A Toothache Can Kill You

As a dentist in private practice, I see all types of outlooks and attitudes regarding toothaches and other dental conditions. I see some patients who are deeply concerned to others who say “it’s just a tooth.” Others will state something like “it’s not hurting so why should I do something about it?”

When I see a patient with an obvious infection, I will often times say something like this: “you have an infection with about 100 billion nasty bacteria less than 2 inches from your brain. Are you sure you want to ignore this?”

Let’s look at a recent case I saw in my office.

Large Dental Abscess on the Lower Right

I saw the following patient who showed up in obvious pain:

Toothache abscess with swelling face photo of patient

This patient came to us with a golf ball size swelling on his lower right. The culprit? A tooth!

In the above photo, you can see the obvious swelling. After an exam, it was apparent the serious infection was originating from a tooth. I was very blunt with the patient. Either you get treatment now, or you will likely be in the ER getting ready for emergency surgery in less than 48 hours.

Want to see how it ended? Then watch our YouTube video below:

Infections like this – assuming they are not so advanced so as to require hospitalization with emergency surgery – are nearly always treated using the adage “cold steel and sunshine.” This expression is referring to extraction. The tooth is removed with “cold steel” and then the roots are exposed for the first time to “sunshine”. By removing the tooth, the source of the infection is removed, the pus drains, and in nearly all cases your immune system can fight off the infection.

How an Infected Tooth can Kill You

Many individuals are still skeptical that a tooth infection can kill you. After all, it’s just a tooth some will say. Well, if you read the stories located here, here, and here, you’ll see this is not a myth. It can happen.

So how does it happen? One of the more common causes is that the infection spreads to your brain. See the photo below:

Skull showing the proximity of the upper teeth to the brain.

Skull showing the proximity of the upper teeth to the brain. The roots are embedded in the bones of your skull and very close to your brain.

The above photo is that of a skull (which everyone knows). The bottom arrow points to the approximate location of the roots of an upper back tooth. In most cases, the infection (bacteria, pus, swelling) originates within the tooth but then enters the rest of the body through the tips of the roots. The top arrow points to the approximate location of the base of the brain. Now, this is a two dimensional photo of a three dimensional object (brain and skull). But you should be able to see that an infection with upper teeth roots places nasty, killer bacteria less than 2 inches from you brain!

If the nasty bacteria end up in the brain, it can fatal, and very quickly. It’s that simple. This is likely what happened in the case of Deamonte Driver.

Other Ways a Tooth Infection Can Kill You

There are other ways in which an infections associated with a tooth can be fatal:

  • Suffocation – no, I’m not joking. Infections associated with lower molars can lead to swelling of the throat, leading to collapse of your airway. You are simply unable to breath. This is most commonly seen in Ludwig’s Angina.
  • Heart Failure – I’m not joking with this either. The bacteria from a lower tooth can quite easily travel downward through the neck and set up around the heart. This can lead to issues with the heart and ultimately cause the heart to fail. An example of a case is located here.
  • And many other ways. Remember, teeth are part of your body too…
Ludwigs Angina

Photo of a case of Ludwig’s Angina. The swelling will literally cause your airway to close. Photo courtesy of wikipedia.

In summary, it’s important to not ignore a tooth infection, even if it does not hurt. You don’t want to be like the guy in our YouTube video!

 

Can You Do a Root Canal Through a Crown?

As a busy dentist in private practice, I get some variation of the “can I get a root canal on a tooth with a crown” question quite frequently. The question comes in various forms, but the general summary is something like this:

“I got a crown done about three years ago. Everything was fine until a week ago, and now it feels like it is on fire. I think I need a root canal. Can you do a root canal through a crown?”

The answer to this question is yes (most of the time).

Why Teeth Need Root Canals

Before we describe why/how a root canal is done through a crown, it is important to know why teeth sometimes need root canals.

tooth with cavity needing a root canal

This tooth had a large cavity. The brown spot visible in the photo is the decay. On subsequent removal of the decay, the nerve became inflamed, and the tooth needed a root canal.

A tooth needs a root canal when the nerve inside the tooth becomes inflamed or infected. This can be due to several reasons, including:

  1. Dental decay (a.k.a. cavity) that either comes close to or enters the nerve of the tooth.
  2. A crack or fracture of the tooth where the nerve become exposed.
  3. A large restoration (filling) placed very close to the nerve. The filling is done due to the presence of decay and/or cracks (as talked about in points 1 and 2 above). Note it is not the filling that causes the need for the root canal, but rather the decay and/or fracture.
  4. Trauma to a tooth in which the nerve is injured.
  5. Other more infrequent causes (internal resorption, external resorption, jaw cysts, metastatic malignancies which enter the jawbone, etc.)

