Help--Dental Infection...WWYD?

[themarquis]

Help -- WWYD?? Long story -- please bear with me!

Last week I had a bad toothache and what seemed like a gum infection near one of my front teeth. (I have deep pockets apparently from my cpap machine, or so a former dentist says ) I was scheduled for a cleaning this upcoming week, but it was so bad last week that I got in early for an emergency appointment. We have just switched to a new dentist so this was the first time I saw them (previously we had been going to the local dental school.)

I had an appt. on Thursday afternoon and they cleaned out the pocket and said I had a gum abscess. They also put some tetracycline gel in the pocket--the only part of the visit not covered by my insurance and charge me $40 for it. I am sent home with a z-pack and told me to take advil round the clock (which I was already doing). Well that night I had the worst pain of my life--worse than when I had a dry socket when I had my wisdom teeth removed. So Friday I call and tell them I've been in so much pain so they call in a prescription for vicodin.

Friday afternoon the pain is still horrible even with the vicodin. The vicodin hardly touches it -- I can't eat or sleep and I can barely drink water. And I have a redish/purplish color that is spreading on my gum and inner part of my lip near the tooth in question. It is the worst thing I have ever felt in my life. I call back and beg them to see me sooner and they give me an appointment Saturday afternoon and say that they might give me a root canal. They also say they will call in amoxicillian which I can start taking saturday instead of the z-pack.

At the appt. on Saturday they seem to have no idea what they are doing. A hygienist begins giving me a cleaning on all my teeth rather than them focusing on the pain issue and evaluating the one tooth in question. They try to send me home after that until I remind them that I am there because I'm in such bad pain. They try to tell me that I'll have to come back for another appt. for them to deal with that at which point I start crying and say they have to do something because I can't live with so much pain. So they agree to look at it then.

They give me a ton of Novocain but I can still feel the throbbing around my tooth/gum and two of the doctors start arguing about why I can't get numb. They all seem puzzled as to why I am in so much pain because they had drained the abscess on Thursday which is supposed to make the pain go away, but instead it got 10x worse. Eventually they suggest that maybe I am allergic to the tetracycline gel they had put in the pocket to seal it. By process of elimination, they assume that is what the problem is and they dig out all the gel. Indeed, as soon as they dig it all out the horrible throbbing starts to subside.

So they then send me home again and I have an appt. tomorrow (Monday) to have the tooth itself evaluated to see if it needs a root canal. My wife tries to pick up the new antibiotic and apparently no one ever called it in. So I am still taking the z pack, but my gum still looks pretty infected. I think there is pus coming out of the pocket and my chin and lip feel swollen and hurt. The pain is nothing like after they put the gel in there, but it is still bad and I can barely eat and am taking vicodin.

After all of this, I am worried that the dentists at the practice I am going to have their heads up their assess and might just give me a root canal tomorrow even if I don't need one. I'm worried that this will cost a lot of money when it's not needed but worse that it won't actually fix whatever is wrong with my gum. What if I have some freak rare infection or something that is not being treated appropriately and will just get worse and worse?

If you made it this far -- What would you do -- go elsewhere (maybe to the dental school where at least they know what they rare doing)? Just deal with it and let these dentists drill the tooth and be patient and wait for them to figure out what is wrong? I feel like I don't trust them and they have no idea what they're doing. Argh!!!

 

[Goofyluver]

Help -- WWYD?? Long story -- please bear with me!

Last week I had a bad toothache and what seemed like a gum infection near one of my front teeth. (I have deep pockets apparently from my cpap machine, or so a former dentist says ) I was scheduled for a cleaning this upcoming week, but it was so bad last week that I got in early for an emergency appointment. We have just switched to a new dentist so this was the first time I saw them (previously we had been going to the local dental school.)

I had an appt. on Thursday afternoon and they cleaned out the pocket and said I had a gum abscess. They also put some tetracycline gel in the pocket--the only part of the visit not covered by my insurance and charge me $40 for it. I am sent home with a z-pack and told me to take advil round the clock (which I was already doing). Well that night I had the worst pain of my life--worse than when I had a dry socket when I had my wisdom teeth removed. So Friday I call and tell them I've been in so much pain so they call in a prescription for vicodin.

