Abscessed teeth

[tx oms]

Advertisement - Members don't see this ad

Well, yet again I have stomped out the lie that abscessed teeth cannot be treated. One of the pastors at my church tells me today that their grandchild has an abscessed tooth and the family has spent about $1000 in the last few days dealing with the situation. Seems that the family dentist told the parents, "I can't do anything until the infection is gone" and referred the child to a pediatrician. The pediatrician gave the kid some expensive IM antibiotics to no avail. The family finally took the kid to an oral surgeon who saved the day. BTW, the tooth had a previous pulpectomy.

Here are the lessons:
1. If you are a dentist you cannot treat an abscessed tooth with antibiotics alone. You must either pull the tooth or access and instrument the canals. No exceptions. Remember this when you are in your private practice. Sure, an MD can use antibiotics b/c they don't know how to treat the tooth. You're a freakin dentist, so figure out how to treat the tooth. If anyone tells you an infected tooth cannot be treated until it "cools off", punch them in the face and kick them in the sac.

2. Don't let a child you care about have a pulpectomy. Just pull the damn tooth and use a spacer. Why risk an abscess in a child? So you can feel like a big man b/c you did a half ass root canal?

 

[lnn2]

Here are the lessons:
1. ... If anyone tells you an infected tooth cannot be treated until it "cools off", punch them in the face and kick them in the sac.

Thanks for the lesson! I'll definitely try that whenever I have the chance!

I agree with you, totally! That's bad dentistry. That "family dentist" should have treated that re-infected tooth. What's up with the referal to a Peditrician?! How about referring to a Pedodontist first?! IM antibiotic, that's what you get for referring a dental patient to a MD!

We always treat hot/infected tooth with or without abscess in Urgent care dept at my school. We rarely do I&D but the patient has a couple of choices.

1. Exo (most popular, the instant gratification!), meds prn
2. Palliative tx (pulpotomy, pulpectomy, or re-instrumentation of the canals), meds prn

I had a few cases with a re-infected tooth. The smell of it is strong enough to kill a linebacker! Molars are the worst.

 

[gonnabdds]

Well, yet again I have stomped out the lie that abscessed teeth cannot be treated. One of the pastors at my church tells me today that their grandchild has an abscessed tooth and the family has spent about $1000 in the last few days dealing with the situation. Seems that the family dentist told the parents, "I can't do anything until the infection is gone" and referred the child to a pediatrician. The pediatrician gave the kid some expensive IM antibiotics to no avail. The family finally took the kid to an oral surgeon who saved the day. BTW, the tooth had a previous pulpectomy.

Here are the lessons:
1. If you are a dentist you cannot treat an abscessed tooth with antibiotics alone. You must either pull the tooth or access and instrument the canals. No exceptions. Remember this when you are in your private practice. Sure, an MD can use antibiotics b/c they don't know how to treat the tooth. You're a freakin dentist, so figure out how to treat the tooth. If anyone tells you an infected tooth cannot be treated until it "cools off", punch them in the face and kick them in the sac.

2. Don't let a child you care about have a pulpectomy. Just pull the damn tooth and use a spacer. Why risk an abscess in a child? So you can feel like a big man b/c you did a half ass root canal?

From what we were taught in pharmacology and endo, you really ONLY need antibiotics if there is cellulitis. In practice, everybody gives antibiotics for everything to cover their butts, but we were taught that it's unnecessary. I guess the dentists that say they want it to "cool off" just want to do endo on necrotic canals, so they don't have to deal with all the pus and blood.

 

[unlvdmd]

One of the pastors at my church tells me

Wait a minute... You go to church? Have you repented for your cat slamming? 😛

 

[Energon]

First of all, I am shocked that the pastor even allows tx oms into the church 😱 . I guess he does not read your posts here 😀

Anyways, I totally agree, if the "family dentist" couldn't make the appropriate desicion to extract, worse send the kid to a pediatrician instead of the pedodontist, he obviously doesnt know the hole the the wall from the one in his @$$.

It is really scary if you think what the level of knowledge that some of these guys in private practice have

 

[DcS]

Word to the wise...don't give out dental advice in a place of worship. You'll have people trying to hit you up for free chit because they want to guilt you into it cause of the church thing.

Just give them a card and tell them to visit the office/school if they want to discuss it further.

