Abscessed about whether my travel plans are going down the drain.

November 8, 2014 9:39 AM

You are not my dentist, oral surgeon, or travel agent: can an extraction or root canal be delayed a week or two if the active infection has temporarily been resolved through a short (10 day) course of antibiotics?

Friday morning I woke up with swollen, painful lymph nodes and swelling and pain at a "hot spot" on the (interior) gum next to a rear-most upper molar, which had cracked earlier. The emergency [general] dentist I saw later in the morning (at the kind of clinic I can afford, who didn't have much to say when I told him that for employability reasons I needed to think about extraction vs. root canal, etc. carefully, because I was concerned about tooth shifting afterwards altering my appearance--I simply can't afford an implant right now) wanted to pull the tooth right then and there, since "root canal might fail," before even beginning antibiotics to bring down some of the swelling and infection. (I've since learned that this can be exceptionally painful--and I told the hygienist beforehand that novocaine doesn't work so well on me in a standard dose under the best of circumstances.)

Because I told him I wouldn't do a same-day extraction, I left with a script for Penicillin V and an appointment to come back to have it pulled in 10 days....which is the day before I have to leave on a week-long business trip out of town.

Salt rinses and the soup I had for dinner last night seemed to bring the swelling to a head--and this morning the swelling and pain was completely gone. (Which is a little alarming, since there's no signs the fluid inside was....expelled...did this reabsorb into my system, and is that worse??)

I've read the horror stories and know how dangerous these can be, and will obviously be completing my full course of antibiotics and following up with a (second opinion) root canal or extraction. However, I also don't think it's the best idea to schedule an extraction the day before a 5+ hour train trip and five 12-hour work days, since I don't know how I'll react.

If I complete the course of antibiotics, is it feasible to go a week without either antibiotics or a drill out/extraction, and take care of it when I get back, or would the full infection rebound that quickly? Would I want to continue the antibiotics (i.e. ask for an extra week's worth) until any further treatment to eliminate the problem within the tooth?

Yes, I know you are not my dentist, oral surgeon, or travel agent. I know that dental abscesses can be fatal, or at least have grave consequences for the jaw bone, other teeth, heart and brain etc. I'll be calling for professional advice on Monday. But I'd like to have some idea of what to expect, as I'm in the position of having to make travel decisions (or cancellations) ASAP.

posted by these are my travel socks to Health & Fitness (15 answers total)

If you have a root canal, you'll have to have a temporary crown put on about 7-10 days later and then go in for the permanent crown when it's been made. I had one done last year and felt totally fine but a little tender around the site the day after. I wouldn't go to work if I'd just had a root canal done because they make the site super numb so your face will be frozen and your co-workers will laugh at you. But you can do anything you want except eat hard candy in the days after.

I can't say anything about an extraction because I haven't had one done in decades.
posted by fiercekitten at 10:13 AM on November 8, 2014 [1 favorite]

Also, while I'm not your dentist, I have had a lot of orthodontics done and I wouldn't have an extraction done if the tooth is on your bite plane, aka the points where you do your most significant chewing. Also modern root canals are not like the used to be. A good endodontist will do the root canal and, if it fails, do the extraction as well. I had to ask what was involved because I paid for mine out of pocket and didn't want to be on the hook for a lot of extra work. I would make sure that's part of what your dental professional provides too.
posted by fiercekitten at 10:20 AM on November 8, 2014 [2 favorites]

If you're seriously broke, a root canal and accompanying crown are going to be much more expensive than an extraction. You can get a spacer put in if you are worried about tooth movement.

I am not a dentist, obviously, but I've had a lot of weird dental issues. My opinions on your questions

1. it's quite possible that the antibiotics worked quickly and your infection is controlled and swelling is down. If the tooth is cracked, pus can leak out, sure. There's nothing inherently wrong with that, it's just gross.
2. I'd be concerned about an extraction before a long trip because you could get dry socket or other complications.
3. Stop reading horror stories.
4. If the tooth is still cracked which it sounds like it is then your infection could start right up again when the antibiotics run out. Doctors are often loathe to give people a ton of extra antibiotics but might in your case.