Friday afternoon the pain is still horrible even with the vicodin. The vicodin hardly touches it -- I can't eat or sleep and I can barely drink water. And I have a redish/purplish color that is spreading on my gum and inner part of my lip near the tooth in question. It is the worst thing I have ever felt in my life. I call back and beg them to see me sooner and they give me an appointment Saturday afternoon and say that they might give me a root canal. They also say they will call in amoxicillian which I can start taking saturday instead of the z-pack.

At the appt. on Saturday they seem to have no idea what they are doing. A hygienist begins giving me a cleaning on all my teeth rather than them focusing on the pain issue and evaluating the one tooth in question. They try to send me home after that until I remind them that I am there because I'm in such bad pain. They try to tell me that I'll have to come back for another appt. for them to deal with that at which point I start crying and say they have to do something because I can't live with so much pain. So they agree to look at it then.

They give me a ton of Novocain but I can still feel the throbbing around my tooth/gum and two of the doctors start arguing about why I can't get numb. They all seem puzzled as to why I am in so much pain because they had drained the abscess on Thursday which is supposed to make the pain go away, but instead it got 10x worse. Eventually they suggest that maybe I am allergic to the tetracycline gel they had put in the pocket to seal it. By process of elimination, they assume that is what the problem is and they dig out all the gel. Indeed, as soon as they dig it all out the horrible throbbing starts to subside.

So they then send me home again and I have an appt. tomorrow (Monday) to have the tooth itself evaluated to see if it needs a root canal. My wife tries to pick up the new antibiotic and apparently no one ever called it in. So I am still taking the z pack, but my gum still looks pretty infected. I think there is pus coming out of the pocket and my chin and lip feel swollen and hurt. The pain is nothing like after they put the gel in there, but it is still bad and I can barely eat and am taking vicodin.

After all of this, I am worried that the dentists at the practice I am going to have their heads up their assess and might just give me a root canal tomorrow even if I don't need one. I'm worried that this will cost a lot of money when it's not needed but worse that it won't actually fix whatever is wrong with my gum. What if I have some freak rare infection or something that is not being treated appropriately and will just get worse and worse?

If you made it this far -- What would you do -- go elsewhere (maybe to the dental school where at least they know what they rare doing)? Just deal with it and let these dentists drill the tooth and be patient and wait for them to figure out what is wrong? I feel like I don't trust them and they have no idea what they're doing. Argh!!!

I would go to an endodontist, who specialize specifically in tooth pain and diagnosing dental issues. They are the specialists in root canals and they also have diagnostic tools that most dentists do not use.

I was sent to one a few weeks ago, and their available tools are far more advanced than your standard dentist. Plus, this is all they do...tooth pain.

Of course, that's not even taking into account that you don't trust these folks. I'd say, go with your gut in that regard.

Tooth pain is THE worst. I hope you get this taken care of very soon!

 

[RNMOM]

I agree with you about the competency of that dental office. I have been through bad dentistry and can feel your pain.

Does your insurance have a referral site on their website? If so, look up the dentists/endodontists and look at their qualifications. Find someone who is is fairly young and has lots of certifications or is listed as involved in professional organizations. In fact, you might be able to find a website for the dental professionals and see if there is a referral area. At least they may list members in your area.

If you know anyone who has had a lot of dental work done, call them and ask who their doctor is and did they have good results.

I find them giving amoxicillin kind of weird. It is not a broad spectrum antibiotic and maybe you would be better with keflex or similar.

Have you tried ice pack to your lip? When I had a dry sockett I got relief from sipping ice water through a straw. I pulled it over the area and it helped numb it. I was in the bathroom a lot but it helped.

Good luck and keep us posted.

The dental society is ADA.org

 

[dis-happy]

First, call the after hours number and see if you can get the rx for amox started now (don't bother if there are no pharmacies in your area open Sun night though). Not sure why you didn't notify them immediately when you realized you had no prescription for it. Amox. works a lot better on dental infections than the z-pack.

Second, I totally, totally agree about going to an endodontist. I had a tooth issue/mystery infection this summer and my dentist (who is award winning fabulous btw) took a look and immediately sent me to the endodontist for a second opinion. He's actually working on me this coming week. But they are the specialists for root canals, etc. and should be able to get to the bottom of this. If you can't afford the endo, I'd follow up with the dental school...the people who teach and oversee things should be very good.

Based on what you've written, I would be cautious of returning the that dental practice. Did they even take x-rays yesterday?



PS. Wanted to note that amox is the usual standard for treating dental infections. I've been on it a couple of times now, prior to getting my follow up surgery. It works really well specifically for abcesses.

 

[bumbershoot]

I would drop them and go back to the school. Nice thing about a school clinic is that you have multiple experts looking at the situation!

Glad you figured out the allergy...definitely remember that!

Vicodin does nothing for me but make me antsy, which makes my reaction to plain worse. See ifnsomeone can give you something different, as you don't seem to be having a positive reaction to that, either.

 

[Sadie22]

I hope you are feeling better.

I am 99.999% certain a CPAP machine does not cause deep pockets. Run that by your sleep specialist.

 

[Cinderella2004]

Hi!

Dental assistant here. Yes, your tooth sounds as though it needs a root canal. I agree, you should see an endodontist. When the infection is that bad, general dentists sometimes have difficulty getting you numb.

Is there any swelling in your face? If so, you should go to the ER, for stronger antibiotics. Infection can spread into your blood stream from dental infections, although it is rare, it can be harmful.

Good luck. I wish we could be of more help for you.

 

[dis-happy]

PS. I think there's a home remedy for dental pain that involves putting a teabag up against your gum. And/or whole cloves. Might be worth a shot to get through the night.

 

[themarquis]

I would go to an endodontist, who specialize specifically in tooth pain and diagnosing dental issues. They are the specialists in root canals and they also have diagnostic tools that most dentists do not use.
Of course, that's not even taking into account that you don't trust these folks. I'd say, go with your gut in that regard. :

Thank you, Goofyluver and many others who suggested seeing an endontist. The place I'm going to (that I'm not feeling I really trust right now ) is a multi-dentist, multi-specialty practice that does have me lined up with an endontist on Monday. I think I will have him/her evaluate the tooth and then take it from there. It could be that their endontist is not as incompetent as the rest of the folks there seem. I don't think I can get into see anyone in the dental school that fast, so I might as well go on MOnday and see what they say -- I can always say 'thanks but no thanks' if it seems sketchy on MOnday. If so, I'll call the dental school -- they have a special clinic that is the faculty dentists who are specialists in their fields -- that might be a good place to go (if they can get me in)

Have you tried ice pack to your lip? When I had a dry sockett I got relief from sipping ice water through a straw. I pulled it over the area and it helped numb it. I was in the bathroom a lot but it helped.

Good luck and keep us posted.

The dental society is ADA.org

Thank you -- great suggestion to ice pack it! I have had a dry socket (actually a double dry socket ) and believe it or not this pain (before they scraped the tetracycline goo out) was WORSE than the dry socket. Before this I would have said dry socket was the worst pain I had had in my life!

 

[themarquis]

First, call the after hours number and see if you can get the rx for amox started now (don't bother if there are no pharmacies in your area open Sun night though). Not sure why you didn't notify them immediately when you realized you had no prescription for it. Amox. works a lot better on dental infections than the z-pack.

Second, I totally, totally agree about going to an endodontist. I had a tooth issue/mystery infection this summer and my dentist (who is award winning fabulous btw) took a look and immediately sent me to the endodontist for a second opinion. He's actually working on me this coming week. But they are the specialists for root canals, etc. and should be able to get to the bottom of this. If you can't afford the endo, I'd follow up with the dental school...the people who teach and oversee things should be very good.

Based on what you've written, I would be cautious of returning the that dental practice. Did they even take x-rays yesterday?



PS. Wanted to note that amox is the usual standard for treating dental infections. I've been on it a couple of times now, prior to getting my follow up surgery. It works really well specifically for abcesses.

Thanks, dis-happy. I agree that the amoxicillan will be a good broad spectrum antibiotic if I can get it! The reason I didn't let them know they forgot to call it in was that we only realized it after they closed on Saturday and they don't seem to have any after hours number or anything. I can call tomorrow morning to at least get it started. The pain has gone way down after the tetracycline was scrapped out, but the whole area just still looks infected to me as if the z pack is not touching the infection.

RE: x-rays, yes, they took x-rays on thursday and saturday and didn't seem to see anything suspicious on either one. I do have bone loss in that region (front two bottom teeth) from ongoing perio issues, but they didn't see signs of any acute issues.

