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Advanced cosmetic and general dentistry

Jaw swelling is worse after a tooth extraction

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My bottom right second molar was hurting on and off for a few months. My jaw started swelling, so I finally went to a dentist. And a little over a week ago, the dentist extracted my bottom right second molar. Before I left the dental office, my doctor gave me an amoxicillin prescription. I’ve been taking the medicine, but the infection and pain are worse. The swelling in my jaw is large and hard. Do I need to ask for a stronger dose of amoxicillin before Io lose the tooth? Thank you. Reuben

Reuben,

Although amoxicillin often works well for tooth infections, your infection is not improving. It’s getting worse. Many infections have a bacterial strain with amoxicillin resistance. That is likely the case with your infection.

Infections in the jaw can become severe, spread elsewhere in your body, and become life-threatening.

Signs and symptoms that the infection is spreading:

  • Diarrhea
  • Dizziness
  • Fatigue
  • Fever, including sweating or chills
  • Headache
  • Nausea
  • Rapid heart rate
  • Stomach pains
  • Swelling that makes it difficult to open your mouth, swallow, or breathe
  • Vomiting
Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Treating a severe jaw infection is the priority. A dental implant can replace a lost tooth.

Call your dentist immediately and request a different antibiotic that will help your body fight the infection. Don’t delay getting the prescription filled and taking the new medicine right away. If your symptoms get worse, go to an emergency room.

The effects on your overall health are at risk. If you lose the tooth, you can visit an implant dentist to replace it. But for now, it is essential to get the infection under control.

Michael Szarek, DMD, of Lowell, MA, sponsors this post.

 

Dental implant crowns make my mouth and teeth burn

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Almost two years ago, I received four implant crowns. After getting the crowns, my teeth feel dry. And the way my upper teeth hit my lower teeth was uncomfortable. My bite was heavy in places, and I developed the habit of tapping my teeth together. I’ve seen my dentist repeatedly for adjustments. Now I think that I have burning mouth syndrome. By mid-morning each day, the backsides of my front teeth are burning. I chew gum all day to keep the saliva flow going. My dentist told me that I need a gum specialist because nothing is wrong with my crowns. Another dentist gave me a second opinion and said my crowns are well-positioned. If that’s the case, why can’t I stop clicking my teeth together? I don’t know what to do next. Stephen from CT

 

Stephen,

Your experience gives us the impression that your dentist doesn’t have the skill and expertise to place four implant crowns all at once on upper teeth. Although Dr. Szarek would need to examine your teeth for an accurate diagnosis, we will use your description to suggest what might be happening.

How crowns affect your bite

If your upper teeth are uncomfortably hitting your lower teeth, your crowns are disrupting your bite. When a dentist places crowns correctly, your bite will feel natural and comfortable without thinking about it. But your bite immediately felt awkward and is causing you to tap your teeth together.

Referral to a gum specialist

If your bite is off and your crowns are causing the problem, a gum specialist (periodontist) is not the answer.

Second opinion dentist

Although your crowns look perfect, your bite can still be off. When dentists place multiple crowns, they must follow occlusal principles. Your teeth must meet simultaneously and be positioned to ensure tooth function is not compromised. Although you had a second opinion, we recommend getting a third opinion.

Look for a dentist who has post-graduate training in occlusion and bite. Many dental schools don’t offer enough occlusion training for dentists to understand how to place multiple crowns at once. Find a dentist with post-graduate training in occlusion, bite, or full-mouth reconstruction from at least one of these training facilities:

  • Pankey Institute
  • Dawson Academy
  • Spear Education Center
  • Las Vegas Institute

Dry teeth and burning mouth

Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Dental implant crowns can make or break yorur bite

Burning mouth syndrome might be the cause of your dry teeth and burning sensation in your mouth. The stress from your bad dental experience might be the trigger for your symptoms. According to the Mayo Clinic, stress is a secondary trigger for burning mouth syndrome.

After you find an advanced cosmetic dentist with training in occlusion and bite, you can receive implant crowns that look beautiful and function correctly. And your quality of life will improve.

 

Michael Szarek, DMD, of Lowell, MA, sponsors this post.

 

Root canal treatment again?

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In 2014, my dentist did a root canal on an upper right molar. Two months ago, the tooth started hurting, and it’s getting worse. Will I need an extraction and dental implant, or if I see a specialist, can they try a root canal treatment again and prevent an extraction? – Thanks. Noble R. from CT

Noble,

Root canal treatment is one of the least predictable treatments in dentistry. Even if a dentist performs the procedure correctly, it has a 5-15% failure rate.

Can Root Canal Treatment Be Repeated?

Root canal treatment can be repeated multiple times. But it doesn’t always make sense to do it. Still, there is an option before extracting a tooth and replacing it with a dental implant.

Why Causes Root Canal Failure?

Sometimes root canal treatment fails because the dentist could not completely remove the infection from a tooth. Canals in a tooth can twist and turn and make it difficult or impossible for a dentist to clean out the infection and seal out bacteria fully.

The pulp in your tooth contains living tissue, nerves, and blood vessels. A pulp chamber is in the crown of a tooth, and a pulp canal conducts blood supply and nerve in the chamber. If tooth pulp is infected, a dentist will clean out the chamber and canal and seal them to prevent bacteria from entering the tooth.

Molar teeth usually have three canals for each tooth root. But sometimes a tooth has a fourth canal that’s difficult to find and clean. Some canals have branches at right angles. A dentist has tiny, highly flexible files to insert in the tooth and remove the infected tissue, but the files cannot enter a side branch with a right angle. Although a minority of teeth have fourth canals and challenging angles, sometimes fourth canals exist and retreatment is needed. Retreatment has a 50 to 75% success rate. But if retreatment is completed by a dentist who is skilled in root canal treatment and it fails, a third treatment is likely to fail.