If it were me, I'd be either

- trying to get the date for the extraction pushed up
- seeing if there's a way my cracked tooth could be stabilized before my trip
- checking out info for emergency dentists in the place I was traveling to

But mostly I'd be talking to my dentist or some dentist to get professional advice on this. Try to separate out what is anxiety about future problems (novocaine issue, heart/brain infection) and what is based on likely outcomes given the set of choices you have before you and your particular situation.
posted by jessamyn at 10:24 AM on November 8, 2014 [3 favorites]

I had a similar issue due to a cracked tooth from an injury and I was literally shaking when I got to the dentist because I was so frightened by everything I'd read! I'd waited a long time with my head in the sand, hoping it would just go away. In my case, I went for the root canal and the dentist was able to save the tooth. Happy ending. It was expensive, but it was a front tooth I couldn't afford to lose.

Take a deep breath. There are so many horror stories out there. You are doing the right thing by taking action, but you don't know at this point if a root canal or an extraction is your best avenue. You can't know the best answer until Monday.

Is your upcoming appointment with a regular, non-emergency dentist? Even non-emergency dentists can have a little wiggle room to take in emergency clients most of the time. They seem to be so much calmer and more practical than emergency dentists.

And no, if you do go the way of extraction, do not plan to travel the next day. I had an extraction years ago, went for a haircut, and ended up with a mullet and a mouthful of blood. NO FUN. Give yourself a day of rest after if you can.
posted by mochapickle at 10:27 AM on November 8, 2014 [2 favorites]

And yeah, I had to pay out of pocket. It killed my budget, but I would absolutely do the same if I had to make the choice again.
posted by mochapickle at 10:30 AM on November 8, 2014 [1 favorite]

You only have one mouthful of teeth, and plenty of further opportunities for travel.

Also, you don't want to risk a bad infection of the deep soft tissues of your face/neck. A lot of those come into the ER and they are NO FUN. You're on antibiotics but as long as the infectious focus is still present you're at risk.
posted by killdevil at 10:41 AM on November 8, 2014 [1 favorite]

The body may have resorbed the fluids. This is actually very normal. The fluid is called lymph and it is basically blood, minus the stuff like red blood cells. It is part of your circulatory system and it gets cleaned up by your liver and kidneys. This is a daily, routine process and nothing you necessarily need to worry about. (And it's a lot less grow than spitting pus out of your mouth -- I have experienced both.)

I did have an extraction, possibly even surgical removal of a failed root canal with crown. (I am not sure which -- I had enough root canals fail that I later had a few cases of telling the dentist "just pull the damn thing now" rather than get another root canal. It was the same outcome, lots less pain and suffering.)

I did not have to work 12 hour days, but I did travel the day after oral surgery. I don't recall the details. I am not recommending it as a method.

Call and see if they will call you if they have a cancellation (or refer you to someone else who can get you in earlier) and see if you can't get the extraction moved up and then, yes, ask for a spacer. Not getting an implant does not mean you have to accept the teeth moving.
posted by Michele in California at 11:03 AM on November 8, 2014 [1 favorite]

I am a dentist (but not your dentist) and this is my advice to you: have this exact conversation with your dentist on monday. explain your current symptoms, and your travel plans. perhaps he/she will advise you try to have the tooth treated earlier, perhaps additional days of antibiotics will get you safely through until you return. the best person to assess this and give you advice is the pro who has seen you. don't be afraid to have this conversation. I deal with these types of situations weekly and they are not a big problem if managed carefully with both parties on the same page.
posted by OHenryPacey at 11:16 AM on November 8, 2014 [5 favorites]

Typically if a person has an actual oral abscess, it gets drained by the dentist at the first appointment. Most of the time, if a person just has dental pain +/- facial swelling, it doesn't necessarily mean there is an abscess, it is typically an infection of the root of the tooth called pulpitis (i.e. there is no actual collection of pus/fluid there). Once the tooth root is infected, the only way to fix it is either root canal or extraction, root canal being the much more expensive option.

