Expert: Mark Bornfeld DDS - 3/29/2007

Question
I've been in pain since a filling I got on March 7th, and my dentist (who also does root canals) referred me to an Endodontist due to irreversible pulpitis.  I was in excrutiating constant pain over the weekend after 2 weeks of moderate pain (tooth in quesiton, surrounding teeth top and bottom, cheek, chine, jaw, ear, eyes), but the pain finally got better yesterday.  THat is, it is still severe, but lasts about 10 minutes, and happens only 3-4 times per day now.

I went to an Endodontist today.  He x-rayed and said the tooth and the one beside it #14 and #15 both need root canals.  He tapped the teeth with instrument and no pain. He did the cold test and no pain on #14, but bad pain on #15. He said I'm not feeling pain anymore on #14 because root died and it's getting ready to abscess.  He said the pain will come back on #14 as soon as it abscesses.  He said probably the intermittent pain I now feel is #15.

I have a lot of fears about choking or not being able to swallow, so he said I have to have sedation if he does the root canals.  I agree, though I've never had IV Sedation before.  I forgot to tell them, but I have un-diagnosed sleep apnea where I wake up at night not breathing.  I did call them back and told the lady who answered, and she said she'd put it in my file.  I'm not sure if this is an issue of concern.  

They are supposed to call me tomorrow with an appointment, but said I won't be able to get in for 2-3 weeks.  Is it customary to have to wait this long for 2 root canals, one about ready to abscess, and in quite a bit of pain?

I was concerned about this tooth about ready to abscess -- I've read where that can be life-threatening.  Endodontist wrote me a prescription for antibiotic, but said don't take it unless/until I get facial swelling.  This is really scary to me.  I live alone, and am concerned about facial swelling moving quickly to throat swelling/closure. Is this something to worry about? Or would starting antibiotics if/when my face swells stop the swelling before it reached my throat?

He says it's not abscess now, so no reason to start antibiotic, even though the tooth no longer sensitive to cold or tapping.  I'm just getting really confused because everything I read on internet makes it look like it's infected now, and to start antibiotic now to prevent the swelling -- but not sure if this is right.

My appt seemed so fast, so much information, and he was gone.  Now I have these questions about this potential abscess.  He said it looks okay for now, so I asked how long can I expect it to be okay? He didn't know -- but just take the antibiotics if I swell.

I'm a worry-wart, true, but something in my gut tells me to be alarmed.  I'm trying to remain calm.  Does this all sound correct to you -- that once the swelling begins, it's okay to start the antibiotics then (not before) and I will be safe from throat swelling/closure?  I'm not ready to die yet.  I'm scared.  Also concerned about recovering from sedation with sleep apnea.  Please tell me what you think -- to either confirm what he says or tell me to get a different endodontist....  Thank you so much for you answer.  Janet

Answer
Dear Janet,

Each case brings its own combination of unique factors to bear on the clinical course of an infection, so I can't necessarily predict the manner in which your infection will present. However (and notwithstanding the fact that you're reading this forum now), you should take anything you read about health on the internet with a generous grain of salt. Much information that is available is either written out of context, or assimilated by the reader out of context. In short, it is quite common to draw erroneous conclusions to specific cases from information gleaned from the internet. The vast majority of dental infections do not proceed to the point of airway obstruction, brain abscess, or any of the other gruesome outcomes that seem to be so popular on the internet. It is entirely appropriate to withhold antibiotics until an infection is manifest; doing otherwise is now considered antibiotic overuse, which presents as much if not more risk than antibiotic underuse.

The question that I cannot answer is whether you should wait for an opening in this endodontist's busy schedule, or whether you should seek care from a specialist who can provide more timely treatment. Keep in mind that an endodontist deals with patients experiencing pain all day long, so he must by necessity apply some triage protocol so that patients can be prioritized in his schedule according to some determination of urgency. It would seem that this endodontist considers your case somewhat less than urgent, and I would hope that this is the case. But that doesn't mean you need to wait for this guy unless he's the only game in town. This is something you should discuss with your general dentist; he may be able to find another endodontist who can see you sooner.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY