s also surgically implanted into your jawbone so you will not have to worry about anything removable.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

My Tooth is Killing Me

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I’ve had a toothache since the quarantine started. Now it is almost unbearable. I’ve heard you can go to the dentist in situations like this, even during the quarantine, but I will be honest and tell you I am absolutely TERRIFIED of dentists. I feel like I’m going to have to go, but is there any way to do this at a hospital where they can knock me out for any procedures?

Todd G.

Dear Todd,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

You are correct that in cases like yours, where you need urgent care, you are able to see a dentist. A hospital isn’t a good solution for you, though. They will not treat dental issues. At best, they’ll give you a $100 ibuprofen and tell you to see a dentist. However, I do have some good news for you.

First, you should know that you aren’t alone in your struggle with the dental chair. Many patients have a phobia of the dentist. Often, this springs from a traumatic experience as a child. Second, and this is the best bit, there are dentists who understand this, are compassionate, and have a solution.

I’m guessing, based on your question, that you don’t have a regular family dentist. I’d like you to do an internet search using the term sedation dentist. ‘for patients with high dental anxiety, such as yourself, I usually recommend looking for a dentist who offers oral conscious sedation. This is administered by swallowing a pill and will absolutely, completely relax you.

In fact, it is so strong you will need someone to drive you to and from your appointment as well as stay with you for a few hours after the appointment until you are lucid. Most people sleep through their appointments. It will give you a stress-free/pain-free appointment.

I say that now because I want you to understand that a tooth infection is serious and that you can get this treated in a way that you won’t have anxiety. When left untreated, they can spread to your heart, lungs, or even your brain. Those turn life-threatening quickly. It sounds crazy, especially given how treatable they are, but people still die from tooth infections in the 21st century.

Treating a Tooth Infection

Unlike other infections, an antibiotic alone won’t “heal” the infection. This is because the pulp in the tooth dies and the medication can no longer reach the root of the infection. A dentist will have to get in there and physically remove the infected tissue. This is typically done through a root canal treatment. If a tooth isn’t saveable, then you will need to have the tooth extracted. This is another good reason to get this dealt with sooner rather than later.

If you lose the tooth, you will want to replace it. Otherwise, aside from the aesthetic issues on your smile, the other teeth will shift or tip into the empty space. This will throw off your bite and could possibly lead to painful TMJ issues. The best tooth replacement is a dental implant. This will be like having a healthy, natural tooth again.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

My Tooth Hurts but Dentist Insists it’s Fine

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I had a root canal several weeks ago. The tooth felt a tiny bit better but never normal. The pain has slowly been increasing again and now hurts like mad. My dentist did x-rays and said the tooth is fine and I should see a neurologist. I don’t think I’m imagining this. What can I do?

Asher

Dear Asher,

Man grabbing the side of his jaw in obvious pain and in need of a dentist

Because I haven’t examined your tooth, I can’t give you a definitive answer, but can give you some possibilities that could point you in the right direction.

Toothache from Referred Pain

Sometimes where we feel the pain isn’t where the pain is originating. It can be the tooth on the arch below it or a nearby tooth. If it is your upper arch, you could actually be dealing with a sinus infection. Our sinus cavities are very near the roots of our teeth.

Toothache from Nueralgia

When the dentist suggested you see a neurologist, it doesn’t mean that he thinks the pain is in your head. It is not uncommon for a nerve to cause tooth pain. Seeing a doctor who can properly diagnosis this can be helpful. It wouldn’t be the first place I’d go, but if everything else fails, don’t rule it out.

Toothache from Misdiagnosis

It is also possible that your dentist misread the x-ray or didn’t listen carefully enough to explore other options that could be causing your pain. If this is the case, you’ll need a second opinion.

How to Get a Good Second Opinion from Another Dentist

When you get your second opinion, just tell them when you had your root canal treatment and what your symptoms are now. You can also bring your x-rays, though they may want to take their own as well if they think the problem may actually be in a different area.

What you don’t want to do is tell them who your dentist is and what his opinion of the tooth was. You want their unbiased opinion. One of the reasons for that is you don’t want your dentist’s diagnosis to sway them or, worse, colleagues sometimes don’t want to speak against a colleague they know. If they ask, tell them you just want their thought, nothing else.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Another Porcelain Veneers Horror Story

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I had some misaligned teeth in the front when I smiled. It’s always been an embarrassment. I recently read that bad teeth can have a negative impact on your career. I decided it was time to invest in my smile and (hopefully) my career as well. I went to see a dentist who said he was a cosmetic dentist to get an idea of what to do. He suggested four porcelain veneers as they would take away the negative appearance but not require me to wear braces. Plus, it would be an instantaneous fix. It sounded great. So, I agreed. Unfortunately, it didn’t work out that way at all. The veneers seemed too small. All of them seemed to have a ridge at the top where I’m worried things will get trapped. On top of that, my teeth don’t match and everything still looks uneven. He also did some reshaping of bottom teeth which I didn’t ask for and charged me for it. I asked him what we needed to do to get the results he promised me and he said my teeth are in bad shape and need root canal treatments and crowns. I found this hard to believe so went to get a second opinion from another cosmetic dentist. He said the teeth are healthy and the only thing I need is to have the veneers re-done. What do I do now? I’m out A TON of money.

Ben

Dear Ben,

A single porcelain veneer being placed on a tooth

The first thing I’ll say is you should know that there isn’t a recognized specialty in cosmetic dentistry. That means any general dentist can call themselves a cosmetic dentist. To make matters worse, smile makeovers aren’t taught in dental school.

In order to be a skilled cosmetic dentist, the individual dentists need to seek out and invest in post-doctoral training in this skill. Plus, that doesn’t guarantee skill. Look at it this way. You can have 20 people taking an art course, but not all of them will do beautiful work. You want the dentist who is at the top of the class.