 

[themarquis]

I hope you are feeling better.

I am 99.999% certain a CPAP machine does not cause deep pockets. Run that by your sleep specialist.

Sorry -- I should have added further details. The dental school faculty felt the CPAP was accelerating the deep pocket formation (though they weren't 100 percent sure) because sometimes when you have CPAP, you open your mouth a bit when sleeping and then the whoosh of air from the machine can dry out the gums in the front of the mouth. That is where I have the deep pocketing -- front top and bottom.

Theoretically if CPAP mask fits perfect and the nose isn't stuffy, you shouldn't open your mouth, but for whatever reason I definitely do despite mask adjustments, etc. I know my wife has seen puffs of air whoosh from my lips in the mornings sometimes (my mouth doesn't hang open -- it just gets puffed open a tiny bit if that makes sense). I also have gum overgrowth on the top in this area -- dental faculty kept asking if I took drugs that would cause it (like seizure drugs? not sure) but I don't. They thought it was quite unusual and settled on the idea that the area must be dried out all the time and thus the gums have become severely irritated and fragile with deep pocketing. It's possible they are incorrect, but they never figured out an alternative theory.

 

[onelilspark]

Try to get the anti-biotic as soon as possible. Getting an infection in your gums is the fastest way for one to get into your blood stream.

I used to take Amox. before every visit because I have a heart murmur. So if I got an infection in my blood stream, it could really hurt my heart.

So I'd try to get that ASAP.

 

[cassie]

Try to get the anti-biotic as soon as possible. Getting an infection in your gums is the fastest way for one to get into your blood stream.

I used to take Amox. before every visit because I have a heart murmur. So if I got an infection in my blood stream, it could really hurt my heart.

So I'd try to get that ASAP.

Same with me. I also use a cpap and I've been told it can create problems with the teeth. Good luck OP on Monday, and let us know how it went.

 

[C.Ann]

Try to get the anti-biotic as soon as possible. Getting an infection in your gums is the fastest way for one to get into your blood stream.

I used to take Amox. before every visit because I have a heart murmur. So if I got an infection in my blood stream, it could really hurt my heart.

So I'd try to get that ASAP.

People take tooth/gum infections far too lightly.. You can literally die from one in a matter of 48 hours or so.. If this situation isn't resolved first thing tomorrow you should go to the ER.. (And I am not one to lightly suggest trips to the ER..) My Dson-in-law almost lost his best friend due to an infection from a chipped/broken tooth getting into his bloodstream.. He was hospitalized for several days - on IV antibiotics - and had his wife not brought him to the ER when she did - on a Saturday - the doctors said he would have died by Monday.. PLEASE take this seriously!!

Good luck!

 

[miste76]

The following is for entertainment purposes only.
For what it's worth...
1) cpap machines often cause/worsen periodontal disease
2) significant perio disease can cause an abscess. I would guess the pain was caused from the locally placed antibiotics (tetracycline) because the pain dulled after the removal of it.
3) amoxicillin is the antibiotic go to of choice for dentists - unless there is an allergy. We generally prescribe the z-PAC or clindamyacin if the amoxicillin doesn't work within 48 hours.
4). Ibuprofen is the best pain killer. In blind studies... It works better than vicodin.
5) endodontists specialize in root canals... (not tooth pain, although root canals generally do take care of the tooth pain.)
6) don't always trust the insurance company lists... We get on those lists by accepting significantly lower fees for the same service/procedure. The only qualifications for that list: be licensed, no previous malpractice charges, will accept 40-70% of standard fees.
7). If you have that much bone loss around you lower anterior (front) teeth... It probably isn't worth paying for a root canal. What are your other options?

The most important thing is that you are COMFORTABLE with your dentist!!!
It doesn't sound like you are... My advice - ask a friend or family member if they like their dentist.

I am a dentist - but the information above is not meant as a diagnosis or recommendation for treatment. Only some general information that may or may not be of any help to any individuals.

Sorry if that was long winded.

 

[beachlover9395]

People take tooth/gum infections far too lightly.. You can literally die from one in a matter of 48 hours or so.. If this situation isn't resolved first thing tomorrow you should go to the ER.. (And I am not one to lightly suggest trips to the ER..) My Dson-in-law almost lost his best friend due to an infection from a chipped/broken tooth getting into his bloodstream.. He was hospitalized for several days - on IV antibiotics - and had his wife not brought him to the ER when she did - on a Saturday - the doctors said he would have died by Monday.. PLEASE take this seriously!!

