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Many things can damage the pulp or nerve of the tooth. The following are common reasons for the need of a root canal:
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The Progress of Your Pain
A tooth abscess (infection) can be one of the most painful and unpleasant problems in your mouth. If you feel that you are developing an infection, please seek immediate dental care.
There are 2 basic types of dental abscesses. Acute Abscess and Chronic Abscess
Acute abscesses are characterized by rapid and painful onsets. Swelling of gum tissue, cheeks, neck, face, and surrounding areas may be present. It can be very difficult to find relief during the painful peak of a tooth abscess. Normal activities are often interrupted during this time.
Acute abscesses present with:
- Sharp or throbbing pain
- Pain during chewing
- Spontaneous pain
- Pain from cold or hot items that lingers for longer than 20 seconds after the hot or cold source is gone
- Foul taste or bad smell
- Swollen glands
Acute abscesses can be the most difficult to diagnose if only a few of the above symptoms are present. These problems can also become chronic in a short time span, causing more severe symptoms.
A significant percentage of teeth that have crowns or fillings can present with an acute abscess. Some studies conclude that over 25% of crowns placed on non-root-canaled teeth progress to either an acute or chronic stage of infection. The reason for this is quite simple: dental procedures that involve drilling out a cavity or old filling cause irritation to the pulp of the tooth. Due to the small and limited blood flow of the pulp, often the tooth cannot withstand this irritation and the flow of blood slows or ceases over time. Once this happens, a low grade infection can begin. This infection can become acute or chronic. If acute, symptoms are evident quicky, such as is normally present days after you receive a new filling or crown on your tooth. Other times, a chronic infection can develop, which may take many years before symptoms of pain or swelling are noted. The underlying factor is the same: blood flow inside the tooth slows down, eventually ceases and bacteria (necrosis) takes over causing infection and eventually leading to one of the symptoms listed above and below.
Acute abscesses are normally treated by performing root canals. In a minor percentage of these cases, antibiotics may be used AFTER the root canal procedure to eliminate and prevent the spread of any infection. We limit the use of antibiotics as much as possible, especially with patients that have had multiple antibiotic prescriptions over the last few years. This is a cautionary step that helps to prevent the spread of resistant bacteria which can occur with frequent use of antibiotics.
Many patients feel that the dentist may have done something wrong when placing a new filling or crown on their tooth. Often the same question is asked: “I had nothing wrong with my tooth before you worked on it, but now I have all of this sensitivity and pain. Why did you do this?” The problem is usually not the dentist and/or the procedure. The problem is due to the limitations that teeth present when we expect them to heal quickly and normally following a procedure that causes irritation and to a certain extent…minor injury to the pulp. Cavities do NOT cause pain or sensitivity until they are large enough to cause infection. Treating a cavity before it gets big enough to cause serious problems is always the best strategy. However, in a small percentage of cases irritation can occur. Such small injury can lead to acute or chronic abscess, if the tooth cannot heal itself quickly and adequately.
Acute abscesses usually do NOT present with X-ray abnormalities. The dentist must use their judgement based on clinical and X-ray findings to make a determination as to what is happening with the tooth. Here are some important factors to consider when making the determination of which tooth is in an acute infection stage:
- X-Rays should help determine which tooth has large, old fillings and crowns. 25% of crowns and old fillings can become infected at any time. A large majority of new fillings and crowns will be sensitive for a few weeks after placement. Should this sensitivity persist or worsen, there is a likelihood that the tooth may be in an acute stage of infection. Any old crown or old filling may predispose the tooth to an infection, even years after initial placement.
- If nothing is diagnosed in the area of pain, then the dentist must consider that it may be a tooth within the area of nerve distribution. Many times, a lower tooth can present with symptoms of pain to upper teeth, and vice versa. Additional X-rays must be taken in order to diagnose all potential problem area.
- Vertically fractured teeth may show no signs of cavities, infection, or other problems. These crack lines are very difficult to diagnose. The pain is usually only felt when you bite on a specific area of your tooth. An acute infection is normally diagnosed.
- Sinus infections can manifest themselves as tooth infections. Nasal breathing must be checked. Obstructed nasal breathing is usually a sign that there may possibly be a sinus infection involved. Nevertheless, all tooth problems must be eliminated first.
- TMJ problems mimick themselves as “ghost” toothaches and symptoms of acute infections may be incorrectly diagnosed. At our office we see hundreds of patients each year who have been incorrectly diagnosed with infected teeth only to have the symptoms worsen over time. TMJ problems are not easy to diagnose. Specific Transcranial X-Rays must be taken in order to determine if there is an underlying TMJ problem. Another rule of thumb is: if the patient suffers with frequent headaches, there is a 99% chance that there is a subclinical, undiagnosed TMJ problem. Only skilled TMJ specialists can pinpoint such complex issues.
This type of infection normally presents as a low to medium grade throbbing in a particular tooth or area around a tooth. It normally maintains as an annoying problem that slowly gets worse over time. The main reason this infection does not cause bigger problems is generally due to the fact that the immune system controls the spread of the infection OR the patient develops a “bubble” (cyst) that may be present on the gum tissue in the vicinity of the infected tooth. Such minor balloon swelling can allow the infection to drain at this point. Chronic infections may persist for many months without elevating to an extremely painful or swollen state. However, chronic tooth abscesses are dangerous because there is an increased risk of damage to the bone surrounding the tooth. Furthermore, cysts may develop around the tooth which could decrease the success of future root canal treatments. Chronic abscesses can slowly grow in size, involve lymph node involvement, and lead to more acute and life threatening situations.
Any abscessed tooth has the potential to become a life threatening situation. Infection of a tooth in the lower jaw can cause swelling of the check under the jaw bone. If the swelling under the jaw becomes advanced, swallowing and breathing can become critically impaired. This is called Ludwig’s angina. This problem requires immediate hospitalization.
An infection of a top tooth may produce swelling in the check, side of the face, or under the eye. The gradual closing of the eye due to swelling and infection can represent a more serious situation…Cavernous Sinus Thrombosis. This infection can spread to the brain tissue via the blood vessels from the upper jaw. Such complex infections pose a risk for death. Although rare, these examples are given so that tooth aches and infected teeth are not taken lightly.
All chronic infections that present with signs of swelling must be immediately treated with antibiotics and drainage procedures. Drainage is normally accomplished by performing root canals and/or making a small incision close to the swelling in order to allow the infection to drain out of the tissues.