 

[OMFSCardsFan]

Wait a minute... You go to church? Have you repented for your cat slamming? 😛

Actually his "church" is one of those golden-calf-worshipping, animal-sacrificing kind of churches. Cat slamming is routinely part of the service. It usually comes right after drinking goat blood. They also fully support aggressive, egotistical, and unprovoked verbal abuse...

As for TX OMS's thoughts on dental abscesses, he couldn't be more correct.

 

[toofache32]

Well, yet again I have stomped out the lie that abscessed teeth cannot be treated. One of the pastors at my church tells me today that their grandchild has an abscessed tooth and the family has spent about $1000 in the last few days dealing with the situation. Seems that the family dentist told the parents, "I can't do anything until the infection is gone" and referred the child to a pediatrician. The pediatrician gave the kid some expensive IM antibiotics to no avail. The family finally took the kid to an oral surgeon who saved the day. BTW, the tooth had a previous pulpectomy.

Here are the lessons:
1. If you are a dentist you cannot treat an abscessed tooth with antibiotics alone. You must either pull the tooth or access and instrument the canals. No exceptions. Remember this when you are in your private practice. Sure, an MD can use antibiotics b/c they don't know how to treat the tooth. You're a freakin dentist, so figure out how to treat the tooth. If anyone tells you an infected tooth cannot be treated until it "cools off", punch them in the face and kick them in the sac.

2. Don't let a child you care about have a pulpectomy. Just pull the damn tooth and use a spacer. Why risk an abscess in a child? So you can feel like a big man b/c you did a half ass root canal?

Preach it, brother!

 

[Pelotari]

If anyone tells you an infected tooth cannot be treated until it "cools off", punch them in the face and kick them in the sac.

This is hilarious! Can I please use this quote?

 

[Dr. Pedo]

2. Don't let a child you care about have a pulpectomy. Just pull the damn tooth and use a spacer. Why risk an abscess in a child? So you can feel like a big man b/c you did a half ass root canal?

Are you sure you aren't a closet orthodontist! 😀 The pulpectomy in primary teeth is a necessary tx for 100-1000s of cases----where space maint. is impossible or contraindicated. Your generalization can be confusing to students who don't have the knowledge of ortho/pedo or desire to do a lit review to understand pectomy vs TE, success rate, failure rate, abscess concern/rate, space maint failure rate, tooth movement predictions, eruptions delays due to TE and complications, etc... it is necessary to have specialized knowledge and good case selection which shouts refer to pediatric dentist. Space maint. is a wonderful tool and if used properly can save parents $1000s in ortho corrections and/or occlusion problems. If you would like some more information to help you understand this area of dentistry better feel free to PM me. I'm not into flame wars or immature babble so if you have a true interest as many of my specializing intelligent friends do------I'd be more than willing to answer your questions.------In the future, [I know you were simply making a generalization that was made in frustration] be careful to stick with your limit of practice and knowledge before making blanket-statements 🙂


Alright gotta take care of some screaming kids.

Dr.B

 

[ISU_Steve]

First of all, I am shocked that the pastor even allows tx oms into the church 😱 . I guess he does not read your posts here 😀

Yeah, I was surprised too. I figured his head would start smoking or just plain burst into flame the moment he set foot on consecrated ground.

 

[tx oms]

In the future, [I know you were simply making a generalization that was made in frustration] be careful to stick with your limit of practice and knowledge before making blanket-statements 🙂

Please be aware that I am biting my tongue in an attempt to not bash you like the ***** I now think you are. This is the gentle version.

You be careful to stick to the limit of your knowledge, whatever it may be. If you care to step out of "baby tooth land", "mr. whistle", and "tooth buttons" into the world of "doctor land" and learn about something other than saving baby teeth at all costs I'll be glad to talk to you. Just PM me. There are more serious things than a failed space maintainer.

Thanks for the asinine disclaimer about knowing were I was coming from. Clearly, however, you did not know where I was coming from or you would have left it at that.

 

[tx oms]

In the future, [I know you were simply making a generalization that was made in frustration] be careful to stick with your limit of practice and knowledge before making blanket-statements 🙂

Please be aware that I am biting my tongue in an attempt to not bash you like the ***** I now think you are. This is the gentle version.

You be careful to stick to the limit of your knowledge, whatever it may be. If you care to step out of "baby tooth land", "mr. whistle", and "tooth buttons" into the world of "doctor land" and learn about something other than saving baby teeth at all costs I'll be glad to talk to you. Just PM me. There are more serious things than a failed space maintainer.

