I blame my father - I have the same teeth as him!

October 12, 2010 11:18 AM

So. I think I have an gum abscess. What happens after an extraction? Questions inside for anyone who has had one and anyone who needed a dentist while unemployed

First off, I have some crappy teeth. Crowded beyond belief. Luckily I have a small mouth, so it's not too noticeable.

Background:

About 2 years ago, I had a root canal done on one of my molars. Of course, my dental insurance at the time was pretty crappy - so I couldn't afford the crown. So the dentist put in a temporary seal.
Well, shortly after that I left the state and have been without health insurance since - so that seal is pretty much gone and the tooth (whats left of it anyway) looks ... less than fine - since there's a open hole in it.

Last week, I noticed my lymph nodes (on the side of that tooth) flaring up. I didn't think anything of it, because this happens frequently to me (had them checked out various times throughout the years).
I then noticed the next day that there was swollen lump in my gums next to the dead tooth. No pain, though.
I took some antibiotics that I had left over from the root canal days. It seemed to reduce the lump - but it's pretty much still there and the tooth in front of it has swelling around it as well. But still, no pain. My lymph nodes in my neck and under my chin are still swollen - but not as much.

I am currently temporarily out of work until I receive a new assignment, and we're pretty much poor right now - living off my boyfriend's underpaid salary. Our credit is crap.

I've done some research and where I currently just moved to (Knoxville, TN) and they have very limited free/low-income dental options. There are no dental schools that would handle more than a cleaning and the local low-income clinic is backed up for a month because of financial issues.
People have told me to go to the ER (mainly, they think I will die - I have heard of people dying from an abscess - but I imagine I would be in some pain or have other symptoms before death ?)-
Anyway, I have an intense phobia of ERs - plus I am in no pain.

The health department has an emergency dental clinic but the lady on the phone told me they do "extractions only".
Well, my dead tooth probably does need to be extracted - as it's about to crumble...
I made an appointment for tomorrow.

But what happens after they extract it?
Will the emergency dentists properly treat the situation and make sure the infection hasn't spread? Will they drain the gums (if needed?) Or will they just yank the tooth out and send me home?
I've never had a tooth extracted - will I be in a lot of pain? What happens afterward? Eventually I guess I'll need a bridge and all that stuff - that will have to wait until who knows when.
Do some dentists have payment plans that don't involve being pre-approved for credit?


Thanks in advance.

posted by KogeLiz to health & fitness (16 answers total)

If you have an infection, it's likely you'll need a course of antibiotics to kill said infection before they extract the tooth. That's what happened with my wisdom teeth, at least.
posted by gnutron at 11:26 AM on October 12, 2010

I had an abscess on one of my molars last year. It hurt like a motherfucker. Had to have the abscess drained, took antibiotics, had a (what appears to be) successful root canal, and finally a coronation.

If left untrained, the infection in the abscess could spread, and hurt like a motherfucker like mine did. What do I mean by "hurt like a motherfucker?" Well, this happened during finals, and I did not sleep for 3+ days straight. Not even 10 minutes of sleep, out of like 80 hours. It was the worst pain I've ever experienced, not to mention the lack of sleep and nearly losing my mind. It could also mean losing the tooth completely, if it's not salvageable.

I'd call the dental school and ask them what they recommend, even if they can't treat you. If they extract the tooth, they'll pull it and sew the gum with stitches. Then you get to eat ice cream, yogurt, and baby food for a few days. If there is a tooth above it, that tooth may also be lost eventually (don't freak out, we're not talking within months or anything), with nothing underneath it to support it (teeth can move a lot). You can get a bridge if there are teeth around it to support it, or you can get a dental implant (I'm getting one in a couple of weeks, and regretting looking up implant animation videos on youtube last night). I'm lucky enough to be getting this done at a good dental school, so while it's all been expensive as hell, it's still much much more affordable than going to a regular dentist. If there's one within driving distance of you, I would consider inquiring within, even if they're not very close by.
posted by raztaj at 11:51 AM on October 12, 2010

On re-read (IANADDS), I would go to the emergency dental clinic, and get it pulled. I imagine that this would be significantly less expensive than going to the ER. They might drain the abscess while they're at it and give you a prescription for antibiotics. And buy you some time to think about what to do next. Believe me - I completely understand your fear and confusion. I've had a lot of dental work in the past year (after putting it off), and it does get better and easier. After the extraction, you might have some jaw soreness. Some people have pain, most don't (I didn't have any at all, and it was practically enjoyable compared to the pain from the untreated abscess). No smoking or using straws, and eat liquidy, mushy foods for a few days. My extraction wasn't bad at all, but YMMV. Best of luck to you.
posted by raztaj at 12:01 PM on October 12, 2010 [1 favorite]

[The usual "I am not a doctor, dentist or any kind of health care professional" disclaimer.]

