Getting an Infected Tooth Pulled

In 2016, I tackled this very subject as Dental MythBuster #16 – You Shouldn’t Have an Infected Tooth Pulled. In this post, I dispelled the myth that if there is an active abscess or other type of infection with a tooth, it should not be removed. I wrote this Dental MythBuster because I had previously encountered some individuals who believed that you are supposed to give antibiotics ONLY and not treat the infection surgically.

This “no pulling when infected” myth was in full force when I posted this video in February 2019 on our YouTube Channel of me treating a patient with a large, life threatening infection. In spite of this, there were posters who were somehow suggesting that I should not remove the tooth? Huh?

Video of Juicy Pus Explosion from Dental Abscess with Extraction

Let’s look at the video that provoked these comments:

It is a very popular video with over 1.6 million views as of 9/2019. As a result, there are many comments. But if you scroll through them, you will occasionally see commenters assert that removal should not have been done.

The “You Can’t Have an Infected Tooth Pulled” Myth in Action

Let’s look at one YouTuber who goes by the name rancar29:

Youtube comment on getting an infected tooth pulled

In the above comment, rancar29 claims that removal would cause sepsis, and that surgical intervention should not have been done at that time.  Apparently, he/she feels that a couple of orally administered pills will cure this infection and that the tooth – the root cause of the infection – should stay put.

I could put forth many arguments to refute the assertions of rancar29, too many to list. But the one point worth highlighting is that with an infection of this size and in this area, bacteria are already into flooding the bloodstream. Generally speaking, removal will not “spread” the infection anymore than it is already is spreading.

Would You Still Want the Tooth in your Mouth?

So, let’s say you go to your dentist with massive swelling and pain. The pain is so intense you feel like your vision is being affected. You can barely drive properly. You can’t think straight. You get in the chair. An x-ray is taken. There is a MASSIVE infection present (but you already knew that).

Large Dental Abscess with swelling and pus

If this were you, would you be OK with a couple of antibiotics pills?

The dentist then says – we’ll just give you some pills and hope the infection clears. Would you be OK with that?

Dental Infection = Infection Just Inches From Your Brain

As I outlined in a more recent post – A Toothache Can Kill You – I talked about how dental infections are close to the brain. And that even in recent times, individuals in the United States have died from untreated tooth infections.

Infections such as the one shown in this video need surgical intervention ASAP. So if you are ever in this situation, you need to get treatment quickly.  Relying on a myth that you shouldn’t get an infected tooth pulled could make you end up in the ER, or worse.

Disclaimer: as always, this post is not considered medical or dental advice. Every case is different. If you have an infection like this, seek out the expertise of a dentist or oral surgeon.

 

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.

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.