Acute infection. Confusing symptoms. Struggling to wait for diagnosis

[SallyUK]

Hi
I have been struggling with an acute episode of clenching, muscle problems throwing my bite off and bashing my top teeth into the bottom. Dentist aware and I was considering a mouth guard. Not sure if that is related but....

Upper Lateral incisor was sensitive to percussion on and off and gums above a few teeth but I had aching everywhere for a while so didn’t think of an abcess. Although looking back there was a period of throbbing pain.

two teeth involved. Canine and incisor. Small gum bump on my palate side appeared weekend before last, nearer base of canine than incisor. Grew and then burst, gums around canine continued to swell but not that painful, percussive pain which I thought was incisor. Visit to dentist on the Monday and he gave me penicillin and explained the symptoms were a bit confusing and we’d review after infection cleared as it was clear I had a nasty acute infection. . First bite wing X-ray didn’t seem to show him much and second there was a large area of shadow associated with incisor, he drilled hole in it and said it was good the infection was draining (through the palate bump I guess) teeth feel out of position but told that’s inflammation and the crowned tooth isn’t coming off.

I was totally freaked out by all this and scared what was going on, my teeth are heavily compromised but I didn’t expect problem with these two. Ive never had gum issues like this or the bump draining. On reflection my check up a week earlier showed deep pocket around the canine which he probed, this area has flared before but been quiet lately the canine is crowned, not sure if has rct, the incisor has small fillings no rct.

My dentist knows dental work triggers huge anxiety for me and is as calm and straight forward as could be but I was so scared not to know what was wrong that I called him. He said it’s either one tooth, both teeth or the gums and he will refer if necessary. Despite reassuring me that this is normal I can’t get it out of my head that this means untreatable, something ominous and more than root and gum infections rather than my dentist seeking expert advise on diagnosing the source of the bacteria. (Which I think he means) he again said if he was concerned he’d refer immediately, not near his threshold, just not able to diagnose right now, although did mention rct on incisor but think that depends what’s best overall.

this is is so challenging to my trust in him, logic says that’s unfair expectation but he’s always known what was wrong and also been ruminating about why first X-ray didn’t show things and whether this issue has been missed and worst fear is that infection will come back and no one will be able to help and what does that mean

i know you can’t diagnose but although it appears my situation is a little perplexing the steps being taken are normal? My review appt is next Tuesday; two weeks from the acute episode. It’s so hard not knowing what’s going on. The good news (I think) is that the antibiotics and hole drilled seem to have calmed everything down. The gums reduced in inflammation within a day or two, the incisor tooth was a bit painful on and off but has now calmed down. My bite is still off as clenching still an issue but doing jaw excercises that help ? So scared of what infection is going on, whether it still is or what damage done, it crept up on me, created huge anxiety.

thanks for any reassurance you can give. I have anxiety and also some traumatic stress responses, often triggered by unexpected events with uncertainty! Resilience low and now have sinus cold, which incidentally happened the last rct tooth I had an issue with some 7 years ago,.

 

[Gordon]

I can't quite see what your question is, do you think you could simplify it for this old curmudgeon?

A few random thoughts from your post:

Bitewing x-rays aren't ideal for showing up abscesses.

Sometimes acute infection can be difficult to pin down to an exact tooth, but if he opened one up and got pus out of it then it sounds like the culprit.

Sometimes there's a link between gum disease and a dental abscess, those are very difficult to treat other than extracting the teeth involved. If he suspects this then that may be why he's waiting to see how things develop before rushing to treatment.

Hope this helps.

 

[SallyUK]

I can't quite see what your question is, do you think you could simplify it for this old curmudgeon?

A few random thoughts from your post:

Bitewing x-rays aren't ideal for showing up abscesses.

Sometimes acute infection can be difficult to pin down to an exact tooth, but if he opened one up and got pus out of it then it sounds like the culprit.

Sometimes there's a link between gum disease and a dental abscess, those are very difficult to treat other than extracting the teeth involved. If he suspects this then that may be why he's waiting to see how things develop before rushing to treatment.

Hope this helps.

Thank you Gordon, I’ve calmed down since writing and can see I was rambling. I guess I was catastrophising and scared that the dentist didn’t seem sure and was confused by my symptoms. I equated the mention of referral as a really bad thing and that the problem can’t be sorted - irrational.

your explanation that bitweings aren’t great to locate abscesses is reassuring and about his wait and see approach before diagnosing if there is a suspicion that the situation might be hopeless. I am upset about that possibility. Definitely pus from the incisor he opened but why the neighbouring tooth gums flared is another issue, they are completely calm again now, he did probe a big pocket days before the infection became obvious and I think the offending tooth was draining near it...... I guess the canine could have infection too that wasn’t clear on X-ray . of course just wish it hadn’t happened. I don’t fully understand what acute infections are. I’ll be reassured that waiting and reviewing next week will hopefully give a clearer picture. Thanks for the explanation that waiting is sometimes necessary and the right thing.

Can clenching your teeth at night cause damage that might lead to an abcess? I had a really stressful period before this and my muscles went into spasm and I was waking with these teeth tightly clenched and does menopause have an effect on teeth and gums?

one more question, my dentist mentioned that this flare might mean we have some thinking to do about our approach, the level of work to keep certain restorations has not been to bad but I think this event might tip him to suggest a denture but also said all options are complicated. Can you have a denture with teeth just on one quadrant? The canine, incisor and back molar? Or does it have to be balanced with teeth on the other side? I say that because I have gaps too and bottom the other side but contact points at present that work for me, if I had to have a denture with teeth on the other side to balance, that would be complicated I guess. I’m basically scared that I will forever be working on my mouth or have dentures that mean I can’t sing or eat! Trying to take this step by step and remain positive, but not easy right now. I’m 48 and feel at the end of my rope with dental issues.

 

[Gordon]

Yes, it's possible that clenching/grinding can trigger an abscess. It's probably due to letting bacteria up the side of the teeth via the periodontal ligament, they can then get into the root system and cause mischief.

It's fairly well established that the hormonal disturbances during pregnancy can cause gum issues, so it's likely that menopause will too.

Yes, you can have a denture covering just one quadrant.

 

[SallyUK]

Yes, it's possible that clenching/grinding can trigger an abscess. It's probably due to letting bacteria up the side of the teeth via the periodontal ligament, they can then get into the root system and cause mischief.

It's fairly well established that the hormonal disturbances during pregnancy can cause gum issues, so it's likely that menopause will too.

Yes, you can have a denture covering just one quadrant.

Thank you so much for answering my questions. Knowledge and information are really helpful for managing fear and anxiety. I just want a healthy mouth, as my dentist does. Will wait and see what happens at my review on Tuesday. Tooth and gums remain calm, so hopefully the infection is under control. Thanks again.

 

[SallyUK]

Had my review with my dentist yesterday. Good news is that infection under control and he seemed more confident about a plan, so no need for a referral.

He will do a root canal on the lateral incisor and whilst doing that he will be taking xrays X-rays that will give him a view of the canine tooth as well. He is still not sure what was going on with the tooth
and initial X-rays didn't show much. The acute gum inflammation has gone but the tooth is mobile, he said it was the root moving. Not up and down but outwards, feels like it's slightly squashing the incisor.... horrible sensation but it has improved a bit. tooth is already root filled and crowned and he suspects it will need extracting as he probably wouldn't choose to work on the tooth.


I am pretty upset about this prospect, not least because it seems to me this tooth is important for function and aesethics and replacement options are limited for me from what my dentist said.

My questions, I'm pretty scared of the treatments:

lateral incisor root canal : what area of my face will go numb for this? I'm terrified of nerve damage...irrational fear

canine tooth: if this needs to be extracted is it a simple process? I've had a lower and an upper molar removed about 8 years ago, one was quick and one more difficult. Found it quite traumatic and my palette tissue was injured but healed ok. Will my face change as the bone shrinks?

Relacement: dentist said a bridge not likely as nothing to attach to. I have a crowned premolars one side and the soon to be root canal led incisor the other. Can the premolar alone be used to attach to? (No experience of bridges)

dentist thought a partial denture was probable but said it was less than ideal, I know he feels that's a failure but wasn't that helpful as I'm now worrying that a partial won't work for me and then what? No tooth? Inability to eat?. He said an implant could be an option if partial not ok but to be honest the cost as well as being super worried about failure and infection etc, I'm not keen.

Are there any any other options of replacement I can learn about incase this tooth has to go? Or any options for trying to save it, even though not sure at moment why it's wobbly? Maybe damage from the infection.

Im feeling overwhelmed by the process to sort this out as it's all new steps for me. Most of my dental work has been on molars and involvement of my front teeth is very upsetting. I'm still not convinced this isn't down to clenching on already restored tooth, bite off from clenching and worrying more damage will happen and all my teeth will break . All feels precarious again after an acute episode of stress/clenching. . I hate my teeth ?But I'm glad we have a plan to follow.

 

[Gordon]

Trying to break this down into separate bits, apologies if I miss a question, ask me again if I do!

1) Movement might be due to gum disease, it would be nice to see the x-rays. If that's the case, then the long term outlook is poor for the tooth but it might last a fair while yet

2) Numb area will be about 4cm each side of the incisor heading up towards the edge of your nostril. Nerve damage is almost impossible from this type of injection BTW, I've never heard of it.

3) Kind of depends why it's being extracted. If it's gum disease it'll be really easy. An x-ray would help answer it...

4) Attaching a canine to a single premolar is unlikely to work, again need to see x-rays and how your bite looks to answer for sure. If it fails though it'll take the premolar with it...

5) Partial should work OK, lots of people manage with them, especially a nice cobalt chrome one. Aesthetically they can be better than bridges

6) Implants are pretty easy in the upper canine area, the success rates are in the high 99% rate. Comfort dentist on here does a lot of implant work so PM him if you want some expert advice.

