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Monday, October 26, 2015

Can A Tooth Ache Be Life-Threatening?

Can A Tooth Ache Be Life-Threatening?

Unfortunately, the answer is a resounding yes!  Not only have we read articles online and heard stories on news broadcasts, but have had our own patients end up in the emergency room or intensive care units.

How does it get to that point?  The harsh truth - neglect.  That word doesn't make us very popular, but ultimately that's exactly what it is.  We do realize that there are a million reasons why people don't visit their dentist regularly: no insurance, no money, afraid, etc.  However, most people budget for things that are important to them: oil changes, hair & nail appointments, entertainment, etc (though there are many extenuating circumstances that don't fall into these categories and dental care can be very difficult to come by).  Many practices now offer in-house memberships and payment arrangements (we do both), making it much more affordable to get the care they need.

What happens?  For example, a patient breaks a tooth and lives with it broken for months.  It's not causing them any pain so they go on business as usual.  With sensitive portions of the tooth exposed, bacteria works its way into the surrounding gum and those broken parts of the tooth.  Eventually, an infection takes hold and begins to spread.  Once the infection gets to the jaw bone, it begins to eat away at the bone.  The infection can cause swelling which can close off the airway in a matter of hours.  The infection can continue to spread through the body and into the blood (heart or brain are only a few inches away) making regular oral antibiotics insufficient.  IV antibiotics may be the only solution at this point.

Just this week I read on Facebook a mother who posted an update on her son who had been hospitalized for an infection that stemmed from a cracked tooth.  The son waited to seek treatment (for whatever reason, was not stated) until the pain was unbearable.  They had to do a tracheotomy due to swelling that cut off his air supply.  His survival was rated at 15% because the infection had traveled to his blood.  Thankfully he is young and will make a full recovery, some are not that fortunate.

Some time ago we saw a patient who had been having a tooth ache for months but had been putting off seeing the dentist.  When this person came to the office the patient was experiencing some swelling, nothing excessive however.  We extracted the tooth and put the patient on antibiotics.  A week later the patient began experiencing severe swelling.  Though the patient had taken the full supply of oral antibiotics, the infection remained and the swelling started to cut off his airway.  It was over a weekend so the patient went to the local emergency room.  They life lighted the patient to OHSU where the patient received emergency surgery and underwent a rigorous antibiotic regiment with a several day stay.

It is absolutely critical for patients to do everything they can to address dental issues as quickly as possible.  Regular dental visits help to prevent situations such as the above stories.  If you cannot afford regular dental care, check the local dental school or possibly a local dental van.  Don't put it off, if can cost you more than the extraction cost, it could cost you your life.

It will never cost less or hurt less than it does today!

Thursday, October 8, 2015

Broken Tooth, No Big Deal Right?

Large abscess has eaten away the jaw bone.

Almost daily we receive calls from patients stating they've broken a tooth.  Some have called within minutes. Some wait days, weeks or months.  Astonishingly, those who have waited to call say it wasn't bothering them, therefore they didn't feel the urgency to get it taken care of.  Yet most of those same people are now calling because the tooth is starting to become symptomatic.

Why did my tooth break and what happens next?  Teeth break for a various number of reasons, and not all are preventable.  Underlying problems may have existed undetected for years, it probably wasn't the roasted marshmallow that caused it.

Why did my tooth break?

  • Accidental injury
  • Amalgam fillings  (regarded safe for use though we do not use the material in our office) have a tendency to be a cause of fractured teeth.  They expand and contract with temperature changes in your mouth which can eventually lead to small fractures. This can lead to an unexpected larger fracture.  In our office, this is just one reason why we chose to use composite materials for fillings.
  • Small fractures are difficult to diagnose as they may not be visible in x-rays.  A symptomatic tooth (sensitive to hot, cold or pressure) alerts the doctor to possible problems. 
  • Age - just like the rest of your body as it ages, nerve tissue and blood vessels that are found in the pulp of the teeth become fewer.  This can cause teeth to become brittle or chip easily. 
  • Excessive force from clenching, grinding or misaligned teeth.
  • Decay - cavities that go unchecked or restored properly.
  • Leaky restorations, such as, bridges, crowns and fillings can cause the tooth structure to become weakened.
  • Root canal teeth that have not been protected by a crown, become brittle and break.
Why do I need to get the fracture repaired right away, especially if it's not bothering me?

Please understand, patients can and have gone years with broken teeth with what seems to be little issue.  However, this is not recommended as bigger issues may loom under the surface that you are completely unaware of. 

Exposed pulp, roots, etc. can lead to infection.  Infection (which may not come with recognizable symptoms) can lead to abscesses that grow (can become cystic) and when unchecked can eat away at the jaw bone or you may develop a pus filled pocket on the gum or around the tooth.  In either case, the abscessed tooth can create a host of health issues such as fever, swelling, difficulty breathing or swallowing. In these circumstances, you should seek care in your local emergency room.

In the picture above the patient had a broken tooth for several months but had not seen a dentist.  The patient waited until the tooth became symptomatic.  You can clearly see that the cystic type abscess had been eating away at the jaw bone longer than the tooth had been symptomatic.  It's highly possible the root canal failed and caused the abscess.

What should I do when I break a tooth?

You should see a dentist immediately.  He/she will take x-rays to determine the extent of the fracture and what your options are for repair.  Some broken teeth may be repaired with a filling or a crown.  Some may require a root canal prior to having a crown depending on the depth of the fracture.  If there is a vertical root fracture, in most cases the tooth will have to be removed.

It will never cost less or hurt less than it does today.