Tooth abcess!

[wilsond]

Oh dear, have had a little discomfort in one of my front teeth...just been to dentist and its an abcess.Problem is,its a crowned tooth that has already had root canal work done in the long distant past,is a front tooth. So course of action is antibiotics,not penecillin as allergic.

Do not fancy the options of antibiotics dont get rid of it...one is to drill through crown or remove it and redo canal work, two is to go through the gum same thing...both at dental hospital.

Does anyone have any experience of an abcess being successfully treated by antibiotics?

Obviously if it needs to be done otherwise,shall contact my EP for advice on Apixaban dosage and what have you.

Its not really noticeably painful ,just sensitive on hot/cold and a litle dull ache.

Teeth Eh? X

[bantam12]

If you have a pocket of infection it should be treated, if you don't want the crown disturbed then the surgical option will likely be best. In my dental nursing days we did many of these in the surgery but dentists these days don't do anything like that !

You could try the antibiotics, see how you get on but chances are it will blow up again at some point in the future.

[wilsond in reply to bantam12]

Thank you,i dont mind them taking the crown off if they need to. She did say that if further treatment required would be at the denta! Hospital near us,where my son had a wisdom tooth out last week....dont fancy them chopping away at the old root canal work there ! Devout dentist coward with a passion!! But would of course go for it if need be.....xx

[sleeksheep in reply to wilsond]

I had an Endodontist who treated my abscess under the front three teeth by root canal and filled with antibiotic paste . It was left for eighteen months and monitored by x ray untill the abscess area had regrown , then the final root canal was put in - not capped as it was done almost at gum level from the back of the teeth.

This was a severe pain but the dentist wanted to do a surgical procedure so I got a second opinion. Far better option to use antibiotics than surgery and cheaper too.

[wilsond in reply to sleeksheep]

Thank you for this,that does sound a better option,hope it works!

[sleeksheep in reply to wilsond]

It was fifteen years ago and still alls good

[wilsond in reply to sleeksheep]

Thank you xx

[Rienij70]

You poor thing, I feel for you. Sorry don’t know the answer. But I do hope you get it sorted soon. Xx

[wilsond in reply to Rienij70]

Thank you Rienij xxx

[Beta44]

I had a similar problem. Given antibiotics to clear infection then crown removed, root canal redone a and new crown fitted. There was no need to stop NOAC.

Peter

[wilsond in reply to Beta44]

That's great news thanks x

[irene75359]

My reaction on reading your post is that little dull ache might progress somewhat - my experience of an abscess at the root of a crown was excruciating pain! Antibiotics didn't help and I ended up having treatment by a maxillofacial surgeon. The abscess had eaten away at the bone, so he entered the root through the gum above the tooth and the area was packed with some sort of granular substance that helps the bone regrow. I had quite a few stitches, the bone did grow and eventually was solid enough to hold an implant screw and eventually a tooth. It sounds horrendous but was all done under sedative (I can barely remember) and wasn't anything as bad as the abscess.

However, this was in the days before I was on warfarin. My current dental surgery knows my medication and is quite happy to treat me providing my INR is between 2 - 3. But you if have the treatment at the dental hospital (going through the gum) you may well have to stop Apixaban. Your EP may suggest bridging, but if not ask!

Teeth and my problems with them are the story of my life, I even have dreams about waking and spitting all mine out!

[wilsond in reply to irene75359]

Thank you Irene,hmmm sounds ominous! Like you have always had problems with my teeth,this particular tooth has had previous root canal work done... I am popping into dentists in a bit to ask questions as to whether they will do another xray to see what effect the antibiotics have had. Xxx

[irene75359 in reply to wilsond]

I don't think I made my description clear and sorry if I painted a black picture. My crowned tooth (also front) couldn't be saved, neither could the root, with the abscess it was practically non-existent and certainly wasn't capable of holding the post for a crown. But the (jaw) bone recovered and I was able to have an implant which hasn't moved in 10 years. The only painful thing was the cost!

[wilsond in reply to irene75359]

Oh dont worry! I have bad history with teeth anyway! I just got back from the dentist,saw the senior dental nurse for a chat and she said come in tomorrow,see the dentisr and ask for referral for the surgical option as I have a!ready had root canal work done on this tooth before. In her words 'dont mess about with antibiotics) It would be at our local dental hospital NHS.....ho hum !!! Thank you for sharing your experience

[pusillanimous]

I had a similar problem with a previously root treated crowned front tooth. The Oral surgeon performed an apicoectomy in his rooms. I was collected by my husband after the procedure, no problems, this was before I was diagnosed with AF, but just illustrates how simple the surgical procedure is - I'm a qualified dental Hygienist.

[wilsond in reply to pusillanimous]

Thank you for this and glad you are ok now.

[ILowe]

I have had this problem twice. In both cases the dentist referred me to a face surgeon who saw me straight away (not in UK). It was considered as urgent, and rightly so. Any enclosed infection can spread. Anyone with a frail heart risks infection of the heart -- endocarditis, which if left untreated, or not caught in time is always fatal (so I was told).

The face surgeon in both cases gave me a choice -- an attempt to remove the source of infection by coming in from the side through the gum, or by tooth removal. He argued that only tooth removal could mean total access to the infection. The risks and pain of an extraction were much lower than the high risk of an unsuccessful gum access treatment and subsequent difficult to treat infection.

If I have this problem again I will push for urgent same week extraction under antibiotic cover. Nowadays even difficult extractions can be done in outpatients. For my second tooth, the root canals had fused with the bone, so the roots required cutting before extraction so it was judged to be difficult. The surgeon slit only the gum away from my tongue so I did not have problems avoiding it during the recovery. I am on Warfarin, and the surgeon said that provided the INR was less than 4.0 he would operate. He used special gauzes to help coagulation. I never had any gum bleeding at all afterwards.

