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Abcess under crown is extraction always necessary?

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toothlesswonder

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Dec 12, 2006
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Hi
First time here so hope I am in the right place!
Last week I had chronic pain from an abcess under a gold crown on my upper tooth (think it is a molar!) I had to see a different dentist at my practice who was less than sympathetic to my dental phobia and after much tutting and sighing and telling me how bad my dental hygiene is she said the gold crown would have to come out in 4 days after a course of antibiotics. Needless to say she made me feel extremely belittled (and I do clean my teeth twice daily and floss!) so much for the effort my dentist has put in to trying to overcome my fears etc. she did this away in 5 minutes.

She asked me if the crown was root filled as she couldnt see on the Xray but I cant remember as I have several root fillings, I would of thought before you go pulling teeth you should know what you are dealing with and if it is the only option.

My concern here is that after 4 days of Amoxycillin the tooth has calmed down, so does the crown and root filling really need to be removed asap as she indicated or have I time to get a secondary opinion?
 
P

Parsnip

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Hi, and welcome!

I hope you ARE in the right place - 'cos if you aren't - then maybe neither am I! :)

Supposing that the tooth has not previously been root filled, if you are interested in saving the tooth - and it sounds like you are (Good!) then it may be possible to deal with the abscess by root filling the tooth. I say 'may' because there other factors involved. We can deal with these later, but for now lets look at why you have the abscess and pain, and why antibiotics have helped.

The usual reason for placing a crown on a tooth is to reinforce the tooth as it has been broken down by decay, failed fillings etc. Every filling that is done to a tooth places the living element of the tooth under strain - ie the pulp which resides in the root canal system. Eventually after so many fillings, a bit of decay, another larger filling etc etc the pulp says "I have had enough!" and decides to cop it. In marriage terms this is like asking for a divorce. I have not yet had the experience of having one of my teeth root filled, but I have the other - both painful in their own way, usually require a long term commitment of some sort - but root canal is probably cheaper. Forgive me, I'm off on one again! Anyway the nerve loses the will to live and dies. The by products of this is a bunch of mush in your root canal system which is full of bacteria and the beginnings of infection. If it were a cut on your hand say, the body could deal with this by forming scar tissue and healing in the normal way... but the dead nerve tissue is trapped within the confines of your tooth and the body can do little about it. The infection spreads and begins to form an abscess underneath the tooth - fed by the bacteria and the dead tissue within the tooth. This spreading infection takes up space in the bone and leads to feelings of pressure amongst others - if you bite on the tooth you effectively push the tooth into the abscess and you get more pain. "Ouch"

You can see a picture of an abscess under an incisor here...

[broken link to image removed]

Antibiotics do essentially what it says on the tin - they kill off the bacteria within the abscess (they also do other things like giving you the runs and interfering with the effectiveness of the oral contraceptive pill, but thats another story..) The abscess gets smaller as a result and once more you can bite on the tooth. Unfortunately you still have that dead matter within the tooth waiting for you to stop taking the antibiotics so that it can return to building the abscess. So antibiotics are only effective in the short term - sometimes weeks - sometimes longer. The dead tissue within the tooth needs to be dealt with by your dentist. This can be achieved by either removing the infected dead stuff by root canal treatment, or by extracting the tooth.

Long story cut short - you have time to get this looked at by a more empathic dentist, and have the reasons for and against either treatment explained to you, and the likely prognosis for each. If you have root canal work you will probably need a new crown - you may need a referal to a specialist endodontist if the root canal work looks at all tricky. If you have the tooth out then you may need a denture in the future... or an implant or somesuch.

Hope this helps (My nurse doubtless would have kicked me ages ago for being too long winded, but thats just my way!)

Take care

Pars :)
 
T

toothlesswonder

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Dec 12, 2006
Messages
10
Thanks Pars!

The explanantion regarding my tooth helps me understand what has gone on! The additional info re pain/expense/divorce was also interesting and brought a smile to my face which is a rarity when the topic is teeth or dentists!

I think the tooth is already root filled, this new dentist lady assumed it was although she wasnt sure from my xray.......I didn't like to suggest the obvious and check my notes on the computer she had alongside her since all my adult work has been at that practice!