Root Canal Surgery

Root canal surgery is a procedure that enters the tooth through the root instead of the crown. A root canal specialist, or endodontist, performs root canal surgery, or an apicoectomy. The treatment is 50 to 75% successful. The specialist will take the following steps:

  • Make an opening in the bone
  • Cut off the root tip of the infected tooth
  • Place a small filling at the end of the tooth to seal it

But even with an apicoectomy, a specialist sometimes can’t access tooth roots, or a root’s location—such as near a nerve in the lower jaw and lip—makes surgery risky.

Extraction Instead of Repeat Root Canal Treatment?

Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Repeat root canal treatment is an option before extraction and a dental implant

An extraction is an alternative to repeat root canal treatment. Although it’s not the first choice, sometimes even a specialist can’t save a tooth, and you’ll need an extraction and dental implant.

Schedule a follow-up appointment with your dentist to discuss your options. You can compare your dentist’s recommendation with a second opinion from a root canal specialist.

Michael Szarek, DMD, a Lowell, MA, cosmetic dentist, sponsors this post.

If get dental implants if I’m 16 and still have baby canine teeth?

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I’m 16 years old, and my upper and lower permanent canine teeth never came in. The baby teeth didn’t loosen or fall out, and the permanent ones never came in. Last December, my dentist removed the bottom teeth. The right permanent canine on the bottom was behind the primary tooth and grew almost in the right space. But the left permanent canine on the bottom is growing too close to the lateral incisor and leaving a space that looks like I have a missing tooth.

The issue with my canine teeth is leaving spaces between my teeth. I don’t want to remove the top canine teeth because I’m afraid that the permanent teeth will come up like the bottom ones and leave spaces. And then my other teeth will start moving, too. Are dental implants a solution for the spaces between my teeth? – Kerry

Kerry,

We are concerned about the situation you’ve described. If you have regular checkups, your dentist should address the problem. What you’re experiencing with your teeth is not uncommon, though. And dental schools train dentists on how to take good x-rays of your entire jaw to resolve the problem.

What Prevents Permanent Teeth from Erupting?

Often, permanent teeth don’t erupt because they are impacted. Some permanent teeth never form. Lateral incisors, lower premolars, and wisdom teeth most commonly don’t develop, but it’s rare for canine teeth not to develop. In the teenage years, when permanent canine teeth don’t erupt, it’s often because they are impacted.

If your dentist takes x-rays of your entire jaw, he’ll get answers to these questions:

  • Where are the permanent teeth?
  • Are they impacted?
  • Are they in front of, or behind, other permanent teeth?

Orthodontic treatment will help the teeth erupt in the correct position. One treatment that allows an impacted a permanent tooth to erupt is for an orthodontist to make a surgical opening in the tissue to expose it. If necessary, the orthodontist might use braces and attach a bracket to the tooth to help it erupt in the correct position. An orthodontist will also determine if there is enough room for a tooth to erupt in the right place.

Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Dental implants need room beneath them to fuse with the bone and provide stability.

Canine teeth are anchor teeth and an essential part of your smile. It’s usually best to remove the first premolar to allow the canine to erupt. Afterward, braces can straighten the remaining teeth.

Will Dental Implants Work with Impacted Teeth?

Dental implants won’t work with impacted teeth because the teeth will block the implants. Implants require a clear path to fuse with your jawbone and remain stable. A dentist will only place implants if there are no teeth beneath them.

If your dentist can’t resolve the issue, we recommend that you get a second opinion or visit an orthodontist.

Michael Szarek, DMD, of Lowell, MA sponsors this post.

Three Causes of Root Canal Failure and How Your Dentist Might Treat It

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My top right upper molar is sore. I had a root canal on the tooth in 2002. I first noticed slight pain about two months ago, but now the pain is more frequent and is intense sometimes. Yesterday I saw a small sore on my gum. Pus was coming out of it in the afternoon, and at the same time, the pain was more intense than usual. I’m afraid that I’m going to lose this tooth and need a dental implant. I’m hesitant about going to the dentist in the middle of a pandemic. Is there anything I can do at home to help the tooth until I’m comfortable going to the dentist? Thanks. Jordan from Richmond, VA

Jordan,

The root canal you received in 2002 failed. And that’s not normal. Root canal treatment doesn’t fail over time. Something caused it to fail.

Causes of Root Canal Failure

  • Tooth not completely sealed – If the dentist who completed the root canal treatment didn’t fully seal your tooth, bacteria can leak in, infect the tooth, and cause significant pain.
  • Untreated canals – Some teeth have canals that, without careful observation, go unnoticed. If the dentist doesn’t remove the infection from all the canals, it can linger and cause future problems.
  • Cracked root – A cracked tooth root is painful. If a dentist can save your tooth, you’ll need some form of endodontic treatment, and the tooth will be protected with a new dental crown.
Diagram of three phases of dental implants, for information on implants and diabetes from the office of Lowell, MA dentist Dr. Michael Szarek.

Dental implants fuse with the bone to provide stability.

We recommend that you schedule an appointment with an endodontist or specialist. After an examination and digital x-rays, an endodontist is skilled at accurate diagnosis or treatment options, including another root canal treatment or root canal surgery. The specialist will also explain the risks and success rates.

If there is a chance of saving your tooth, let the endodontist try to save it. If keeping the tooth isn’t an option, a dental implant is the tooth replacement option that’s closest to mimicking the look and function of your natural tooth.

Accredited cosmetic dentist Dr. Michael Szarek of Lowell, MA, sponsors this post.