Infection after dental work

[Droosie]

Hello - I'd really like an opinion about my current situation.

I am a sort of dental phobic in that I never had any problems until 6 years ago just after my son was born. I developed a really severe infection under one of my back teeth when my son was four weeks old. I went to a dentist who said the tooth needed to be extracted but who struggled to numb the area. It was all very traumatic but I realize the difficulty in anesthetizing the area was due to the infection.

Fast forward 6 or so years and I finally pluck up the courage to visit a dentist again. The dentist I saw was lovely and explained all my options for treatment - and I needed a lot of treatment as my teeth had really deteriorated. To be honest my goal is just to be able to smile without feeling self conscious.

Last Thursday I went and had three extractions - these were really just roots and three fillings including one root canal filling. My biggest fear was pain but once the local anesthetic was in it was all pain free.

However, since the work I have developed a big infection. As I had received so much work I expected there to be some residual discomfort and put all the pain I experienced down to that. On Sunday morning I woke up looking like a hamster and in severe pain. I contacted NHS Direct and one of their dental advisors referred me to an out of hours dental service who saw me. The dentist I saw there was very critical of my dentist for doing so much work in one go. He then went on to say that she should have given me antibiotic cover and he could not believe she hadn't done so. . His opinion was that the infection was not coming from any of the extraction sites which were all upper jaw but from the root canal filling in my lower jaw.

Now - I am a health care professional too and although i am not a dental HCP I do recognize that there will always be differences in opinion with regard to any treatment. But - this has now left me worrying about things. My dentist took lots of X-Rays and one of the things she told me was there was a small infection under the tooth which needed the root canal filling. It also appeared that this was the tooth which caused the big infection after treatment. Yesterday the gum began to ooze blood and yukky stuff utterly, utterly disgusting and horrible but it showed me and my dentist that the infection was actually under the tooth next door to the root canal one.

I am now on Amoxycillin five hundred mgs tds and two fifty mg of Metronidazole tds - excuse words instead of numbers but number keys are not working .
I am much less hamster like now and in minimal pain which I assume means the infection is beginning to clear.

I suppose my questions are:

Was all this treatment too much in one go? I have been very phobic about going back so in many ways was glad my dentist got all the big stuff out of the way. I am going back for some private cosmetic work and also a private denture for the upper back teeth. I feel hugely relieved the other stuff is out of the way but am wondering if it was all too much in one sitting.

Should I have been given antibiotics? I am wondering what the consensus is on antibiotics following treatment now. I have often been given antibiotics following dental work in the past - usually following an extraction. My dentist didn't suggest them at all after all this work and to be honest I just assumed that things had changed - that perhaps research had shown they were not necessary in most cases.

Thank you for reading. I am off sick but thanks to the antibiotics and especially the Metronidazole cannot indulge in any

I have to see my dentist again on Friday - she has said that if the tooth looks too complicated to treat she will extract it and add it to the denture. I really, really do not want her to do this though as I work with the public and am already self conscious about my teeth - sporting a huge great gap is NOT tempting.

 

[letsconnect]

Hi Droosie , some of our regular dentists are away at the moment so I thought I'd chime in.

Was all this treatment too much in one go?

It does sound like a lot, but length of time would only be an issue in terms of discomfort (most people find having to open their mouths for a long period of time very uncomfortable, and many people prefer shorter appointments because it makes it easier to cope with things if you're anxious). The one thing which might have set off the emergency dentist's alarm bells was that the root canal treatment was done at the same time as all the other stuff. Was this a front tooth or a back tooth? How long did the root canal treatment take? Did the dentist use a rubber dam for the root canal treatment? Were they using a microscope while doing it?

Should I have been given antibiotics? I am wondering what the consensus is on antibiotics following treatment now. I have often been given antibiotics following dental work in the past - usually following an extraction. My dentist didn't suggest them at all after all this work and to be honest I just assumed that things had changed - that perhaps research had shown they were not necessary in most cases.

Your own dentist is right I think. There is no reason why antibiotics should be given routinely following dental work, as far as I am aware. Recently, there has also been a change of guidelines (both in the UK and in the US) regarding the use of antibiotics prior to treatment in people with certain heart problems (antibiotics are now no longer recommended).

 

[letsconnect]

I have to see my dentist again on Friday - she has said that if the tooth looks too complicated to treat she will extract it and add it to the denture. I really, really do not want her to do this though as I work with the public and am already self conscious about my teeth - sporting a huge great gap is NOT tempting.

Has she suggested referral to an endodontist if it's too difficult for her to treat? (endodontists are dentists who specialise in root treatment)

 

[olanda]

just wanted to add that when i had my root canal re-treatment by a specialist endodontist she gave me antibiotics following treatment as a routine procedure. however, when the same tooth was root-treated the first time around by my previous nhs dentist he didn't do this - i didn't have any adverse effects, luckily, but perhaps it's not nhs policy to routinely give antibiotics following root canal where as specialists do?

 

[letsconnect]

I suppose antibiotics would be given when there is an acute infection still present - regardless of NHS or private. I was under the impression that in this case, the infection only flared up afterwards and thus the dentist at the time saw no reason to prescribe an antibiotic

 

[olanda]

i'm pretty sure that i didn't have an infection present at the re-treat (i'd already taken antibiotics before!). Still, maybe I did because I've just read on-line that antibiotics are given after root-treatment on a case-by-case basis as required!

 

[Droosie]

Thank you for the quick replies

The root canal work was at the lower front of the mouth while the root extractions were upper jaw and at the back.

The dentist said that x-rays showed an infection under the tooth which needed the root canal. To be honest I've no idea what she used to do the root canal work - I just know she was working a long time and that she took two x-rays during the work.

My jaw is still sore and uncomfortable but a lot of the stuff has drained now although not quite all. At least my hamster cheeks have gone and at least the work I have dreaded for so long is done. Just the cosmetic stuff to have done now - a few fillings and infills on my upper teeth at the front. My dentist reckons that the fillings are so small I won't even need the local. Yeah right.

 

[Gordon]

I don't think that the "routine" use of antibiotics is ever indicated, especially for a straightforward root canal treatment. Overall I think that your first dentist was correct and that the second dentist has some issues...

 

[Droosie]

I don't think that the "routine" use of antibiotics is ever indicated, especially for a straightforward root canal treatment. Overall I think that your first dentist was correct and that the second dentist has some issues...

Thought so. As I said - am a HCP - although not dental - myself so know there are always differences in opinion with regard to clinical matters. To be honest the emergency dentist was very nice but actually not that helpful with his comments - especially when dealing with a coward like me. I like my new dentist - she's been calm, kind and understanding.