Thanks for the asinine disclaimer about knowing were I was coming from. Clearly, however, you did not know where I was coming from or you would have left it at that.

PS--How about you wait until you have a DDS to talk like a doctor?

 

[north2southOMFS]

I think you meant to say pulpotomy in your original statement, not pulpectomy.

P.S. -How about you wait until you have a pedo certificate to talk like a pediatric dentist.

 

[tx oms]

I think you meant to say pulpotomy in your original statement, not pulpectomy.

P.S. -How about you wait until you have a pedo certificate to talk like a pediatric dentist.

Well, now we finally know what you're good at: pedo. I've been wondering for a while now.

 

[Dr. Pedo]

Please be aware that I am biting my tongue in an attempt to not bash you like the ***** I now think you are. This is the gentle version.

Someone's fun buzzer went off----thanks for the gentle version, I was so concerned about getting the rough version from the "important one" 😉

You be careful to stick to the limit of your knowledge, whatever it may be. If you care to step out of "baby tooth land", "mr. whistle", and "tooth buttons" into the world of "doctor land" and learn about something other than saving baby teeth at all costs I'll be glad to talk to you. Just PM me. There are more serious things than a failed space maintainer.

At least you're true to form. You make a ridiculous statement, react in arrogance, mislead students, degrade pediatric dentistry and then tell a pediatric dental resident to stick to his area of knowledge 😱. Put down the 301 let some air out of your inflated self-importance----stick to ripping wizzies and doing a couple of le forte--all important one in dr. land---but leave the rest of the face to the real surgeons; *****. Oh and pm me with any questions although I can't help you with your narcissism.

Thanks for the asinine disclaimer about knowing were I was coming from. Clearly, however, you did not know where I was coming from or you would have left it at that.

Oh look boys and girls he's perceptive too-----it's like telling a joke and then having to explain it. Thanks for clearing-up this tricky issue.

PS--How about you wait until you have a DDS to talk like a doctor?

hmmm 😉

Enough with the pissing match, act like a DDS

Dr.B (DDS)

 

[tx oms]

Someone's fun buzzer went off----thanks for the gentle version, I was so concerned about getting the rough version from the "important one" 😉

At least you're true to form. You make a ridiculous statement, react in arrogance, mislead students, degrade pediatric dentistry and then tell a pediatric dental resident to stick to his area of knowledge.

Enough with the pissing match, act like a DDS

I guess your fun buzzer went off too, eh big fella? I wrote a thread about how to treat abscessed teeth and my opinion on pedo root canals. I'll stick by my opinion. I didn't mean to degrade everyone in your specialty.

What is the advantage of doing a pulpotomy? Sure the kid gets to keep his tooth another few months to a few years, but so what? Take the tooth out and the kid doesn't risk a large infection.

 

[Dr. Pedo]

I guess your fun buzzer went off too, eh big fella? I wrote a thread about how to treat abscessed teeth and my opinion on pedo root canals. I'll stick by my opinion. I didn't mean to degrade everyone in your specialty.

What is the advantage of doing a pulpotomy? Sure the kid gets to keep his tooth another few months to a few years, but so what? Take the tooth out and the kid doesn't risk a large infection.

At the risk of being civil----tx oms. We need to clarify something. The cases you are seeing are blown-up teeth for one reason or another. They are most likely always indicated for TE. Any abscessed tooth that has swelling in 2 spaces, sinus tracts, purulence expression, systemic manifestations, etc... needs to be TE. PERIOD. Heroics is malpractice in those situations, however, there are 100s of cases were pulpotomies or pulpectomies are necessary and the best TX option.

Pulpotomies----success rate of ~90-98% using formocresol and GI/IRM with SSC. Pulpotomies are NOT indicated for cases mentioned above. They are for deep caries, symptomatic teeth, and no mobility etc... Like you stated we can get years out of them. That's the name of the game. Space maint. is important and the normal dentition is the best space maint. The likelihood of a severe infection due to pulpotomy is miniscle and TE is overkill. We are not trying to perserve teeth indicated for TE.

