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Wisdom Tooth Broke

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I have a wisdom tooth which has been bothering me for quite a while. I kept avoiding going to the dentist because they are not my favorite (no offense). I could live with the pain because I have some really good prescription pain pills due to some medical treatments I am going through. The decay grew to the point that the tooth just fell off. Not the underneath part, just the part that is visible. My question is, am I fine now or should I be concerned?

Steve

Dear Steve,

Man holding his cheek in need of an emergency dentist

No offense taken. In all honestly, there are a lot of people who are uncomfortable going to the dentist. Often it stems from dental trauma in childhood. Not all pediatric dentists realize that their actions and chairside manner can impact the child’s view of dental care for decades to come.

In the case of your wisdom tooth, your next actions (or non-action) will depend on whether or not the decay turned into a tooth infection that infected the root of the tooth. If you currently have no pain and have not had any pain in a while, you may be okay. Ideally, you’d get an x-ray that can tell you for sure if there was an infection. X-rays are painless and you are not obligated to get treatment based on what you learn.

If there is no infection, then you are probably fine to just leave things as is. If, however, there is an infection, then you will need treatment. In most cases, for other teeth, you’d get a root canal treatment. This is so that the tooth can be saved. However, wisdom teeth do not need to be saved. Your best bet is to just have it extracted.

I know the idea of treatment terrifies you. My suggestion is that you see a sedation dentist to get this work done, if it is necessary. I recommend oral conscious sedation. They can give you a pill that will completely relax you. In fact, you can even sleep through the appointment if that is what you want. If there is an infection, you don’t want to put off treatment. These are dental emergencies and left untreated they can cause serious problems. People still die from untreated tooth infections. However, the dental sedation will make sure you have a pain free appointment.

This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.

Dentist Can’t Figure Out Why My Tooth Hurts

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I’ve had a horrible toothache for several days and was able to get an appointment with my dentist. I’d just had some radiographs done three months ago, so he used those. He told me he didn’t see any crack in the filling where I am having the pain. He did prescribe me some antibiotics and told me if the pain goes away that I do not have to worry about it. However, this has me very worried because everything I’ve read said that if a tooth is infected, antibiotics will only be a temporary solution until the meds are done. Maybe I’m wrong.

LeeAnn

Dear LeeAnn,

A woman in pain holding her jaw, needing an emergency dentist.

The very first thing I am going to say is that you need a new dentist. There is so much wrong with both his diagnostic skills as well as his treatment plan. Let’s start with the diagnostics. He went from a three month old radiograph. Three months old. You didn’t have a toothache three months ago, did you? If not, then those imagings are useless. Something has changed in the last three months.

Second, there are other tests to do in addition to the one he did. For instance: tapping the tooth to evaluate pain, hot/cold tests, even electrical tests to determine if the pulp is alive. He did none of these. He just looked at three month old imaging. That is insane.

Even worse, however, is his treatment plan.If your antibiotics do help, that is a sign of a tooth infection. As you indicated, antibiotics do not cure tooth infections. You have a better understanding of this than your dentist.

There are two ways to adequately treat a tooth infection. The first is with a root canal treatment. The second is by extracting the tooth. If the antibiotics do cause the pain to get better, then I want you to see a dentist, a different dentist, to get this tooth treated. If you don’t, you’ll end up with a dental emergency that can turn life threatening.

This blog is brought to you by Portage Dentist Dr. Susan Dennis.
Click here to learn about holistic dental care.

Misdiagnosis Caused Pain and Dental Emergency

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I need advice on what to do. I went to my dentist telling him that my first molar (#19 according to an online chart) was bothering me. He felt like it was actually because of an impacted wisdom tooth. He suggested I get a filling, which I did, but it didn’t help. Then, he suggested I pull the tooth, which I did, but it didn’t help. A few weeks later, my cheek became swollen. I went to the hospital and they told me that I had a tooth infection and needed to see a dentist. The abscessed tooth is on the first molar, like I originally said. I’m not sure I trust my dentist. Should I see a specialist?

Ashley

Dear Ashley,

A woman in pain holding her jaw, needing an emergency dentist.

I’m sorry this happened to you. I’m not sure why your dentist thought a filling would fix an impacted wisdom tooth or why he didn’t check out the tooth you told him was hurting. You didn’t mention anything about him doing x-rays, but that doesn’t mean he didn’t do them. Either way, I wouldn’t trust this dentist either.