A couple of years back, I was in a very similar situation. A root canal that was not crowned and, in my case, done pretty poorly [another story]. Eventually, this tooth (last molar on the lower) cracked on me, split right in two and became infected. I had to have an extraction; thankfully my (now regular) dentist was able to pull it out in two clean pieces.

From my experience as a former dental-phobic patient, I can share these thoughts with you:

• Don't put it off. Get into a dentist and get the infection cleared up. I found the extraction procedure to be simple and fast, but I also had the aid of Nitrous Oxide. If you're nervous at all, ask the Doc to hook you up. Really makes you not mind the whole business.

• I did have discomfort for about 24 hours, but nothing horrible - just aching. Doc gave me pain killers that did the trick. The bleeding stopped when it was supposed to and the socket healed nicely.

• Most Dentists will accept Credit Cards, but it sounds like that's not an option for you. Talk to the office *ahead of time*, explain your situation honestly and see if you can make payment arrangements. I would suspect some Dentists are having trouble keeping chairs filled just as much as any other business these days; perhaps they would be willing to work with you. Be honest with them about the resources (or lack thereof) at your disposal.

• Barring any of this, perhaps a road trip might be in your future to an area that has a Dental School with a reduced-price clinic.

Feel better soon!
posted by pianoboy at 12:02 PM on October 12, 2010 [1 favorite]

I had EXACTLY The same experience as raztaj, including the finals week timing. Do not put this off.

I did not have health or dental insurance at the time. I asked around for friends of friends. A friend's mom had a dental practice some distance from where I was living. She did the procedure at a reduced rate.
posted by fake at 12:16 PM on October 12, 2010

This place offers low-cost dental care for the uninsured. Other options are noted here.

I am not in Knoxville and can't vouch for these facilities, but I am a fellow loser in the genetic dental lottery, so I've felt your pain! (And I second pianoboy's recommendation not to procrastinate.)
posted by virago at 12:25 PM on October 12, 2010

It'll take about a week of antibiotics to get the infection to go away (presuming your bacteria haven't become resistant to the usual types), and after that you get a choice of an extraction or a redone root canal and a crown.

Manual extractions actually aren't very painful when they're pulling it, presuming they use enough anesthetic. It still feels like they're trying to rip your jaw off, but all you feel is pressure, not excruciating pain. Root canals can be far worse, although usually aren't for me. Other than the pain in the butt of having to be careful so as to avoid dry socket and having your mouth full of gauze for a day, it's just a bit sore for a few days. A Percocet in the morning the two days after the extraction followed by some ibuprofen every 6 hours, and I didn't even really notice it. After a couple of days it quit hurting entirely.

After that, find a way to get your teeth cleaned every six months. I lived with dental problems for years until I finally got it all taken care of and started going to the dentist regularly. In the last 4-5 years I've had one small cavity. Yeah, I end up spending $300 a year on dental services, but it keeps me from having to get more expensive stuff done. I have very crowded teeth, so it's essential for me. If I didn't have them do it, there are places I could never get completely clean on my own.

Also, you do want to get this taken care of sooner rather than later. I know someone who recently died after the infection from a tooth abscess spread to his heart valves, necessitating a valve transplant that apparently didn't go so well.

You've got my sympathy. I did the insurance gamble once, and ended up taking a couple of years before getting a crown put on after a root canal. Thankfully, I managed to get dental insurance before it got infected again, but just prior to getting the crown put on it did end up being reinfected and so I had to have that tooth redone. It's a much longer process the second time, as they have to drill out whatever it is they seal the roots up with.

Lastly, if it's a molar, you don't really need any sort of prosthesis. I'm missing a molar (and four wisdom teeth, 3 pulled, 2 surgically removed) and it doesn't bother me one bit. I have others that have opposing teeth, so I can chew just fine.
posted by wierdo at 12:41 PM on October 12, 2010 [1 favorite]

It depends on the infection, but I had an infection prior to an extraction, and the dentist said that based on where the infection was, that removing the tooth would also get rid of the infection (he was right, and I didn't need antibiotics, although he kept an eye on it). The procedure itself was a piece of cake, and I only felt mild pain for a couple of days after (mind you, I tried to stay ahead of the pain by taking pain relievers at regular intervals).