Antibiotics are just a temporizing measure. After they are stopped, the infection comes back, because the infected tooth root is still there - so just stopping them and not getting the tooth addressed is a bad idea. Having the infection return would be very inconvenient while on a business trip. Personally, I would get the extraction done sooner rather than later, but I hate taking pills even once a day, not to mention four times a day like pen VK. Yes, it's painful, but it's brief. Ask if he'll give you a dose of narcotics to take an hour beforehand (if you want), have someone to pick you up when it's done, and make sure he uses plenty of local anesthetic until you feel numb.
posted by treehorn+bunny at 11:36 AM on November 8, 2014 [1 favorite]

As a counter-example to any horror stories you've read; I had a cracked molar a few weeks ago, I was waiting for an appointment with my dentist while the pain continued to increase day by day. Eventually, I woke up in the middle of the night in pain and started researching dentists to call in the morning.

I found one that opened at 7am, called and had an appointment at 9am, and was having a root canal at 9:30. I was back at work with a temporary crown by 12:30. They prescribed pain medicine, and a course of antibiotics. I never had any pain during the procedure or after. I also never missed any additional work, and made an 8 hour round trip by car two days after the root canal. I have dental insurance, and total cost for the root canal and crown was $800. Without insurance it would have been $1600.

Obviously circumstances vary, but not all root canals fail and they're not necessarily painful.
posted by tz at 11:53 AM on November 8, 2014 [1 favorite]

It's been my experience that how a tooth responds to antibiotics predicts a) whether you need a root canal in some cases and b) whether a tooth can even be saved by a root canal in worse cases. This is just my anecdata, and I am a dentally complicated person.

I recently bit a hard thing in a falafel and cracked my tooth in early August, then had what looked like an abscess over September labor day weekend (swollen blister thing, it hurt, the crack was bigger, I felt stupid). I saw a dentist in my neighborhood and they just did films, saying I could sit tight. I established care with a dentist who treats medically complex people like meand our treatment plan has been to work around that tooth and put off the root canal or extraction decision to see how it does with antibiotics. I am only now, in November, doing to an endodontist - and that's for whenever they have time next week.
posted by sweltering at 2:42 PM on November 8, 2014 [1 favorite]

For what it's worth, once upon a time I was in a out of country when my root canal failed. I was given two kinds of antibiotics (primcillin V and something else) which cleared things up until I got back to my endodontist in the US about two weeks later.

On the other hand, this was a front tooth, which they told me is the easiest tooth to root canal. The molars are apparently a huge pain.

Also my root canal was completely painless (the root was dead so there weren't nerves to feel a thing).
posted by Comrade_robot at 2:46 PM on November 8, 2014 [1 favorite]

I left a failed root canal for like 6-8 months and ended up with a deep abscess in my lower jaw, so definitely don't wait 6-8 months. Idk how much of a difference a week would make.

Which is a little alarming, since there's no signs the fluid inside was....expelled...did this reabsorb into my system, and is that worse?

Sure, it either reabsorbed or you swallowed it while you were sleeping. (sorry)
posted by poffin boffin at 2:50 PM on November 8, 2014 [1 favorite]

I'm a health worker living/working in an indigenous community (in Australia, with free dental clinic) with no fluoridated water, and so bad teeth are very common. There are often presentations to emergency for infected teeth and abscesses. This is what we do:

1. Script for antibiotics.
1a. They don't take them and then get hospitalised for IV antibiotics a short time later.
1b. They take them and continue on to 2)
2. Appointment for dental clinic (usually in 2 weeks)
3a. Person gets that tooth pulled.
3b. Person doesn't get tooth pulled, go back to making an appointment with dental next time they present.

While ideally you get a root canal, I can understand why you'd go for extraction. If we are perfectly comfortable doing this for our people here in the community -- going for antibiotics and then sending them off to dental clinic in 2 weeks time, because that's when the dentist is in town, well, make your decision from this.

** note: I have not seen you personally, and so don't know how bad your infection is, or assessed you personally, to recommend this 100%.
posted by owlrigh at 3:02 PM on November 8, 2014 [1 favorite]

Response by poster: Thanks to all who have logged in. I'm feeling much less cavalier/hopeful since suddenly developing a fever tonight of 100.6 (36 hours after starting antibiotics--temp was normal until now). I'll be checking in first thing Monday morning (with a doctor first, if necessary).
posted by these are my travel socks at 6:36 PM on November 8, 2014 [1 favorite]