When you have an abscessed tooth it is serious. The fact that yours has spread to your cheek makes it more serious. I would consider it a dental emergency at this point. You don’t have to see your current dentist. I understand why you are having trouble trusting him. However, you do need to see a dentist soon. It doesn’t necessarily need to be a specialist, just someone able to treat you.

Most dentists leave room in their schedule for dental emergencies. Just explain to them what is going on and someone will get you in quickly. Hopefully, all you will need is a root canal treatment. That will save your tooth, but you will still likely need a dental crown on it.

If the tooth is too far gone to save, then the tooth will have to be extracted. Don’t just leave the open space once the tooth is gone. It will be important for you to replace the tooth. The ideal replacement will be a dental implant, but there are other options as well. Your first order of business is to get this tooth infection treated.

This blog is brought to you by Portage, MI Dentist Dr. Susan Dennis.

Porcelain Veneer Came Off

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I had porcelain veneers placed several years ago to cover my tetracycline stains. This week, I had one on a front tooth that split into two pieces and fell off. My new dentist glued it back on temporarily and is planning on replacing it with a crown. I moved to a new state since getting the veneers. However, this dentist says he can’t even get to the temporary tooth for a couple of weeks. The repair is not well done, is uncomfortable and looks fake. First, do I have to have a crown because the veneer broke? Second, would this not be considered a dental emergency?

Allie

Dear Allie,

A single porcelain veneer being held up o a tooth

First, do not let this dentist put a dental crown on your tooth if it is still healthy. That would grind it down and is completely unnecessary. Plus, a crown on a front tooth will weaken the tooth. This may be a sign that your new dentist is not a skilled cosmetic dentist. When a dentist suggests crowns in place of porcelain veneers, it generally means they don’t know how to do veneers well enough to feel comfortable with them.

Don’t force his hand to do a veneer. You won’t like the results. This is especially true because yours are covering tetracycline stains. This is one of the more advanced cosmetic procedures and requires a great deal of post-doctoral cosmetic training, along with some natural artistry on the part of the dentist. I recommend either returning to the original dentist to get this replaced or seeing someone else closer to you. Because he or she is out of state and you’re wanting to hurry, you can look for a skilled cosmetic dentist in your area. Make sure they have advanced cosmetic training and also ask to see example cases they’ve done with tetracycline stains. They should have a smile gallery that showcases their work.

While technically not a dental emergency, most cosmetic dentists understand an aesthetic emergency and will make room in their schedule for you. It should not take several weeks.

This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.

Are Tooth Infections Really Dangerous?

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I had a molar break a couple of weeks ago. Now the tooth hurts a lot and my cheek has stared to swell. I’ve been taking some antibiotics I had laying around. It helped at first, but hasn’t done much recently. Now I feel pain going up to my temple. Could this be a sinus thing or is it the tooth? Someone told me this is dangerous, but I don’t have a ton of money right now. How serious are we talking?

Luke

Dear Luke,

Man holding his cheek in need of an emergency dentist

I am very glad you wrote. This is a tooth infection, and yes, it is dangerous. If this remains untreated, it could spread to your brain and become life threatening. The situation you are in would be considered a dental emergency. Antibiotics alone will not deal with the infection. The best it can do is hold it at bay temporarily. But, it sounds like you have gotten everything you will be able to out of your antibiotics.

The only way to cure this is for a dentist to get in there and physically remove the infected pulp. This can be handled in one of two ways. First, you can have a root canal treatment. This is ideal because it means the tooth can still be saved. If that is no longer possible, then you will need to have the tooth extracted. I would not mess around with this.

Sometimes patients avoid the dentist because of anxiety. If that is your case, then I would look for a sedation dentist. They can provide you with an anxiety-free appointment.

If you end up extracting the tooth, then you will need to replace it or the adjacent teeth will then shift or tip into the open space. This will throw off your bite leading to jaw pain, headaches, or even TMJ Disorder.

The best tooth replacement is a dental implant. However, those are expensive. For now, you could always get a dental flipper, which is much less expensive and will hold the space open, giving you time to save up for the implant.

This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.

