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Emergency Dentist

Can a Tooth Infection Spread to My Brain?

I’m worried about this tooth infection I have. I went to the dentist and he provided me with an antibiotic but told me not to take it until two weeks before my procedure, which isn’t for another month. I read somewhere that a tooth infection can spread to my brain, but he is insisting there is nothing to worry about. What do I do?

Miranda

Dear Miranda,

toothache

While it is true that a tooth infection can spread to your brain, as well as your heart and lungs, there are some dental infections that are so small, you’d have time before you had to worry about that type of spread. Starting the antibiotic in two weeks, will help prevent it from spreading as well.

The danger often comes when there are patients who avoid the dentist out of fear. By the time they see a dentist, if they do at all, the infection has progressed so far that it is a dental emergency and they need treatment right away or they can put their lives in danger.

This doesn’t sound like you. However, I’m sure you know someone in your life who suffers from dental anxiety. For the benefit of those who do struggle getting to the dentist I want to post here that dental sedation can change their life. By using something like nitrous oxide or oral conscious sedation, which is even stronger, you can have an anxiety-free dental appointment.

Not only will that prevent them from waiting until they need a painful emergency procedure, but it will also allow them to get caught up on their dental care, giving them a healthy smile for the first time in a long time. In turn, this makes the remainder of their appointments easier.

When You May Have a Problem

Though I said this infection likely won’t be a problem, sometimes a dental infection will surprise us and take off suddenly. If your pain worsens or you develop a fever, call your dentist and have him move up your appointment.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

CEREC crowns, Uncategorized

CEREC Crowns on Front Teeth

I need to get a dental crown on a front tooth, but my dentist doesn’t want to provide it. He insists I won’t like it. Yet, he offers CEREC crowns. It doesn’t make sense to me. Why does he have the machine? Should I go to a different dentist to have it done?

Alan

Dear Alan,

Close up of front teeth

My guess is your dentist uses the CEREC crowns on teeth other than the front two teeth. There is a reason for this. When a CEREC crown is made, it is milled out of a single block of porcelain. This does fine on other teeth. However, if you look closely at the teeth above you’ll notice the teeth aren’t uniform from top to bottom. There are differences in opacity. When you get a traditional porcelain crown, which your dentist is suggesting, it is formed from several different blocks of porcelain in order to mimic those differences.

So, you have a few choices. You can go to a dentist who cares less about how the results will turn out and more about bringing in the fee from a patient in order to get the same-day crowns. Or you can listen to your dentist and allow him to do the traditional crowns.

It is your teeth and your smile. So, if having the best result isn’t as important to you as the convenience of one appointment, which is totally fine, then I would switch to another dentist to get the crown you want. You could also tell your dentist you understand it won’t look as good, but you still want CEREC and would prefer he get the fee than another dentist. Then, he may go ahead with it.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Affordable Dentistry

Can’t Afford Tooth Care

I have had a decaying wisdom tooth for some time. I just don’t have money for the dentist. Lately, though the pain is going up my cheekbone toward my eye. Because it is not just in my tooth, do you think I could get antibiotics for a doctor for the infection? I have medical insurance, but not dental insurance.

Eric

Dear Eric,

Man in pain, grabbing his cheek in need of emergency dental care.

I don’t want you to mess around with this. Believe it or not, people still die from tooth infections. While you could go to your doctor and he might give you an antibiotic, all that will do is hold the infection back for a short time. As soon as the antibiotic finishes, the infection will flare back up.

Dental infections are different than other types because once the pulp of the tooth is infected and dies there is no blood flow in the tooth. The antibiotic cannot reach the root of the infection. The only way to “heal” a tooth infection is to physically remove the infected pulp.

Normally, if the tooth can be saved, the best treatment option will be a root canal treatment. However, with a wisdom tooth you would just extract it.

Affording Dental Care

I know that does not mean you have any more money. However, I want you to think about what will happen when this infection spreads. It is already moving up your cheek. It is not too far from there to your brain. An infection like that will be life-threatening.

One thing I would do is look for a dentist who advertises as an affordable dentist. This almost always means they are willing to work out payment options for patients. That will especially be likely in a situation such as yours where there is an urgent care situation.

