Expert: Frederick R. Liewehr DDS, MS, FICD - 5/4/2005

Question
Hi Frederick,

While going out to dinner with my wife, I had terrible pain in my left jaw. Woke up at 2 AM with the same pain and some swelling. Tried calling my dentist but couldn't reach him. Went to the phone book and found a dentist willing to take me in at 5 AM and perform a root canal. I wasn't sure of his credentials, but he has a DDS and MAGD(Mastership in the Academy of General Dentistry). The tooth already had a gold crown. He gave me an antibiotic and pain prescription. I see him again next week. The pain is gone but I still feel some pressure, sometimes towards my ear. Do you feel I should go back to my dentist or finish up the RC with him? I just want to make sure I'm in good hands and am looking for an objective opinion. Thanks.

Answer
Hi Dan,
    It would really be impossible for me to evaluate your dentist without any further information. He is not a specialist, but has made the effort to pursue the Academy of General Dentistry's mastership program, which involves a test an accumulating a large number of credit hours of continuing education. So, this indicates a desire on his part to improve himself - a very laudable trait.
    As for the treatment you received, it was probably suboptimal, but unfortunately extremely typical of what I see. I don't know the condition of the pulp, but either you had an irreversible pulpitis, which could give you a lot of pain but not swelling, or a necrotic pulp with an acute apical abscess, which would give you both. If you had the former, you should not have been prescribed antibiotics. If you had the latter, the antibiotics might have been appropriate if you had systemic symptoms (fever, malaise, etc.) but only in conjunction with opening and draining the tooth and/or performing soft tissue incision and drainage. So, one way or the other, the treatment was not ideal, yet is unfortunately typical of what we usually see, particularly at 5 in the morning.
    As for whether or not he will do a good job with your endodontic treatment, I don't know how difficult the tooth is, or what his experience level is, so I have no idea whether or not he would do a good job. Obviously you stand a better chance with an endodontist, who has not only had several years additional training specifically in performing root canals, but also probably does a lot more of them. That, however, is up to you. Some general practitioners love to do endo and are quite good at it. The odds, of course, favor the endodontist, however.
    Whichever you choose, if the pulp of the tooth was in fact necrotic, you need to be seen ASAP for treatment. The infection may be temporarily in abayance, but could worsen at any moment. Good luck.

Dr. Liewehr