Generally speaking, reasons 1, 2, and 3 are the causes for 99% of all root canals.

What is a Root Canal?

Describing a root canal is not the point of this post. But a general summary can be presented.

Root canal access cavity

View of a cleaned out nerve chamber of a lower tooth as seen from directly above the chewing surface. The 3 holes are entry points to 3 separate canls.

In a root canal, the infected and/or inflamed nerve tissue inside the tooth is cleaned out and then filled with a special filling material. We do this by drilling a hole from the top of the chewing surface of the tooth into the nerve chamber. In the photo above, you can see the large hole in the tooth which leads down and exposes 3 smaller openings or orifices. These are the openings to the canals of the tooth.

In a root canal, the roots of the tooth remain. They are not removed. By having a root canal done, you are able to keep a tooth that might otherwise have to be extracted.

How a Root Canal is Done Through a Crown

A crown, often called a cap, is a custom fabricated restoration comprised of metal and/or ceramic that covers the top of portion of the tooth. Crowns are done for many reasons, but they are mostly done to protect a tooth that has been compromised by decay and/or fractures.

When a tooth with a crown needs a root canal, you can expect the following sequence:

  1. You will be given local anesthetic so that your tooth is totally numb (and other parts of your mouth too).
  2. A rubber dam will be placed over the tooth.
  3. A small hole will be drilled through the crown into the tooth and into the nerve chamber.
  4. Then the dentist is ready to begin cleaning out the infected and/or inflammed nerve.

Before and after photos showing a root canal through a crown. In the left photo, you see the procedure in process with the rubber dam and access into the nerve chamber. The right photo shows the completed procedure with a filling sealing the access hole. The crown is saved! Photos and dentistry Dr. Nicholas Calcaterra.

In nearly all cases, the root canal is done through the crown, the access is sealed, and then everything goes back to normal.

When Saving the Crown is not Possible

In some cases, doing a root canal through a crown and keeping that crown is not possible. This can happen for a variety of reasons. Some of them include:

  • The decay – which caused the need for a root canal – is so advanced that a new crown is needed.
  • A large piece of porcelain broke off during the procedure so that the crown is no longer functional.
  • A root fracture of the tooth was discovered during the procedure and the tooth must be extracted.

The above list is not comprehensive but covers many of these situations.

In all cases, your dentist or endodontist should discuss with you the likelihood of you keeping the same crown after the root canal procedure.

Five Fast Facts on Fluoridation from the Science Moms of Fluoride Exposed

The following is a unique guest post from two accomplished scientists (and moms). I hope you enjoy it.

What is the government really up to putting fluoride in the water?  Are dentists part of a mass conspiracy?

We are two science moms, Effie Greathouse, Ph.D. freshwater ecologist, and Kylie Menagh-Johnson, MPH public health educator, and we say yes – a conspiracy to strengthen enamel and prevent caries!

Today, we’ve got five fast facts about fluoridation and oral health for you:

1) Fluoridation works together with fluoride toothpaste.

The baseline recommendations from the U.S. Centers for Disease Control’s oral health section, as well as other science organizations like the American Dental Association and the American Academy of Pediatrics, is to brush twice a day with fluoride toothpaste (a pea size for adults, a small pea size for kids 3-6 years old supervised by parents, a rice-grain smear for kids under three years old) and drink fluoridated water.  Brushing with fluoride toothpaste twice a day makes fluoride available to teeth for topical mechanisms of counteracting demineralization, while also counteracting gum disease via the mechanical action of brushing.  Fluoridated water delivers fluoride to saliva to counteract demineralization topically throughout the day in between brushing, and it strengthens kids’ developing teeth, too, prior to eruption.

Periodic table showing fluoride

Fluorine, the element from which fluoride comes from, is located on the periodic table next to oxygen

2) The recommended level for fluoridated water is now 0.7 parts per million (ppm).

In 2015, the U.S. Public Health Service (USPHS) reviewed and updated the recommended level of fluoride for community water fluoridation.  Based on a review of the science by a panel scientists from environmental, agricultural, and health agencies, USPHS determined that the previous climate-based range for fluoridation (0.7– 1.2 ppm) could be changed to a single level for the whole country (0.7 ppm).  After addressing hundreds of unique public comments, the new level was published in the Federal Register and Public Health Reports and became official.

3) At both the new and the old recommended levels of fluoridation, rates of severe dental fluorosis are nearly zero.