So, if it is root filled already can it be re-root filled? I have got my head around losing it if I have to but dont fancy my chances with this lady!

My plan is to try to get through Xmas/new year and locate a new dental practise where I will be treated as a person rather than a 15 min slot for a filling! I have been going every 6 months for years but my small amount of faith in my existing practice has gone out of the window after this last visit and I am back to where I started with my fears and I don't want to go down the road of not going for years on end again.
 
P

Parsnip

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Where is the dentist that you saw before you met up with this lady?

A previously rootfilled tooth can be re root treated, yes. Chances of success are usually slightly less to be realistic. But it can be done - again maybe a specialist referral for optimum results.

It might appear rude of you to ask if she would check the x-rays - but it is your mouth after all. You are paying them to help you and you are worth a decent standard of care. A fresh x-ray may have been appropriate too. But bear in mind I can't see your teeth or assess the condition of your mouth otherwise.

Vote with your feet I'd say.

:)
 
T

toothlesswonder

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My dentist at the practice is now part time ready to retire next year so I was going to have to look elsewhere and I think this new lady is taking a lot of his work.

She had a new Xray done that day but the abcess she showed me was pretty big, the cloud thing was above 3 teeth !

I appreciate without seeing my teeth etc it is hard for any judgement to be made regarding my problem! my concern was having to continue with the extraction right away as she wants to do or if I had some breathing space before this flares up again as it seems it will with my new found knowledge on a tooth abcess! and I think from the info you've given me I have a few weeks to follow this up.

thanks for putting my mind at ease!
 
P

Parsnip

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You are welcome. :)

If you're going away over the festive season however, it might be worth having some antibiotics handy just in case it does flare up and you can't find a dentist at short notice.

btw - it was an upper tooth? The cloudy thing might just be your nasal sinus... just a thought. Had a cold or flu lately?

:)
 
brit

brit

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Agree with Pars that if the dentist you get on with is about to retire and you're stuck with her instead, its time to look elsewhere....personally though I'd start looking straightaway and not put it off until the New Year.

If he's still working part-time, could you persuade him to treat this one tooth for you...ask for a second opinion/play up the phobia? Offer to see him privately if you don't already.

They may have all their fancy professional etiquette rules which the front desk will try to fob you off with but I think you have a right to ask to see the dentist you thought you were registered with, for a second opinion.

:grouphug:
 
F

freakout

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Oct 26, 2005
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Hi and :welcome: I also agree with Pars and Brit. My parents are in the same situation, thier dentist has gone part-time and turned his practice over to his female partner. They still have the option to see him, if they need too. They are however keeping thier options open, to seek a new dentist, as the female dentist does not have the best rep. with compassionate care. I would first see if it is possible to see the dentist that you saw in the past. If not than I would start looking for a more caring dentist that you feel comfortable with. Start looking now, as you do not want to wait too long and be uncomfortable for the holidays.

Keep us posted
 
brit

brit

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freakout said:
Hi and :welcome: My parents are in the same situation, thier dentist has gone part-time and turned his practice over to his female partner. They are however keeping thier options open, to seek a new dentist, as the female dentist does not have the best rep. with compassionate care.

Hi Freakout
Isn't this a no brainer for your parents? Why don't they go to your dentist instead? Hope your boss enjoyed himself by the way :p and that you get sorted soon...it will be okay by Xmas...it will :XXLhug:.
 
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freakout

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Hi Brit...My parents are attached to the hygentists at thier current dentist's office. They (the hygentists) have told them, that if they decide to move on to another practice they will let them know where they go to. My parents do not like the cubicle style of my dentist's office (which took some getting used too ;)) They like private rooms. And also a slower paced practice.

It was actually a little interesting seeing my boss preparing to go to the dentist. He even looked a little nervous. I had a little fun though :p Everytime I go, he tells me to have fun and enjoy myself. So as he was leaving for his appointment, I repaid the favor :p
 
brit

brit

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Gees..those cubicles again...I can understand that...at least we don't seem to have those in Europe (yet).
 
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toothlesswonder

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Dec 12, 2006
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Morning

Thanks for all the advice, I have made contact with the surgery, via my hubby as I get tongue tied trying to talk to the receptionist, he made a strong case for me to see my original dentist and I have an appointment Monday at 0900 so no waiting time to get too scared!