Another option, if you can’t find a dentist willing to work with you is to work through Care Credit. This is a medical credit card that will pay for your care and allow you to pay it off. You have to have reasonable credit, but if you qualify their terms are remarkably good.

Please don’t put this off.
This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Dental Emergency

When Does a Tooth with a Root Canal Treatment Need a Crown?

I have a root canal treatment that has never been crowned. Recently, I read that is a mistake. Should I get this crowned? I used to have dental insurance, but now I don’t so I don’t want to spend the money if I don’t have to. What are your thoughts on it?

Bruce

Dear Bruce,

I’m very glad this question came up because I have seen some people just crown every tooth that had a root canal. In some cases that can do more harm than good. Much of the answer to this question will depend on which tooth you are talking about. If it is a back tooth, such as a molar, then I would say to crown the tooth. It will protect it from the type of biting forces those teeth face. With other teeth, it gets more complicated.

illustration of a a front tooth

The biting stresses on a front tooth and their adjacent teeth are mostly horizontal because of the tearing stress. This means the neck of the tooth is the most vulnerable. By the time you prepare a tooth for a dental crown, it loses a minimum of 30% of its diameter, putting additional stress at the neck of the tooth. If that tooth also lost a significant amount of structure before the root canal treatment because of decay, there will be even less structure there.

If you place a dental crown on a front tooth that doesn’t have the necessary diameter to support the forces it is subjected to, it could end up breaking at the gumline. Some dentists try to overcome this by placing a post in the tooth, though that can increase the chances of the root fracturing, which will require an expensive repair.

The issue with front teeth after a root canal is that they tend to turn dark, which becomes an appearance issue. Our smiles are one of the first things people notice about us so we want them to look as nice as we can. Here is my advice on how to keep its white color longer and what to do when it does turn dark.

Helping a Tooth with a Root Canal Keep its Color

Your dentist needs to thoroughly clean out any root canal material and cement from the crown of the tooth, these are huge contributors to the dark appearance. Next, he or she should place a white fiberglass post into the tooth. Fiberglass is more flexible and will help with the stress. Finally, fill the remainder of the open area with white composite filling material. Doing this will extend your tooth’s color.

If it does eventually turn dark, instead of crowing it, I would suggest a porcelain veneer placed on that tooth. That removes far less structure, which will be better for the tooth viability in the long run.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.
We treat dental emergencies.

Sedation Dentistry

12 Shots of Novocain to Get Me Numb

I recently had a tooth extracted. The whole procedure was a nightmare. It took twelve shots to get me numb. I don’t know how a dentist can miss a spot that many times! Have you heard of this happening before? Is there a way for a dentist to find the right spot the first time so I don’t have to go through that again?

Paula

Dear Paula,

woman wearing nitrous oxide nose piece

While it is possible that your dentist missed the spot to numb your tooth over and over again, it is much more likely that you had some dental anxiety in the beginning which worked against your numbing medication. Then, as you were still in pain, your anxiety went up even more, creating a vicious cycle. There are too many dentists who do not realize the link between anxiety and the inability to get numb in the dental chair.

The simplest solution to this is to find a dentist who offers dental sedation options. It may be all you need is some nitrous oxide, which is administered with a nose piece, as in the image above. This can relax you enough to enable the Novocain to do its job properly. However, if your level of anxiety is super high, you will be better served with oral conscious sedation. This is significantly stronger, in fact, you will likely sleep through the entire appointment. Be aware though, that it is so strong you will need someone to drive you to and from your dental appointment. You will not be able to do this on your own.

Those who have dental anxiety have found that by using the appropriate level of sedation for stressful dental procedures, they are able to have stress-free as well as pain-free dental appointments.

Dealing with a Missing Tooth

You didn’t mention what tooth was extracted. In most cases, it will be very important to replace the tooth. This isn’t just for appearances sake, though that is important. Without that space being filled, the adjacent teeth will start to drift or tip into the empty space. This will throw off your bite, which can lead to painful jaw problems and even daily migraines.

The best option for replacing a single tooth is a dental implant. This is what I would recommend to a patient of mine.

This blog is brought to you Gilbert Dentist Dr. Matt Roper.