Severe dental fluorosis – the kind that involves pitting and brown stains – is seen at very high levels of fluoridation. This rate of this adverse effect – when studied by the U.S. Environmental Protection Agency and a 2005 panel commissioned by the National Academies of Sciences – is nearly zero when fluoride levels are below 2 ppm.  So there’s no severe fluorosis associated with the new level of 0.7 ppm or the old level of 0.7-1.2 ppm.  Mild fluorosis does occur below 2 ppm, but it consists of white spots and markings that are often only noticeable to dental professionals and not to the general public.  Mild fluorosis will decrease with the move to the single 0.7 ppm level.

dental fluorosis caused by levels far greater than the CDC recommendations.

Severe Dental Fluorosis. The amount of fluoride needed to produce this defect is FAR greater than the levels recommended by the CDC. Photo courtesy Dr. Nicholas Calcaterra at Calcaterra Family Dentistry.

4) Fluoridated water is not just for kids.

Most of the studies of fluoridated water – especially historically – have looked at prevention of cavities in kids.  But in recent years, there’s been much interest in how fluoridated water prevents decay in adults.  A 2007 meta-analysis of 20 studies of fluoride and fluoridation effects on adult teeth points to the importance of fluoride for preventing cavities among adults, including root cavities.

5) Fluoridation of drinking water is one of 10 great public health achievements in the 20th century named by the U.S. Centers for Disease Control and Prevention.
Surgeon General Dr. Richard Carmona.

Surgeon General Dr. Richard Carmona was involved in declaring fluoridation as one of the top 10 public health achievements.

Fluoridation ushered in a new era of prevention in dentistry.  The development of all modern fluoride products – including fluoride toothpaste – built on the initial classic public health measure of fluoridation.  And the result was a dramatic decrease in cavity rates from the 1950s to the 2000s.  The other public health achievements with which fluoridation ranks include vaccines, motor vehicle safety, workplace safety, and tobacco control.  CDC judged fluoride and fluoridation to be right up there with seat belts, worker’s compensation, refrigerators, and cigarette ad bans for promoting health and wellness.

Those are five quick facts about community water fluoridation.  Our non-profit website is Fluoride Exposed. From oral health to public health, from drinking water treatment to chemistry, from geology to nutrition, and everything in between, we use real science to expose all the facts about fluoride and fluoridation.

If you’d like more fluoride facts, check out our articles and features on the Fluoride Exposed website.  We’re also up on social media at Twitter and Facebook, you can sign up for the Fluoride Exposed newsletter, and we have a custom T-shirt you can get to support the non-profit, and show off the 10 great public health achievements, including fluoridation.

Webmasters note: I am very selective on guest posting and linking to other sites. I was happy to publish this unique article and then link to Fluoride Exposed because of the scientific and non-profit nature of Effie’s and Kylie’s site.

90 Second Wisdom Tooth Extraction Video

This post, featuring an HD video of a wisdom tooth extraction, is different from many previous posts. Instead of tackling a topic and answering questions via the written word, this post uses a YouTube video to answer questions regarding one of the more feared and dreaded procedures in all of dentistry: wisdom teeth removal.

This video was shot in my office and features a young, early 20s patient having a lower right impacted wisdom tooth removed under IV sedation. The third molar and sedation procedures are performed by me along with two assistants. Check it out here:

Having participated in the filming of dental procedures before, I will tell you that capturing high quality video footage is not easy. Camera angle, proper lighting, patient participation, etc. are all difficult to control. I can confidently say that this is very high quality video footage of a third molar extraction (click here to go directly to the video on YouTube).

This video does answer many questions and resolve many myths that I’ve seen in blog comments and in questions I’ve received over years of private practice. Let’s review them.

Does getting a wisdom tooth extracted hurt?
  • No. In the YouTube video, the patient was given local anesthesia (a.k.a. novocaine) beforehand. She does not flinch nor respond during the procedure. That is because she is numb and is also under twilight sedation.
Does the dentist have to put a knee on my chest to pull the tooth?
  • No. That is a popular myth that I debunked in this post. Extraction of a tooth requires the controlled, precise application of force. It rarely requires a pulling force. The tooth literally slides up and out of the socket – as you can see at the 2:00 mark of the video.
Will I be in pain for days after getting my wisdom tooth out?
  • Not necessarily. Each and every case is different. In this video, the extraction itself only took 90 seconds. So she had very little pain afterwards. Other third molars require more time and are more invasive. Those will likely be more painful afterwards.
What is an impacted tooth?
  • An impacted tooth is when bone, gums, and/or other structures prevent the tooth from coming into the mouth properly. Wisdom teeth are frequently impacted. In the YouTubevideo, we see a soft tissue impacted tooth, meaning that there was a flap of gum tissue preventing the tooth from coming in properly. Other teeth are considered bony impactions in which there is bone preventing the tooth from coming in completely. Bony impaction extractions are typically more invasive.

I hope you enjoyed the video and it helped to answer questions and dispel some myths. Comments are welcome.