How To Get A Refund From a Dentist That Messed Up

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I had a tooth that was crooked for years because I was a thumbsucker as a child. I was hoping to straighten it out, but my dentist told me the same thing could be done with a dental crown. I liked the idea of not needing braces so I agreed. It was really sore after it was placed. He told me that was normal for the first week or so. Several weeks later, I was still in pain. I called but then he said it is probably because I am not used to wearing crowns and to give it more time. A few months later and I’m in so much pain that I almost went to the emergency room. My husband told me to get a second opinion by another dentist. I did the next day. He even got me in the very next day on an emergency appointment. When I went in he did an examination and an x-ray. He told me the tooth was very infected because the dentist who placed the crown did not place it properly and there are open margins. He showed me on the x-ray and the margins are huge. I need to get a root canal treatment now on top of another crown. I called my dentist and asked for my money back. They said what happens to my crown after I have it is not their problem and they expect me to pay the balance or they will send me to collections. Now I’m mad. They gave me a faulty crown that is going to cost me even more money and I need another procedure. I wasn’t asking them to pay for the root canal just my money back on my faulty crown. Is there any way to get my money back?

Caroline

Dear Caroline,

A woman in pain holding her jaw, needing an emergency dentist.

I am very sorry this happened to you and I’m glad the second dentist got you in for an emergency dental appointment. You’re fortunate it didn’t grow worse and turn life-threatening. Your jaw is very close to your heart, lungs, and brain. You don’t want an infection spreading there.

While I haven’t examined you, but based on what you said, I do believe your dentist violated the standard of care. After placing a dental crown, it is considered standard operating procedure to run an explorer around the margins to make sure it is properly fitted and there are no open margins. It helps that you have an x-ray to back up the claim.

It may not be financially worth it to go for a full malpractice case. There are some things you can do. I’d start by letting them know that you are going to the dental board with the x-ray and second opinion from the other dentist. This is something that the dentist would like to avoid almost as much as a malpractice suit.

Another thing you can do is have the second opinion dentist talk to your original dentist. Sometimes, dentist are more willing to listen to a peer than to a patient. If you do decide to go forward with a malpractice suit you will need to have another dentist testify on your behalf. It is required to have a medical opinion.

You could ask a lawyer to write you a threatening letter on his or her official stationary. That might make your dentist more willing to take the threat seriously and will cost you less than a full law suit.

This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.

Am I Too Old to Get My Wisdom Teeth Out?

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I am 30 years old. About five years ago, I had a wisdom tooth out. However, my dentist then never told me that the other teeth might eventually need out. Now one of the other wisdom teeth are bothering me. A friend mentioned that my age might be a problem. Am I too old to have this wisdom tooth out? If so, what do I do if it gets infected?

Bethany

Dear Bethany,

images of four types of impacted wisdom teeth

You are not yet too old. While the ideal age to have wisdom teeth removed is between the ages of 18 to 25 years, I don’t get too worried until the patient hits 40. Once you are above the ideal age, your chances of complications go up, but it does not mean that you will have complications. Because you’re still in a safer age, my suggestion is that you have the remainder of your wisdom teeth out at the same time.

While it may be tempting to just extract the wisdom tooth that is bothering you, there is a very strong possibility that you will end up in the same situation you are in now having to remove another tooth in a few years when you are at a more risky age to have the procedure done.

Even if you were at the “I’m concerned” age, if the tooth is infected, it has to come out. An infected tooth is considered a dental emergency. If you leave it untreated, then the infection will spread and you will end up with a life-threatening emergency. Your jaw is very close to your heart, lungs, and brain. You do not want an infection reaching those areas.

I would get a consult with either a sedation dentist or an oral surgeon. This needs to at least be looked at. Though, as I mentioned before, you’ll want to remove these teeth while it is still safer to do so. This is one of those cases where being proactive is essential.

This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.

Terrified of Getting My Wisdom Tooth Removed

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I am 36 years old. I had a wisdom tooth that was partially exposed and partially under the gum and bone. It had a cavity that has now turned into an infection. My dentist says that taking this out is high risk because of the angle, the fact that it is next to a tooth with a root canal treatment, and I have risk of nerve damage. Now, I am absolutely terrified of extracting this and having something go wrong with the tooth or nerve. Because it is at the side of my cheek, I’m worried my face will look sunken in as well in that area. I’m attaching an x-ray. Can I just treat the infection with an antibiotic?

Thanks, Keri

Keri's x-ray

I’m not seeing the infection, but if there is one, you do want to treat it. An antibiotic will not “cure” a tooth infection, only hold it at bay temporarily until you get the real treatment. There are two ways to treat a tooth infection. The first is with a root canal treatment. The second is with a tooth extraction.

For any tooth other than a wisdom tooth, I’d say get a root canal because this means you can save the tooth. A wisdom tooth you just want out. If the tooth is infected and you don’t extract it, you will not only end up with a dental emergency, but could end up with something that turns life threating. The infection will continue to spread to other parts of your body. Your jaw is close to your throat, heart, and lungs. If the infection spreads upward, it can even reach your brains.

