Based on some comments I’ve heard in the last few weeks, it seems there is a widespread belief that a dentist or oral surgeon will not remove a tooth until the infection is gone. If this was the case, very few teeth would ever be removed! So let’s look at what really happens:
In most cases of tooth infection, a deep cavity, crack or other defect creates a path that bacteria from your mouth can take to reach your tooth’s dental pulp, which contains the tooth’s nerve. The tooth nerve starts dying in response to the presence of this bacteria. As the nerve dies, it creates gases and other byproducts that may or may not result in symptoms such as pain or swelling.
Why are symptoms not always present? Very simply, your own immune system tries to contain the infection. If it is successful, you may have very few symptoms. Gas build up causes pressure which creates pain. Pus building up results in swelling. Your body tries to find a way to release these—if it does, your symptoms may go away for a time (but the infection is still there!) Symptoms are things you experience—so pain and swelling are part of symptoms.
Dental professionals also look for physical findings, called signs, that indicate the presence of infection. These signs can include, but are not limited to:
- A tooth that looks darker than other teeth
- A drainage tract (sometimes called a fistulous tract, often resembles a pimple but located on your gum rather than on your face)
- A dark area at the end of the root of your tooth on a dental x-ray
- Pus that comes out when the area is pressed or probed
As long as the bacteria has path to the tooth nerve, the abscess or infection continues. This is true EVEN IF you have no pain, no swelling, or don’t think you have an infection. Antibiotics DO NOT eliminate infection in this case. They can’t stop the bacteria from getting into the pulp chamber. You must either do a root canal or remove the tooth to eliminate the infection. If you have a root canal, the infected tissue is removed, the area is cleaned and then sealed against more bacteria entering it. Removing your tooth removes the tooth from the presence of your oral bacteria. In either case, your immune system can then clean up whatever infection remains.
So in most cases, when you have your tooth removed, there is still some infection present.
What is true is that if you have swelling that is visible on your face or that stretches your oral tissues quite a bit, we may not be able to remove your tooth. In that case, we do not want to inject through infection or possibly spread it more. In some cases, you may need to have some of the infection drained prior to having the tooth removed. Antibiotics may be used along with the drainage to help slow down the bacteria so that your immune system can remove them.
Dr. Jennifer Robb is a general dentist located at 1612 Cooper Foster Park Rd., Lorain, OH 44053. She can be reached by calling 440-960-1940. She is also on facebook at www.facebook.com/DrJenniferRobb or online at www.drjrobb.com