HTH and good luck with it all

 

[SallyUK]

1) Movement might be due to gum disease, it would be nice to see the x-rays. If that's the case, then the long term outlook is poor for the tooth but it might last a fair while yet

2) Numb area will be about 4cm each side of the incisor heading up towards the edge of your nostril. Nerve damage is almost impossible from this type of injection BTW, I've never heard of it.

3) Kind of depends why it's being extracted. If it's gum disease it'll be really easy. An x-ray would help answer it...

4) Attaching a canine to a single premolar is unlikely to work, again need to see x-rays and how your bite looks to answer for sure. If it fails though it'll take the premolar with it...

5) Partial should work OK, lots of people manage with them, especially a nice cobalt chrome one. Aesthetically they can be better than bridges

6) Implants are pretty easy in the upper canine area, the success rates are in the high 99% rate. Comfort dentist on here does a lot of implant work so PM him if you want some expert advice.

Thank you for taking the time to answer my questions Gordon, really helpful.

I don't have any xrays unfortunately - I suspect that gum issues have played a part in this tooths situation, I don't have gum disease but I did have deep pockets around this tooth a few years ago and I had a deep clean and things improved until the recent episode where I had pain in the two teeth and the gums swelled all around this canine and after that it was loose - gums are tight again now after the penicillin and the drainage of the neighbouring incisor.

When you say last a while - does that mean I wouldn't have to rush to have it taken out? only it would help my anxiety & Christmas timings for appts etc to take my time and spread out these steps to sort my current issues.

Are there any other treatments to help a tooth with gum disease to this extent? presuming it plays a part.

I guess getting a gum shield now is not right timing - need to wait for work to be done, would I be right with that? Any other tips to stop this clenching? Its been bad for 6 weeks when this whole episode started. I am doing jaw alignment stretches given by the dentist which do help but my bite is still off which probably doesn't help

Thanks for the info on the numbing area - I get very anxious about feeling numb and thank you for the thoughts on extraction, partials and the implants, it is helpful to feel I have options. Still not accepting the potential loss of this tooth. These two teeth were not ones I was worrying about.

 

[Gordon]

Deep pockets equals advanced gum disease, sorry. Again without x-rays it's a guess but it could soldier on for a year or so, if it's not that mobile yet, it doesn't sound like it.

A bite guard just now might be a good idea, depends on the treatment that's planned, you should discuss the idea with your dentist. The clenching is usually a symptom of stress, so anything you can do to reduce the stress levels in your life will help, your GP can refer you to NLP which can be very helpful, we've just covered this in another thread

I'd hate to be Theresa May's dentist just now, she must be grinding the heck out of her teeth

 

[SallyUK]

Deep pockets equals advanced gum disease, sorry. Again without x-rays it's a guess but it could soldier on for a year or so, if it's not that mobile yet, it doesn't sound like it.

A bite guard just now might be a good idea, depends on the treatment that's planned, you should discuss the idea with your dentist. The clenching is usually a symptom of stress, so anything you can do to reduce the stress levels in your life will help, your GP can refer you to NLP which can be very helpful, we've just covered this in another thread

I'd hate to be Theresa May's dentist just now, she must be grinding the heck out of her teeth

Ha ha Mrs May. I’ll look for the thread re NLP, thank you. I am receiving counselling right now for anxiety and I’ve talked to her about the fact I appear to be destroying my teeth at the same time as fearing that very thing ?

i spoke to soon about things calming after antibiotics, my gum has swollen a bit over the weekend and the tooth is a bit tender again, not excruciating pain but then I didn’t really get that in any case.

I have my appt for a root canal in a week and am using salt water rinses a few times a day. Worrying a bit that the RC can’t be done if infection flares, is that right? My dentist did say something about splitting the treatment if infection prominent still, at least that’s what I think he said. I’d rather not take more antibiotics, they made me feel terrible, dentist said he didn’t expect things to kick off again but presume my body will be fighting off infection until treatment is complete. Is it usual to still feel a bit of uncomfortableness?

 

[Gordon]

The RCT can be done during acute infection if necessary, some dentists prefer to do it in 2 stages to let the infection settle, others don't. You can probably imagine the arguments between the 2 camps

A general feeling of tenderness around the abscess is normal, I'd be almost more surprised if it wasn't present.

 

[SallyUK]

The RCT can be done during acute infection if necessary, some dentists prefer to do it in 2 stages to let the infection settle, others don't. You can probably imagine the arguments between the 2 camps

A general feeling of tenderness around the abscess is normal, I'd be almost more surprised if it wasn't present.

Thanks again for your help Gordon.

I had the RC this morning and my dentist did the whole thing and was happy with how it looked. There is a temp filling in there and I go back in two weeks to review and hopefully fill with permanent.

Understand a bit more about the neighbouring canine. There is bone loss. My dentist still doesn't know if the incisor infection or the canine (previous deep pockets) started the acute infection. We are both hoping the review in a couple of weeks will make things clearer but he said we are not in a rush now the acute phase is over - that was music to my ears and signal to really calm my hypervigalence down! He said if incisor was the cause the bone might heal somewhat in the canine. I've got my fingers crossed. Strong and stable is my aim - something Mrs May isn't doing too well at ??