How long before penicillin kicks in?

G

Guest

Guest
Hi,

I'm glad to have found this board. I had a very embarrassing experience at the dentist today - I think the actual details of what happened probably belong on the support board so I'll post there too. I'm in the UK by the way - just in case any of my terminology seems weird! ;)

I have a front tooth (canine, top) which had a huge cavity in the back of it, and which, because I am so scared of dental treatment, has been getting worse for ages. Recently the tooth broke and I now only have a small shard left at the front, plus the root etc of course. I wasn't really in much pain at all, just the odd ache, and I had a dental appointment due for that tooth the same week, by coincidence, so I went then. The tooth was still aching minimally at this point - in fact, I was surprised to be experiencing so little pain.

The dentist judged that it could wait the couple of weeks or so till he could fit me in for proper treatment. I agreed. He put a temporary filling in. The next day (I realise this might be coincidence and is probably nothing to do with the temp filling) I started to experience intense pain. I waited to see if the tooth would settle, it didn't and I was in agony so a day or two later I made an emergency appointment. My normal dentist was unavailable so I had to see another.

The second dentist offered me the option of getting a root canal underway or having the tooth extracted. I have had some terrible experiences of root canals so opted for extraction. Just before he got started, though, he changed his mind commenting that there was a large swelling (he didn't actually call it an abscess so I don't know if it is) at the top of my gum. He said that this could compromise the efficacy of the anaesthetic. Needless to say, I agreed to let him prescribe penicillin and wait to have the treatment another day.

I started taking the penicillin last Friday and finished end of Tuesday. It's Thursday today. The pain is much better and is tolerable now, but not gone, the swelling hasn't gone, and in addition I still have a feeling of numbness from the top of the tooth up my gum to the swelling, like a local was just wearing off. (I have had this since the severe pain started, BTW.)

I went back to my regular dentist today and he said that although the penicillin hadn't completely killed the infection, the only way to get rid of it was to extract the tooth. He said that there would still be some pain because, as the other dentist had said, the infection would affect the anaesthetic.

I declined to have the tooth treated today - partly in sheer fear of the pain, partly because there is a part of me that isn't convinced the penicillin has had time to work. Infections tend to take a while to clear up, for me. However, the dentist refused on 'ethical' grounds to prescribe more penicillin so we were left at a stalemate and the tooth still needs treating.

Here's my question. Is five days really likely to be enough for the penicillin to have fully done its job? I realise the answer is likely to vary a great deal from person to person and I am not going to put off seeking further treatment - I plan to try to get in to see another dentist tomorrow for a second opinion if I can, and regardless of the outcome I realise something needs done about the tooth very quickly. If the second dentist says the same as the first, I know I will have to accept it and proceed with treatment. However, given my fears about dental procedures, I am naturally hoping fervently that I will not be faced with a scenario of having to have the tooth removed with inadequate anaesthesia!

Maybe clutching at straws here, but given that I generally find that when I get infections they take a while to clear up, do you think there is any chance that a) the penicillin may yet kick in given more time, or b) that if another dentist was happy to provide more penicillin, this may resolve it?

Bottom line: is it really the case that I may have no alternative but to have this tooth pulled out (or root filled) even though the anaesthetic is inadequate to deal with the pain?? Just thinking about it is making me break out in a cold sweat. Advice hugely appreciated!

Cheers,

Sky :)
 
G

Guest

Guest
Very brief reply, I'm just going back to work. Fuller answer tomorrow. The Penicillin will have killed off some bacteria, typically the aerobic (oxygen breathing) bugs. The remaining infection will be caused by either Penicillin resistant aerobes or more likely anaerobes.
A different antibiotic with an activity spectrum effective against anaerobes should be helpful. Metronidazole is a good choice.

HTH for now.

--
Gordon
 
G

Guest

Guest
Thanks, Gordon, yes, that is helpful to know. A friend also said she was given Metronidazole in a similar situation. Look forward to hearing more of your thoughts when you have time - thanks! :)

Letsconnect, yeah, I realised later that I'd be talking to British dentists - one gets so used to so many internet resources being US-based! *lol* I'm about to ring round a few dentists, so hopefully one can see me soon. I will also post over on the support board about the 'phobia' element of yesterday's visit and the way my fears were treated by yesterday's dentist, which wasn't great IMO! :(

Thanks again, I think you guys are providing a great resource here!

Sky :)
 
G

Guest

Guest
Hi Sky,

I agree with Gordon, a course of Metronidazole would probably be the way ahead . It would target a slightly different group of bugs (the anaerobes) than the penicillin and may help to reduce the abscess some more. Usually if a course of penicillin has been given, we try to avoid giving another course of penicillin within one month or so, as it is possible to create bugs resistant to it- meaing that future problems are more difficult to treat- this is probably why they didn't offer you more of the same.

Without being totally aware of your medical history I cannot obviously say for sure that you can take metronidazole - there are a few contraindications. However if you are fit and well, not taking other specific medications eg warfarin, and can avoid alcohol for a few days (alcohol + metronidazole = vomitting), it may be worth asking your dentist if it would be possible to have a 3 day course of 400mg Metronidazole. (Standard dose is 200mg, but I often give the max. of 400 to make sure things get cleared up as much as possible prior to the extraction.) The appointment for the extraction should be made for when you have just reached the end of the course, or soon after.
Also- a couple of reasons why we don't inject into abscesses if possible. 1) It can cause a spreading of the infection or 'cellulitis' which can be quite upsetting as the whole side of the face can become very swollen - although this generally only happens if the abscess and swelling was quite substantial to begin with, so don't panic!!!!
2) The anaesthetic may not have as powerful an effect as the acidity of the abscess stops it from working fully. It may be that a little extra anaesthetic would do the trick in making sure things are as comfortable as possible. Don't be afraid to ask for more - it's not that expensive!!! Also if things are too sore at the time you can always abort and reappoint- might annoy an impatient dentist, but certainly isn't the end of the world!! It's your mouth- you are in control!

I hope that this finds you well - and is of some help.

Kind regards and best wishes,
Mike
 
G

Guest

Guest
Hi Mike,

Just wanted to say a belated thanks for the advice! - I've not been able to get online any sooner. The update: I found a much more sensitive dentist, who didn't actually suggest any further medication but took some X-rays and indicated that she would probably be looking at root treatment. Obviously that gave me the cold shivers and I am dreading the next appointment, but I think I would trust this dentist to do it. She seemed far more sensitive to my needs as a nervous patient and was very reassuring - it was a completely different experience from that which I had to endure at the last dentist, so there is hope! :) - and I've managed to get in as an NHS patient too. :)

The tooth itself has sort of settled down. Not completely - I still have the swelling which I am presuming is an abscess, altho of the three dentists who have seen it so far none have actually called it an abscess. I still have some numbness in the gum, and some pain, but I only seem to be getting pain if I have been fiddling with the tooth with my tongue without realising it! *lol* Your information about abscesses and the effect they can have upon the efficacy of anaesthetic was helpful. The dentist I saw last week made the same point, which obviously scares me a little, but it helps to be prepared.

Again, thanks for the advice! :)
 
Top