Infection in the gums can spread. It probably caused me endocarditis and a Mitral Valve replacement. Take care.

[sleeksheep in reply to ILowe]

Did you see an Endodontist about this as well as when I was deciding what to do I had a referral to a Surgeon and an Endodontist. The surgeon more or less had the same plan as what you describe but the Endodontist was totally different in his approach.

Maybe it was three years before the bone had fully grown back , I still had three root canals but no surgery , quite painless actually.

Just to qualify this - here a surgeon mostly does extractions and the endodontist is at the pointy end of the dental tree.

[Tapanac in reply to ILowe]

I have a broken tooth which my dentist says can’t be saved and needs to be extracted. I am waiting for an appointment at the hospital because like your second tooth the root canal has fused to the bone. I am such a coward with dentist (despite having a bigger surgery in brain tumour) so did they sedate you when you had this done please? All ok afterwards??? How long before you were better, etc????

[ILowe in reply to Tapanac]

I too was scared stiff even the second time. Strange in a way, because the open heart surgery to replace my Mitral valve was far worse! But, I trusted the surgeon.

Did they sedate me? Not that I know of. I did not even have an intravenous line put in me. I said I gagged easily and he said it was possible to avoid anaesthetic working at the back of the throat. I also said I preferred to tolerate pain if it had a purpose rather than have xtra anaesthetic. We agreed a hand signal for pain then he would decide to push through the pain or give me more pain relief. I asked for and got a good dark eye cover because despite my fascination with medicine, the tools of the trade for dentistry are not for me.

The operation itself was the easy bit for me. Afterwards came the need for pain relief. There are very few pain drugs available to those of us on Warfarin. Cutting the root, followed by packing the socket with haemostatic dressing to reduce bleeding means that the normal process of a good clot of blood forming at the base is inhibited. Result: dry socket. Pain tablets either did not work or I disliked. The pain spread to the muscles of my neck and head -- like a never ending cramp -- I sometimes get these when nervous. Fortunately, I could still talk and work, and the best solution was distraction. I was able to sleep at night. In the end I had to grin and bear it, knowing that there was a good reason for it, that the reason was not a sign of danger, and that it would pass after a month or so.

By the way, I avoided the usual mouth washes since as the gums doctor said, they also kill off the good gum cells. I obtained some oral hydrogen peroxide. You really have to keep the wound clean -- at a risk of bleeding and pain. Peroxide has the beautiful advantage that it gets in the cracks and attacks particles of food.

Sounds aweful, but I would do it again simply because the fearsome risk of endocarditis and other killer infections is frightening to think about.

[Tapanac in reply to ILowe]

Hmmmm can’t wait.....

thank you for replying. I’ll let you know what a cowardly baby I’ve been when it’s done

[ILowe in reply to Tapanac]

Someone who admits fear in public is no coward. You had courage. I hope it all goes well.

[wilsond in reply to ILowe]

Thank you for the information,I am contacting the dentist today to see what I should do once the antibiotics are finished...i.e should furhter action be taken in view of what people have said here,that it can come back.

Glad you are ok now!

[wilsond in reply to wilsond]

In tomorrow for consultation and to request a referral to the nHS dental hospital xx

[ILowe]

Well spotted -- different systems. I used someone who only did extractions and minor surgery eg all four Wisdom teeth extracted in one go under general anaesthetic. My dentist though specialised in root canals. He really did believe in saving the tooth if possible. So, if you like, the 'almost' endontologist referred me to a tooth surgeon. In the second case it went quick, and by quick I mean that. 4pm diagnosed. 5pm panoramic X-ray (because the surgeon in those days always required that for the initial contact) and 6pm arrived unannounced and he agreed to see me as an additional patient since I was already known to him. He immediately agreed the infection risk was high and scheduled extraction within 2 days. In the first time, I was also seen quickly, a scan was ordered which took a few days to arrange. Once I had the data I took it round to him, and there was nothing to be seen. He was good. He said there are physical signs, so there must be something, so that evening he went to the Scan lab and studied the data on the computer and found it then confronted me with a stark choice.

In both cases the infection was too deep for an Endodontist. Sometimes you have to wave red flags of danger in front of them so that you are treated urgently. My British Cardiologists had told me to always push for rapid treatment whenever there are signs of an infection.

[Hidden]

WilsonD, Did you have AFib before you had the root canal? And have you had other root canals prior to this one?

I suggest if you have Netflix, that you watch the documentary, "Root Cause". If you don't have Netflix, you may be able to order it through your local library or even through Amazon.

I hope you do this. It explains everything about my particular AFib, SVT.

Best to you.

Sadie

[wilsond in reply to Hidden]

Interesting will look it up,definetly had root canal work done before Af was eventually diagnosed.

[Hidden in reply to wilsond]

Wilson,

In May, I'm having two root canals removed, purged of all infections and dead tissues.

Originally I had a front bridge that broke off at the gum line. After the root canals, within a few days, I developed AFib and SVT. I did not know what was happening to me, until I went to the Emergency Room.

It's been a long haul with many different approaches to stop the AFib, SVT. A different dentist told me to watch the DVD, "Root Cause". When I did, it all made sense.

Best Wishes to you.

Sadie

[rosyG]

Hi

Had an aces treated recently under a crown and root canal work done. No problems but hoping it stays OK!!

[wilsond in reply to rosyG]

Hope so too Rosy. My crown has already had root canal work done before,years ago,but think its so old now(the crown)is not fitting snugly against my gum...and hence a route for infection...Im popping by the dentist later this morning to ask whether she wants to do another xray after the antibiotics are finished.Got a bit of AF going on so sitting it out first..ho hum thank goodness for this forum and good books!