So, how is a patient to know? The American Academy of Cosmetic Dentistry (AACD) has an accreditation program for just this reason. If I were looking to improve my smile. I’d go to see an AACD accredited dentist.

When Your Porcelain Veneers are a Disaster

You have the right to a refund. I’d start by just outright asking the dentist. You have three things going for you in this:

  • He did work without your permission. This is a big no-no in the dental field and he can get in trouble. He is supposed to have your go ahead.
  • His work is faulty. With what you described the ridge on your teeth, it sounds like he gave you bulky margins by not getting the porcelain veneers flush. Your concern that things will get trapped there is valid. They will and it will lead to decay.
  • You have another dentist saying he lied to you and his work is subpar.

With these factors going for you, if he declines to give you a full refund I’d play hardball. However, be sure you get the other dentist to write out what’s wrong with your case and also that you did not need root canal treatments. Let the dentist know that if he doesn’t return your money you will be reporting him to the dental board as well as taking him to court. That should give him some pause.

This blog is brought to you by Grosse Pointe Woods Cosmetic Dentist Dr. Theodore Hadgis.

Root Canal because of Crest Whitestrips?

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I had a damaged tooth years ago that was repaired by an oral surgeon. Since the repair, it’s always been a bit discolored and the gum misplaced in a way that exposes some dentin. I’d decided I wanted to try to get the color even with the rest of my teeth. My dentist suggested I try Crest Whitestrips. I was excited to try them. Everything was fine for the first week. Then, my injured tooth began to hurt. At first, I thought it was a fluke but when the pain didn’t subside, I decided to stop the treatment. It’s been two weeks and the pain is still there. My dentist thinks I need root canal treatment. I have some questions. Do you think a root canal treatment is the way to go? If so, is this a common side effect of teeth whitening? If so, should I have been warned of this ahead of time?

Annabeth

Dear Annabeth,

teeth whitening trays

Can teeth whitening lead to needing a root canal?

First, I need to express that your dentist doesn’t understand much about teeth whitening. Which, if I’m honest, sort of frightens me. While there are quite a few cosmetic procedures, such as a smile makeover with porcelain veneers, which require serious expertise, teeth whitening generally isn’t one of them. That’s a procedure I’d thought every dentist understood, at least until your question.

The first thing he did wrong is forgetting that the whitening strips only whiten your front six teeth. While it obviously was able to reach the necessary tooth, it will whiten all six teeth uniformly. So, while your darker tooth will whiten, so will the other five along with it, causing it still to be the tooth which is darker than the others.

Did the Teeth Whitening Cause this?

I’m not sure what’s going on with your sensitive tooth. While it is certainly irritated, I couldn’t tell you if it is infected. An x-ray should help. Also, a cold-sensitivity test would indicate a need for a root canal treatment.

As for whether or not bleaching your teeth can cause sensitive teeth, it’s possible. It’s always important to do any whitening procedure under the supervision of a dentist. While Crest Whitestrips are much weaker than professional teeth whitening, you do have exposed dentin. It’s possible the whitening just threw the tooth over the edge.

The bigger question for you is where do you go from here? I’d get a second opinion from a different dentist. Let them do an x-ray and exam along with a test for cold sensitivity. If a root canal treatment is necessary it will solve the problem. If it’s not, he can help you discover what is.

Can You Get This Tooth to Look Beautiful?

If you really want to improve the look of your smile, what you need is a consultation with a truly skilled cosmetic dentist. It takes both technical knowledge and skill, along with an artistic eye to create beautiful smiles. See if there is an AACD accredited dentist in your area. If not, check the mynewsmile.com website and see who they recommend near you.

This blog is brought to you by Grosse Pointe Woods Dentist Dr. Theodore Hadgis.

Free Dental Sedation in 2019?

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I was told the law is changing in 2019 for dental sedation to be covered by insurance. If I have a tooth that’s bothering me, is it okay to wait until the sedation will be covered by insurance?

Kelly A.

Dear Kelly,

Woman asleep in dental chair from dental sedation

You should know each state has their own laws regarding dentistry and sedation. There is a change in the law regarding dental sedation on the books in California that is proposed. If it passes, it’s slated to take effect in 2019. However, it’s a long way from passing at the moment.

Currently in California anesthesia is only covered when the patient is in the hospital. A lot of patients who prefer to use anesthesia for treatment don’t really need a hospital (which naturally has a higher cost). The proposal re-words it to cover anesthesia in certain other medical settings as well. This could be a great help for patients with dental anxiety.

Don’t Wait on the Dental Sedation Law for Treatment

Woman grabbing her jaw with pain

It’s dangerous for you to hold off on dental care when you have a tooth in pain. Pain, in the dental sphere, usually represents an infection. If you put it off too long, you’ll have a dental emergency on your hands. Wait longer and you will have a life-threatening emergency on your hands.

Most people don’t realize how dangerous a dental infection can be. Your jaw is very close to both your heart and brain. If the infection reaches those areas, you can die. In fact, several people died just this last year due to waiting too long to deal with their teeth.

In other cases, the decay can become so invasive that you can’t save the tooth. That means a tooth extraction and expensive tooth replacements, such as dental implants.

Most dentists are compassionate. If you have dental issues that need addressing and don’t have the money, it usually only takes the willingness to talk to them about it. Often, they’ll offer payment plans. If for some reason you have a dentist who’s unwilling to work with you, you can either try another dentist or apply for Care Credit.

It’s a medical credit card which has low and even no-interest payments depending on your credit. There’s also no penalty for early payoff.

This blog is brought to you by Dr. Theodore Hadgis.