Pulpectomy--- As I mentioned----specialized knowledge and case selection is most important. So now comes the problem with semantics: abscess. A periapical RL on #T with class I mobility and symptomatic is considered an abscess. No systemic issues, no lymphadenopathy, minor-to-no swelling, no sinus tract. Pulpectomy is a TX option that is correct and better than TE. (Overall oral health must be eval and the parents/childs motivation) What if the patient is congentially missing premolars as many people often are----how do you procede with space maint. if you TE #T or #S? If that #T is in a 3 y.o mouth we have 3 yrs before #30 erupts and ~7-8 years before #29 erupts 😱 What a mess--- Now do we hold #T at the cost of systemic health-----nobody is hopefully that stupid. Case selection. Plus if you have ever had the opportunity of placing a distal shoe you'd want to retain space as much as possible using the primary dentition 😀 There are so many issues to look at, not just the posterior teeth but anterior as well. Premature loss can cause several issues----nutritional, emotional, phonetics and proper speech in some cases, space maint., occlusion issues, delayed eruptions etc... Simply removing teeth because they are classified as abscessed and baby teeth is...... well.......wrong. No kidding-----Took my child to her peds MD. Peds MD says,"My kid has big black spots on 2 back big teeth, but they don't bother her (she's 3.5 y.o) should I bring her in----because my husband and I don't want to put money into teeth that are going to fall out. 😱 My point is yes they are baby teeth and you can say what you want about my specialty choice-------but there is more to pediatrics than singing songs.

Compromising a patients systemic health for space maint. is *****ic---that we can basically all agree on. But pulling an abscessed tooth simply for fear of a future large infection is simply premature in many cases.

Dr. B

 

[mtheman]

---but leave the rest of the face to the real surgeons;

Oh no she didn't 😡

 

[toofache32]

What's a TE?

 

[OMFSCardsFan]

What's a TE?

EXT is my guess...

 

[Dr. Pedo]

What's a TE?

TE= tooth extraction

 

[lnn2]

TE= tooth extraction

that's new. I thought that we write exo or ext. learn something new every day!
I wonder where's tx oms?! no reply to Dr.2b?! probably busy getting lunch/dinner for his chief resident!

 

[Geezer99]

I wonder where's tx oms?! no reply to Dr.2b?! !

Probably berating some undergrad for being an ignorant dental student...That ought to bring him back up after being put in his place by DR.B. Nice job!

 

[umkcdds]

typical arrogant talk from an oral surgeon, the "commander-in-chief of dentists," as the surgeon i worked used to state it.

he probably thinks that endo is an antiquated profession and that all teeth that would require endo should be extracted and have implants placed. the surgeon i used to work for always said he would never have endo done on a tooth in his mouth. he would extract it and have an implant placed instead.

 

[aphistis]

typical arrogant talk from an oral surgeon, the "commander-in-chief of dentists," as the surgeon i worked used to state it.

he probably thinks that endo is an antiquated profession and that all teeth that would require endo should be extracted and have implants placed. the surgeon i used to work for always said he would never have endo done on a tooth in his mouth. he would extract it and have an implant placed instead.

I'm sure if that's what he thinks, he doesn't need you to say it for him on his behalf. 😉

 

[tx oms]

typical arrogant talk from an oral surgeon, the "commander-in-chief of dentists," as the surgeon i worked used to state it.

he probably thinks that endo is an antiquated profession and that all teeth that would require endo should be extracted and have implants placed. the surgeon i used to work for always said he would never have endo done on a tooth in his mouth. he would extract it and have an implant placed instead.

One of my good friends is an endodontist. I would have a root canal done in my mouth. I may even have an apico or a retreatment of a root canal. I've never had a cavity so I can't say for sure what I would do.

You know, the problem I have with dentistry is this: who cares? I mean, why do people get so damn worked up over teeth and a smile? Is there not something more to life than enamel and dentin? Why don't we obscess over toenails like some people do teeth? Maybe we could have a whole area of medicine that deals with toenails exclusiverly. Maybe the toenail doctors could go on and on about how much better their quality of life is compared to real doctors.

Hell, my residency wears me out with the obsession over the greatness of oral surgery. Sure, we do some cool stuff where I am and provide good services. Still, I think there's more to life than teeth or even oral surgery. Presently, I'm not all that excited about being a doctor in general. I have more fun remodeling my house. I guess any job becomes just a job at some point.

Yes, dentistry is a job--and a good one at that. Yes, we provide a service. I'm not even sure about how necessary our services are. It's seems that most patients are either dental ******s who have uncontrollable decay or they don't really have that much wrong with them. It's hard to make money off people who don't really need our services, so we have to sell elective stuff. Seems to me most patients are either hopeless or suckers.

