Should I wait until my tooth infection clears before getting them extracted?

April 21, 2012 3:13 PM

My two right wisdom teeth are infected and abscessed. I'm on 500mg of Amoxicillin three times a day. Should I wait until the infection clears before getting them extracted?

Sorry for the grossness in advance! On Thursday, I woke up with an intense pain in my throat, and incredibly swollen glands. I went to an urgent care, and the PA who saw me said that it looked like I have a dental infection, and prescribed me Amoxicillin (500mg 3/day). I was in a pretty bad car accident a few months ago that I'm still recovering from, so I'm already on Norco. The next day, after taking the antibiotics, my neck felt a million times better, and that afternoon my right wisdom teeth both ruptured and began to drain. That night was pretty awful until I figured out to elevate my head for the draining, but once I fell asleep, I feel relatively fine this morning, apart from the general weakness from being on the antibiotics. I've scheduled a dental appointment for April 30, when I'm supposed to be done with the Amoxicillin. Do I need to go sooner, or should that be fine? IKYANMD, but I've never had a tooth infection of any kind before - I broke one once, and had a bridge put in - and since I haven't actually seen a dentist yet, only a PA at the urgent care, I just wanted some reassurance that this is generally the way things should be going.

posted by clcapps to Health & Fitness (12 answers total)

I am not a dentist, but my dentist once told me that novocain or lydocain or whatever anesthetic that they use nowadays doesn't work when the tissue is swollen. I think the normal sequence is to remain on the antibiotic until the swelling goes down, then go see your dentist.
posted by Daddio at 3:24 PM on April 21, 2012

Best answer: I have had two dental abscesses, one treated with Amoxicillin and one with Metronidazole. Both were followed by Endodontic therapy ("root canal").

In the first case the antibiotics cleared the infection before I was treated, in the second case there was no longer pain but there was swelling and other indications that the antibiotics hadn't been completely successful. In the later case the dentist seemed to do the same actual procedure as before, including vague arm-waving comments about "cleaning it out" after he'd drilled and before he'd capped.

Whether that "cleaning it out" was actual draining of an abscess or just the pulp/nerve removal I have no idea. But it worked - pain free in both teeth since then.

As an aside - Root canal therapy is nothing like as bad as the mythology would have you expect. It's a drawn out dental procedure (and so hardly pleasant) but if done properly it shouldn't actually be painful.
posted by samworm at 3:33 PM on April 21, 2012

Best answer: I just had an extraction due to an infection and, as Daddio notes, the infection does greatly inhibit the ability of the anesthetics to deaden the pain. Like you, I was put on 500mg Amoxicillin for a week before the extraction and there was still plenty of infection left when I had the tooth extracted. There was hope I could have eliminated the infection by then (which would have allowed an implant to be started right away) but that didn't happen. Taking the antibiotic before any surgery is important and I think they expect you to be still taking them when you have the extractions, so check with your dentist to make sure the timing is right.

My dentist applied tetracycline directly into the infected area once the tooth was out and I got a second Amoxicillin prescription to continue for ten days following. This seems to be standard procedure but you might not have to if the infection is under control by then.

The big downside to long periods of strong antibiotics is the damage it does to your intestinal bacteria. I started taking probiotics when I was still on the Amoxicillin and it helped with some of the symptoms.
posted by tommasz at 3:46 PM on April 21, 2012

Best answer: Infections create an acidic environment and anesthetics don't work well in acidic environments from what my dentist told me during a root canal. He got around this problem by continually using more anesthetic as he got deeper and deeper into the jaw. Overall I got through it mostly pain free.

I had abscessed teeth pulled when I was a kid and I don't recall any pain from the procedure, fwiw.

Tell your dentist everything before you go in and they may use a lot more anesthetic up front before they do the extraction. Mine were decayed and infected, but not to the point of abscess and I didn't really have any pain other than the usual pulling.