Oh, and they will drain the infection if necessary, although it sounds like my infection was similar to yours, and when the tooth was removed, it essentially drained at the same time. I was in no pain prior to the procedure either.

Don't know much about the insurance situation, as I was covered (thankfully) when I had my procedure done. But best of luck to you, and I hope you have a speedy and comfortable recovery!
posted by I_love_the_rain at 12:45 PM on October 12, 2010 [1 favorite]

I got an abscess when i was on a remote island with no access to antibiotics. I did have Vitamin C and took about 3,000. mg (?) a day for a few days and it cleared up.
posted by mareli at 12:46 PM on October 12, 2010

I'm gonna go with the others that say not to put this off. An untreated infection *can* spread and it *can* kill you (hence your friends telling you to go to the ER). The extraction won't hurt if you go to a competent dentist - I've had two failed root canals, which = two extractions. I cannot take pain killers so mine hurt for a while, about three days.

I've had two teeth abscess on me - one wisdom tooth and one of my failed root canals. Both times they put me on antibiotics for a week before extracting the tooth.

My familiarity with dental insurance is nodding at best - meaning I had about a year of it when I had a "real" job (as opposed to working temp), so everything I've had done I had to pay for out of pocket (except for one root canal). A dental emergency is the same as any medical emergency. They *will* treat you. Don't gamble with your health because you don't think you can afford it.
posted by patheral at 1:28 PM on October 12, 2010

Maybe you alreayd did this, but are you elligible to apply for state funded insurance? I don't know if TN has this, but MN's state insurance covers dental and you can apply on an emergency basis.
posted by ShadePlant at 1:44 PM on October 12, 2010

2 simple, cheap tactics to make healing faster and more comfortable:
1. moisten a tea bag and place it over the swollen gum area. It has an astringent effect; less swelling = less pain.
2. after the first day (or when the dentist advises), rinse regularly with mild, warm salt water.
Good luck!
posted by Corvid at 1:48 PM on October 12, 2010 [1 favorite]

I had the same experience as raztaj and fake, down to the finals (ok, it was an entire semester, including finals) but it wasn't due to putting it off, it was due to my dentist who was supposed to be treating it being inept. Anyway, because proper treatment was delayed, my bone was eaten away t to the point that I had no choice but to have the tooth extracted. I also had to get a bone graft so I can eventually get an implant since it's an important tooth for chewing. Do. not. wait. on. this.
posted by elpea at 2:14 PM on October 12, 2010

IanYD, but...
Mostly sound advice here so far, and by now you've likely had your consultation. If they have put you on antibiotics follow the instructions and take them all, even after you start to feel better.
An extraction site is a wound, and will heal like a wound. Follow the instructions, don't smoke or otherwise create suction in your mouth that might dislodge the fragile blood clot (unlike a scab on your skin, the clot in your mouth will stay moist and can be dislodged, which is the essential problem in a 'dry socket').
Er is almost never a better destination than a dentist, because most er's do not have a dentist on staff (some teaching hospitals or hospitals with a dental resident will, but not 24/7). they can put you on ab, but that's about it and then you are adding the er expense to the inevitable office visit anyway.
good luck
posted by OHenryPacey at 11:36 AM on October 13, 2010

Seconding the tea bag suggestion, if you end up having an extraction. It sounds nuts, but it's quite helpful, and should help stop any extra bleeding that you might be having too.
posted by ashirys at 1:36 PM on October 13, 2010

Update...

First, thanks for the advice all.

I went to the health dept for my emergency dental appointment. They wouldn't take me because I didn't qualify. Apparently I need to be under 21 or over 65 or have kids... or be disabled.
I left crying and pissed at the state of tennessee. Never had this problem in FL or MA.

Anyway , they referred me to interfaith but they are no longer providing dental services.
So. The only option was the ER.
Decided to go to a smaller one and luckily only one other patient was there.
The PA was short with me and asked why I didn't go to the dentist. She spent about two minutes with me.
I received a rx for antibiotics, motrin and a pain killer.
As for treating the cause of this, I guess Ill have to wait until I start working again and then save up to pay out of pocket.
posted by KogeLiz at 3:14 PM on October 13, 2010