Good luck!

Totally off-topic: which is totally why dental should not be separate, but should part of medical insurance. Yes, cosmetic dentistry should be treated as just that - cosmetic. But when you could die from an infection, it should be covered by medical -- and they try not to! Teeth are in our mouth and part of our body -- medical insurance tries very, very hard to not pay for anything to do with teeth, and it's asinine! C. Ann is right - people can and do die due to teeth infections and it can go from bad to worse to death in a very short period of time. C. Ann, I'm so glad your DSIL's friend is OK and that they took it very seriously.

Sorry, rant off! Good luck to you, OP and I hope you can get this problem taken care of tomorrow, hopefully first thing in the morning.

 

[C.Ann]

Totally off-topic: which is totally why dental should not be separate, but should part of medical insurance. Yes, cosmetic dentistry should be treated as just that - cosmetic. But when you could die from an infection, it should be covered by medical -- and they try not to! Teeth are in our mouth and part of our body -- medical insurance tries very, very hard to not pay for anything to do with teeth, and it's asinine! C. Ann is right - people can and do die due to teeth infections and it can go from bad to worse to death in a very short period of time. C. Ann, I'm so glad your DSIL's friend is OK and that they took it very seriously.

Sorry, rant off! Good luck to you, OP and I hope you can get this problem taken care of tomorrow, hopefully first thing in the morning.

I've always felt the same way about dental/medical.. Sure - certain things should be strictly dental insurance - but there are many serious and/or fatal dental related issues that should be considered medical.. And the worst part about my DSIL's friend is that if he hadn't woken up with his face swollen as big as a football that Sat. morning, he would have insisted on waiting till Monday - which would have been too late..

Back when I was much, much younger, a former classmates DH died from an abscessed tooth (the infection got into his bloodstream) and he was only 28 years old!

 

[golfgal]

Well, after my DD's dental issues, get to an endodontist. They specialize in this. If that doesn't help, I would suggest seeing an oral surgeon as well. I would also try for another antibiotic. We were told by our dentist, endodontist, the pedictrician in the hospital and our oral surgeon for DD's issues that clyntomicin is the best for oral infections.

 

[Sadie22]

Sorry -- I should have added further details. The dental school faculty felt the CPAP was accelerating the deep pocket formation (though they weren't 100 percent sure) because sometimes when you have CPAP, you open your mouth a bit when sleeping and then the whoosh of air from the machine can dry out the gums in the front of the mouth. That is where I have the deep pocketing -- front top and bottom.

Theoretically if CPAP mask fits perfect and the nose isn't stuffy, you shouldn't open your mouth, but for whatever reason I definitely do despite mask adjustments, etc. I know my wife has seen puffs of air whoosh from my lips in the mornings sometimes (my mouth doesn't hang open -- it just gets puffed open a tiny bit if that makes sense). I also have gum overgrowth on the top in this area -- dental faculty kept asking if I took drugs that would cause it (like seizure drugs? not sure) but I don't. They thought it was quite unusual and settled on the idea that the area must be dried out all the time and thus the gums have become severely irritated and fragile with deep pocketing. It's possible they are incorrect, but they never figured out an alternative theory.

Thanks for explaining that the inability to get a good fit with your mask may have contributed to gum problems for you. A simple chin strap with my nasal pillow straps is enough to keep my mouth closed during sleep. I didn't realize how lucky I am. I'm sorry that hasn't worked for you. Perhaps there are some new designs available. Please keep trying to get the best fit for you.

I hope you are much improved by now.

When you interview new dentists, now you know to ask what their procedure is for weekend emergencies.

 

[golfgal]

Thanks for explaining that the inability to get a good fit with your mask may have contributed to gum problems for you. A simple chin strap with my nasal pillow straps is enough to keep my mouth closed during sleep. I didn't realize how lucky I am. I'm sorry that hasn't worked for you. Perhaps there are some new designs available. Please keep trying to get the best fit for you.

I hope you are much improved by now.

When you interview new dentists, now you know to ask what their procedure is for weekend emergencies.

Mouth breathing with or without a CPAP machine can cause dental issues so this is a good suggestion.