Also, my dentist gave me a course of amoxicillin along with motrin after my wisdom tooth extraction. The question I'd ask is if running two courses of amoxicillin that close to each other is a good idea, it may not be.
posted by mikesch at 3:49 PM on April 21, 2012

Best answer: I had an abscess due to a wisdom tooth. I went through about 3 days of horrible, horrible pain until finally my jaw and the entire side of my neck swelled up. I went to an urgent care facility they prescribed antibiotics and they set up an appointment with a dentist for me in 3 days.
I was a bit worried and wanted a 2nd opinion so I called my childhood dentist and he said I needed it out ASAP and set me up with an oral surgeon the next day.
The surgeon was relieved that I came in as soon as I did.
It turned out that my impacted wisdom tooth cracked the molar next to it so I had both teeth removed and a tube inserted into my jaw to help drain all the swelling. He actually put me under for the entire procedure so it was pain free and not so traumatic.

The biggest factor with the rushing seemed to be the infection. The side of my neck had swollen and there was a fear that the infection would reach my lungs.
Yours seems under control now so maybe there is significantly less urgency.
posted by simplethings at 4:30 PM on April 21, 2012 [1 favorite]

Here's the thing: you were seen by a PA, not a dentist, so you haven't really had a diagnosis, just some whitewash treatment that may or may not be treating your condition or hiding something else.
go see a dentist and have a diagnosis, and then decide what to do and when to do it.
posted by OHenryPacey at 5:17 PM on April 21, 2012

I've had three root canals. Two were the result of abscesses. In both of those cases, there was a week-ish course of antibiotics to knock down the infection before seeing the endodontist. The third was a retreatment of my first root canal for which I hadn't previously been able to afford a permanent crown.

Take this with a grain of salt, though. In both the cases with antibiotics it was the dentist that prescribed them after an exam, and in neither case did I have any kind of swelling other than at the tooth, although the first one was causing excruciating pain, which is what prompted me to actually get myself to a dentist after years of knowing that tooth was done for.

I suggest at least asking a/the dentist about it over the phone, if not in person. You're on a course of treatment that I would expect, but I'm not a dentist, just a patient.
posted by wierdo at 6:01 PM on April 21, 2012

Response by poster: Thanks everybody! I feel a whole lot better. My girlfriend just reminded me that it was actually an Nurse Practitioner, not a PA, so I feel a bit more confident about the diagnosis. The pain is all gone, along with the swelling in my neck (there's still some in the gums around my teeth) and all I really feel now is a little bit of nausea/chills, which is probably just my body fighting the infection. My dentist's office is closed until Monday, but I'll call that morning and see if I can get in.
I just fell down the web diagnosis rabbit hole, and started worrying about really scary stuff like sepsis or MRSA without realizing that it's clear that the infection is already responding to the antibiotics.
posted by clcapps at 6:46 PM on April 21, 2012

I would strongly suggest you go and have them extracted. The infection isn't going to go away easily with something irritating it constantly. I have worked on many of these sort of cases and it is better to remove quickly and then treat. Good luck!
posted by Yellow at 7:15 PM on April 21, 2012

I, too, had an infection due to my wisdom teeth. My oral surgeon wouldn't actually take them out until the infection was "gone". All four of my teeth were impacted, so it wouldn't have lasted long before they got infected again, but I did still have to wait. They took them out pretty much as soon as I was better, though. You are on antibiotics, and you are calling your doctor on Monday. Sounds like you have a plan and are doing great.
posted by two lights above the sea at 10:00 PM on April 21, 2012

I also am taking a course of antibiotics to get rid of the infection before I get my tooth pulled in a couple weeks. My doctor also said that pain meds/anesthesia will work better once the infection is gone.

My girlfriend just reminded me that it was actually an Nurse Practitioner, not a PA, so I feel a bit more confident about the diagnosis.

Sorry for the derail, but I'm curious, is there a reason why an NP would be more reliable when diagnosing a dental problem than a PA? I really don't know the extensive differences between the two.
posted by batonthefueltank at 11:47 AM on April 22, 2012

Response by poster: I can't speak with any direct experience, but my girlfriend used to work in medical staffing, and according to her an NPs are allowed to diagnose and work without the supervision of a doctor, while a PA cannot.
posted by clcapps at 6:00 PM on April 24, 2012