CEREC crowns

CEREC Crowns Doesn’t Fit

I thought CEREC crowns were supposed to be more accurate because they are milled by a computer. I had a four-year-old crown break so I needed to get another one. I was in a hurry and my dentist just got the CEREC machine that is supposed to create your crown in one appointment. When I got the crown it was way too bulky. I came in again and she could see it was too big in spots. While she did grind it down in some of those spots, I am biting my tongue now every time I eat. Is this technology not what she painted it to be or is something else going on?

Mark

Dear Mark,

porcelain block for CEREC crowns

I think the problem here is more your dentist than the CEREC technology. First, she provided you with a dental crown that broke after just four years. They shouldn’t break, especially when they’re that “young”. That by itself tells me she struggles with some basic dental skills.

Now she has this great new technology. Normally, when you are preparing a crown with the CEREC machine, it is basing it off of a tooth that is already there and has been scanned into the program. Because your tooth already had a dental crown and now that was broken and gone, there wasn’t a previous tooth for her to base the crown on.

That being said, the software has the ability for the dentist to design a crown for a tooth that is no longer there. It’s fairly easy to shape the tooth using the software. The problem is she doesn’t know how to do that yet.

You have a couple of options here. The crown needs to be replaced. It also needs to fit so perfectly you don’t even know it is there. Nor, should you bite your tongue because of its fit. You can either have her provide you a traditional crown that is made in a laboratory, but again, I’m concerned that the last one only lasted four years.

Alternatively, you could just ask for a refund and go somewhere else to get your crown done. You may want to do this to make sure you get the right crown.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper. We’re open Saturdays.

Sedation Dentistry

Must I Go to an Oral Surgeon to Get Dental Work Done?

My dentist tried to numb me for two different procedures. Neither time worked. I’ve always ended up having to go to an oral surgeon and have my work done with an I.V. that knocks me out. That makes getting any dental care quite expensive. Am I condemned to spending a fortune and still not having healthy teeth? Have you heard of someone in my situation before? Is there a different solution?

Matt

Hi Matt,

Someone asleep from dental sedation

Yes, I think I know exactly what is going on here. The great news for you is there is a solution. One thing I’ve found is that patients with dental anxiety have trouble getting numb. Sometimes it will seem like the numbing medication is working but once the work starts, they can feel pain. However, if they can be relaxed with something like nitrous oxide before the Novocain is administered, then when they are relaxed give them the numbing medicine, it works almost every time.

Some patients have such a high level of anxiety that they need a stronger level of sedation. For those patients, I recommend oral conscious sedation.

For either of these, you will not have to see an oral surgeon. Just do an internet search for a “Sedation Dentist”. They are able to help you in the office, saving you a good amount of money. You will also find that if you use oral conscious sedation, your dentist will be able to do a lot more work in each sitting. This will allow you to catch up on your work more efficiently. In fact, you’ll probably sleep through all the work.

One thing to be aware of, however, is oral conscious sedation, though administered with a simple pill, is so strong you will need someone to drive you to and from your appointment.

Once you’ve caught up with your work, if you’re looking for a quick, inexpensive way to improve the appearance of your smile quickly, I’d consider teeth whitening. That one procedure takes years off the appearance of your smile.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Sedation Dentistry

How Much Dental Work Can be Done at Once?

I will be honest and admit that I have neglected going to the dentist for many years now. However, it has gotten to the point that I need to do something. I can see decay and a couple of broken teeth. I’m sure I need even more work than I think I do. In order to get this over with fairly quickly (you can probably tell dentists aren’t my favorite thing), how much work can be done in one sitting, so I can minimize the appointments?

Kirk

Dear Kirk,

Someone asleep from dental sedation

While each dentist varies from office to office in how much they’ll do at each appointment, you will find the dentists who are willing to do the most in one sitting are sedation dentists. There is a procedure, oral conscious sedation (OCS), that enables both the patient and the dentist to get through more work at a time. Some people have dubbed it sleep dentistry because they are so relaxed they end up sleeping through the entire procedure.

There are many reasons patients avoid the dentist. One of the leading causes is dental anxiety, which can usually be traced back to a traumatic dental appointment. Having a means to experience stress-free and pain-free appointments with OCS has changed many lives.