Your lower left wisdom tooth does not appear to be impinging on a nerve at all. I would get your wisdom teeth out sooner rather than later. Don’t wait for all of them to develop a problem. The one exception to this is the tooth on the other side of the one bothering you now. That one looks like the roots are very close to the nerves.

I’m going to recommend that you get 3-dimensional scans of your mouth anyway. The dentist or oral surgeon will want to know exactly where all the nerves are in order to avoid them. Plus, he or she will need to be careful about the tooth with the root canal treatment.

I’m not too worried about the tooth that has the immediate problem being an issue. It would have been better if you had this done in your twenties before the roots are fully formed and the bone gets denser, but you’re still in a time where I don’t worry about complications. If you wait much longer, even just a few years, you will be in a danger zone for complications. That is a big reason why I do not want you to wait on the other teeth.

As for your face looking sunken in, that isn’t something to worry about. Your jawbone is more what determines the shape of your face in that area.

This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.
Click here to learn about dental sedation.

Extract My Wisdom Teeth or Wait Until They Bother Me?

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I have four impacted wisdom teeth. I’m 24 years old and only one of them is bothering me. While I know I need to extract the one that is having the problem, do I need to extract the remainder of the teeth or can I wait until they are actually bothering me? One of the things I am a bit concerned about is that one of the teeth has a root that is past a nerve. My dentist is suggesting leaving that root there and just removing the tooth part.

Kristin

Dear Kristin,

A woman in pain holding her jaw, needing an emergency dentist.

While you are young, as you are now, it is relatively easy to remove your wisdom teeth. That is because everything is rather pliable at your age. The older you get, the more difficult these extractions become. By the time you are 30, your chances of complications double. They double again every five years.

Because you are dealing with impacted wisdom teeth, it is not a matter of whether or not your wisdom teeth will become a problem but when. If your wisdom teeth were completely erupted, I would say leave them as it. However, yours are impacted. In my opinion, you are better off to get them all done at once while there is the least chance of complications.

As for the tooth root that is near a nerve. Your dentist was right to suggest leaving the root in order to avoid the nerve. However, I do not recommend leaving the entire root. I would only leave the very tip. This way your body is less likely to see it as a problem and will leave it alone.

What you do NOT want to do is wait until one of the wisdom teeth becomes infected, because then you will have a dental emergency on your hand. The good news is that wisdom teeth do not have to be replaced the way your other teeth do.

If you were to lose a different tooth, it would be essential that you replace it with something like a dental implant. This way the other teeth don’t shift or tip the remainder of your teeth into an empty space.

This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.

An Infected Tooth and No Money

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I have a missing tooth in the back of my mouth that I never replaced. Now, I have another tooth that is infected. It hurts so much that I cannot concentrate on anything anymore. This morning, my cheek started swelling. I don’t have any dental insurance and I was recently laid off from my job due to cutbacks. I have some Medicaid, but they don’t cover dental for adults. Is there anything I can do to help my tooth through my Medicaid, like an antibiotic that works on teeth?

Stephen

Dear Stephen,

Man in pain, holding his jaw and in need of an emergency dentist

Your situation is difficult. I am sorry you were laid off. I’ve seen so many people hurting economically these last few years. While the antibiotics can hold off an infection temporarily, once the antibiotics run out, your infection will return stronger than ever. Tooth infections are different than a bodily illness. They are more like a cancer. The only way to heal the tooth is for a dentist to get in there and physically remove the infected pulp.

There are two ways to accomplish this. The first is to have a root canal treatment done. This is where the dentist will open a hole in the tooth and remove the infected pulp, then fill the canal with dental material. This would be the preferred treatment because it will save your tooth.

If the tooth is too far gone, the next option is to extract the tooth. This ends up costing you more money in the long run because you will need to replace the tooth. If you don’t, your other teeth will eventually begin to drift or tip into the empty space. This will happen even faster for you because you already have a missing tooth in the area. Your bite is going to get thrown off and you may end up with TMJ Disorder and a lifetime of jaw pain and headaches.

Call your local dental society and see if there are any dentists who help a person in your situation. If not, there may be a dental school in your area. They have students doing the work so it is usually much less expensive. You are safe because there is an instructor there, but I would expect the appointment to take longer than your typical appointment. If none of that is available to you, I would simply call around to dentists in your area and explain your circumstances. Dentists are compassionate and are sometimes willing to work with someone financially during a dental emergency.

This blog is brought to you by Kalamazoo Dentist Dr. Susan Dennis.