I am still undecided whether to go ahead with an extraction as the tooth and gum above it are still feeling tender after 6 days of antibiotics and it scares me that ANY work on a tooth still infected will be excruciatingly painful. but it also tells me that the source of the infection is still alive and kicking as pars described yesterday so maybe extraction is the way to go!

I have also talked with hubby over changing dentists, we are currently NHS so there will be a cost involved as I will have to go private, and he agrees I cant be put through the trauma from the lady dentists attitude in addition to my dental traumas as this will only make matters worse and so I am beginning my search today for a new dentist to see in January and begin a programme of major repairs etc!
 
brit

brit

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Thanks for all the advice, I have made contact with the surgery, via my hubby as I get tongue tied trying to talk to the receptionist, he made a strong case for me to see my original dentist and I have an appointment Monday at 0900 so no waiting time to get too scared!
Well done you :jump: and its great that your hubby is so supportive about it all.

I am still undecided whether to go ahead with an extraction as the tooth and gum above it are still feeling tender after 6 days of anti biotics & it scares me that ANY work on a tooth still infected will be excruciatingly painful.

Ask your dentist about this aspect...you can always agree to try to save the tooth but change plans if it doesn't work out...but you need to be numb to extract it too.

Pain is my only concern so I do understand your reluctance here. It is possible to get 'hot' (infected) teeth numb but apparently not all dentists have the skills/patience to do it...it may be that you jointly decide to take the antibiotics for longer. If the nerve has died off - it is possible to do a root canal painlessly without anaesthetic at all because the nerve is no longer sensitive, but often you will be given some LA anyway just to make you feel more comfortable psychologically.

A major part of the dentist's job is to provide you with adequate anaesthesia - agree to the procedure on the basis that you are sufficiently numb during it and agree a stop signal where you raise your hand which will give you a feeling of being in control.

we are currently NHS so there will be a cost involved as I will have to go private, and he agrees I cant be put through the trauma from the lady dentists attitude.
You should be able to find a private dentist with various sedation options available as a fallback if there are problems with 'getting numb' or whatever.

I hope it all goes fine for you...which it may very well given that you have built up a relationship of trust with this guy who is about to retire..maybe he can recommend someone else nearby apart from the lady colleague!

Worse case scenario is: he gives you hassle about why on earth weren't you happy with his wonderful colleague and what an awkward position this puts him in (professional etiquette stuff) , then simply leave and find another dentist....
 
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Parsnip

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Brit said:
If the nerve has died off - it is possible to do a root canal painlessly without anaesthetic at all because the nerve is no longer sensitive, but often you will be given some LA anyway just to make you feel more comfortable psychologically.

Hmm - in some instances perhaps - personally I'd rather have the local anaesthetic.

Well done TLW - good luck with it all.

Pars :)
 
brit

brit

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Reply..so would I :p and lots of it.
 
T

toothlesswonder

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Dec 12, 2006
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UPDATE!!!!! :)
I went to MY dentist yesterday , explained what happened with his new associate and he could not have been more re assuring over my Crown! he said as the anti biotics have taken down the abcess he will leave well alone!!! he added if I get further infections there we may have to look at an alternative treatment which could mean extraction but as it is the first time I have had an infection and the drugs appear to have worked we will leave it to settle down!!!
He also looked at the X-rays the lady took and said he thinks the infection was in the gum alongside the crown rather than the actual root filling.
I felt a right heel for rushing around trying to locate a new dentist and making a check up appointment at new dentist , I think I will give my existing chap a chance to do some of my fillings in January and rearrange my new dentist appointment for the end of January in case things don;t work out with my existing dentist but I was on cloud 9 yesterday as he was so nice to me!! Even showed me how to floss properly and gave me samples of mouth wash (Listerine) which he advises I use or salt mouth washes if I would rather.
All in all after 10 days of angst I feel so relieved its unreal that I could of been so stressed out by my emergency visit.
Of COurse I have to say thanks to all here who have also helped me through the last 10 days with support and with reading others experiences of how things are not always as bad as we think!

HAPPY CHRISTMAS ! :party:
 
brit

brit

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Glad it worked out for you :jump:
Merry Christmas too.
 
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