Avoiding a Dental Emergency

Hopefully, you’ll find a sedation dentist fairly soon. I am especially concerned about the broken and decayed teeth. These can quickly turn into a dental emergency if the pulp of the tooth becomes infected. When you think about how close your jaw is to your heart, lungs, and brain, you can see how a simple tooth infection can turn life-threatening.

People tend to underestimate the seriousness of toothaches, which is why even in the twenty-first century we still have people who die from a tooth infection.

I’m not saying this to frighten you. I just want you to recognize, if the tooth starts to feel pain or if a pimple develops on your gums, both are signs of an infected tooth and you will need to be seen as soon as possible.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Dental Emergency

This Dentist Doesn’t Understand Tooth Infections

I had a tooth infection and went to see a dentist. It’s my first time with this dentist. To be honest, I usually avoid dentists but this one couldn’t be helped I was in so much pain. He gave me and antibiotic and I started to get better, but now I’m worse again. Do I need a second round or did I have the wrong antibiotic?

Leslie

Dear Leslie,

A woman grabbing her jaw in need of an emergency dentist

Either there is some miscommunication between you and your dentist or he has a profound lack of understanding of how dental infections work. An antibiotic is only useful to hold off a dental infection. It won’t cure it. In order for a tooth infection to be completely treated, a dentist has to get in there and physically remove the infected pulp. This can be done by a root canal treatment or by extracting the tooth completely.

It is always better to try and save a tooth, so a root canal would be my first recommendation. If your dentist didn’t tell you this would be necessary and just prescribed you antibiotics and sent you on your way, I would consider this gross negligence on his part.

Yes, you would start to feel better after taking the antibiotics, because they were doing their job. Once they ran out, however, because the infected pulp is still there, it rears its ugly head again. This will continue to spread and what was a dental emergency can turn into a life-threatening emergency rather quickly. This is because your heart, lungs, and brain are all close to your jaw. This needs to be treated.

Dealing with Dental Anxiety

I noticed you said you usually avoid dentists. That is a common issue, especially with patients who suffer from some dental anxiety. If that is you., one step you can take that will help is to see a sedation dentist when you go in for your treatment. They can provide you with a pill that will completely relax you, allowing you to get the dental care you need in an anxiety-free and pain-free way.

Please don’t put this treatment off. It’s important. Sadly, people still die from tooth infections.

This blog is brought to you by Gilbert Dentist Dr. Matt Roper.

Sedation Dentistry

Dentist or Oral Surgeon?

I’m going to honest and just admit I avoid the dentist. I had a filling fall out. I avoided the dentist. Then I needed a root canal treatment. I did get that, but it was rather traumatic. So, I didn’t go back for the crown. Now my tooth was hurting so badly that I had to go to a dentist again. Though I did go to a different dentist. He told me the tooth is too far gone and needs to be removed. However, he said it’s extensive enough that I may consider an oral surgeon because he’d have to cut through both gum and bone. I like the idea of it not costing as much going to the local dentist, but wonder if it’s not safe and that’s why he mentioned an oral surgeon.

Patty

Dear Patty,

Someone asleep from dental sedation

I hate it when dentists say stuff like this. It makes patients uneasy. They wonder if they’re being unsafe choosing the more financially feasible option for them. I don’t know if your dentist phrased it that way because he’s uncomfortable with the procedure and he was trying to steer you another direction or if he’s perfectly comfortable doing it and just giving you non-opinioned options.

I’d ask your dentist a few questions before making a decision:

  • How comfortable does he feel with the procedure?
  • Has he done this type of extraction before?
  • What type of sedation does he offer?
  • What are the roots like? Straight and tapered or twisted with knobs?

The Importance of a Sedation Dentist for You

Based on what you’ve described of your oral hygiene habits, you have dental anxiety. It’s not uncommon. However, it wreaks havoc on your oral health, as you’ve discovered. If you were comfortable going to the dentist when your filling first came out, you wouldn’t be facing this difficult extraction and then facing pricey tooth replacement options.

Dental Sedation will change your life. However, at your level of anxiety (and especially for your extraction procedure), you will need something stronger than just nitrous oxide. You will need oral conscious sedation. This is strong enough to allow you to sleep through the procedure.

You will be able to have stress-free dental appointments from now on and even get all your teeth back in shape.

This blog is brought to you by Dr. Matt Roper.