Having served as a dentist for over 14 years in Bountiful, Utah, I have seen infections caused by teeth. If not addressed appropriately these odontogenic (tooth related) infections can lead to serious situations. In the past the dental practitioner would often write a prescription for antibiotics to help with both the pain and the infection. Times have changed.
Misuse of antibiotics to treat tooth infections has led to antibiotic resistance. Even when antibiotics are used correctly there can be complicating problems such as toxicity or allergy, superinfection with resistant bacteria, chromosomal mutations to resistance, gene transfer to vulnerable organisms, and expression of dormant resistant genes (http://www.ncbi.nlm.nih.gov/pubmed/22207664).
The medical, dental and other health professionals are actively changing their regimen and recommendations for when it is appropriate to prescribe antibiotics for treatment of disease. Fortunately in dentistry, a majority of tooth infections will clear up without the use of antibiotics. In order for treatment of tooth-related infections to be successful, identification of the infectious source (which tooth), determining an appropriate treatment plan, and initiating treatment quickly can reduce the need for antibiotic dosing.
I draw upon four symptoms to help determine if a tooth may be experiencing an infection:
- Long-duration cold pain. This means that the tooth hurts 30 seconds after exposing it to cold stimulation. If a tooth hurts for just a few seconds after being exposed to cold stimuli then an infection can sometimes be ruled out. Often when a tooth experiences long-duration cold pain, the tooth is not infected but is actually experiencing irreversible inflammation. Antibiotics will not help an inflamed nerve inside of a tooth.
- Biting pain. Be careful here. Biting pain can present when a new restoration (filling or crown) is “too large” causing the newly restored tooth to receive too much force. Biting pain can also be present in periodontal disease or a cracked tooth. But sometimes a tooth that suffers from biting pain is infected.
- Night pain. When a tooth is infected it sometimes will hurt worse at night.
- Spontaneous pain. The tooth will begin to hurt without any stimulation being presented.
When a patient experiences tooth or jaw pain it is important to address it quickly. Call your dentist and get it checked out. At times a patient will delay calling their dentist because the patient is concerned about disrupting the dentist’s evening or weekend. I have seen some cases where delay required an expensive round of IV antibiotics. I am aware of other cases where delaying dental treatment of an infected tooth nearly caused death, or actually did cause death of the individual.
Do the right thing and call your dentist when something is concerning to you. I am confident that your dentist will make him or herself available to help you.
I certainly will.