 

[tx oms]

Probably berating some undergrad for being an ignorant dental student...That ought to bring him back up after being put in his place by DR.B. Nice job!

Put in my place by a pediatric dentist? Impossible! I have been working on my house. I layed some tile in the kitchen and ran new trim. I do have other things to do besides busting *****s on the internet--though few are as fun.

 

[tx oms]

At the risk of being civil----tx oms. We need to clarify something. The cases you are seeing are blown-up teeth for one reason or another. They are most likely always indicated for TE. Any abscessed tooth that has swelling in 2 spaces, sinus tracts, purulence expression, systemic manifestations, etc... needs to be TE. PERIOD. Heroics is malpractice in those situations, however, there are 100s of cases were pulpotomies or pulpectomies are necessary and the best TX option.
Student Dr. B

This is the best paragraph you've written. I agree with what you say. I only skimmed the rest b/c I don't really care about pulpotomies and pulpectomies. Blah, blah, blah.

Perhaps I should clarify something: I don't even consider a tooth abscessed until there is swelling, either in the mouth or extraoral. A PA lucency is nothing in my book. It's a bias I have b/c about 80% of my patients have PA lucencies; therefore, I don't think of things as abscessed until something swells up. I also don't consider an abscess serious until it requires emergent OR attention.

PS--Please don't tell me the "systemic manifestations" to which you ellude includes fever.

 

[lnn2]

I have more fun remodeling my house.

Nice to hear from others with the same interest.

Seems to me most patients are either hopeless or suckers.

LOL! "There's a sucker born every minute"!

 

[toofache32]

I have more fun remodeling my house.

I just remodeled my dog house for my 2 labradors. Now it has air-conditioning for these Texas summers. I mounted a window-unit A/C behind it with some insulated duct going into the back of the house. When I first did it, they didn't come out for 3 days. It has a remote so I can adjust it through the window from inside my house. There's also a heater inside for the winter. Here's a couple of pictures of my proud work:

 

[north2southOMFS]

You redneck son of a bitch!

I just gave my dog an air conditioned dog house, but THEY MAKE DOG HOUSE AIR CONDITIONERS!!!!!!.


I bought one on futurepet.com, granted it was 300$, but it is a small central air unit that has two 2in. hoses that go into the doghouse through 2 small holes, one is a delivery and one is a return. And it only runs on the same power that 4 lightbulbs use.


You redneck.

ps. i'd put up pictures if it if i knew how.

Here is the pic from the website though.

Unfortunately my German Shepherd puppy keeps eating the damn hoses. He cant figure out that

Eaten hoses = hot as hell doghouse

So if i come home and see him sitting outside the doghouse just looking at it panting in the 105 degree louisianna nastyness;


..............I know he ate the damn hoses again.

 

[toofache32]

You redneck son of a bitch!

I bought one on futurepet.com, granted it was 300$,

I take the redneck comment as a compliment. You would probably interested to know I also wear a Dale Earnhardt, Jr. scrub hat in the OR that I found on eBay for 8 bucks. My wife has a "Dale Jr." tag on her front license plate.

I had no idea they made those, but it looks pretty similar to mine. I paid $40 for the A/C unit and about $20 for insulated duct, metal ring-adapters, and foam insulating spray to seal off any openings. I'm not sure why that other one has a hose to remove air. I'm just a big cheapskate, though. I waited 6 months to propose and give my wife her engagement ring....I was waiting for her birthday so I wouldn't have to buy her an extra present since I already had the ring.

I got the dog house at a fence company that used scrap wood to make doghouses on rainy days when they can't work outside. I mounted a baseboard heater on the ceiling to use in the winter, and I've cut some 1-inch foam insulation to line the inside walls in the winter.

My wife says I treat the dogs better than I treat her. She's probably right. I remind her that dogs are better because they don't mind when you pet other dogs.

 

[buddy_in]

i dont think antibiotics work to their full extent without draining pus

 

[Bifid Uvula]

My wife says I treat the dogs better than I treat her. She's probably right. I remind her that dogs are better because they don't mind when you pet other dogs.

Dude, you just kill us here..... all of our residents are just getting great kicks out of you (and the other OMFS guys). nice work guys.

 

[toofache32]

Dude, you just kill us here..... all of our residents are just getting great kicks out of you (and the other OMFS guys). nice work guys.

Where are you? You don't have to answer, of course.

 

[tx oms]

i dont think antibiotics work to their full extent without draining pus

1. Duh
2. That was random