tooth infection Archives

Worried About Safety of Dental Sedation

Posted on January 8, 2025 by writeradmin.

I have a pretty bad toothache. My husband says that I need to see a dentist. However, I have pretty bad dental anxiety. He’s suggesting I get dental sedation. I looked into that and it does look like a good option. The one thing that has me worried is an article I read about a woman in Iowa who died during a dental procedure where the dentist gave her double the recommended dose. Is there a way to ensure that won’t happen?

Carol

Dear Carol,

I am glad you wrote. First, I want to let you know right up front that dental sedation is safe. We’ll go over this particular case in a bit. I just didn’t want you worried about getting the care you need. If you have a bad toothache, there are decent chances that you’re looking at needing emergency dental care. It’s best to call sooner rather than later so that you can have a pain and anxiety free appointment.

I am familiar with the case from Iowa. I even know a dentist who wrote a legal opinion on this case. The dentist, in this case, did not do anything that led to this woman’s death. While the recommended dose of triazolam was 0.5 mg and this patient was given 1.0 mg, there are some important considerations here. First, the patient was 270 pounds, which is twice the weight of a woman who would normally take this medication. That would require a higher dose. When she arrived at the office she showed no signs that the medicine she already had taken was affecting her. Normally, you are very sleepy after taking this medication, but she was lucid and having conversations with the staff, showing no signs that it was even working. If she had too much sedation, she would not be able to converse with them at all. She did have a history of drug abuse as well.

To help you understand how safe this medication is, I’m going to quote the dentist who wrote the legal opinion about it. “Some drugs have a wide safety margin. Triazolam is such a drug. To determine the maximum safe dose, we need to turn to clinical data establishing what is called the LD-50. The LD-50 of a drug is the dose at which 50% of the animals in a clinical trial die. This dose is extremely high for triazolam. Tested on mice, its LD-50 is greater than 1,000 mg/kg (see Halcion data from the FDA). For a 270-pound woman (a little over 120 kg), that would work out to a dose of 120,000 mg. While mice data can’t be extrapolated accurately to humans, it does give us a rough idea of the safety.” You can read his entire post about this case here.

This patient was no where close to a dangerous amount of the medication. In fact, it would be extremely difficult to get that much of the medication.

Don’t let a rare incident, that had other mitigating factors, keep you from getting the care you need. A tooth infection should not be ignored. Otherwise a dental emergency could turn into something life threating once the infection spills out of the tooth.

This blog is brought to you by Lexington, KY Dentist Dr. Fred Arnold.

Is My Dentist Putting Me In Danger?

Posted on January 19, 2024 by writeradmin.

I went to the dentist a few days ago and learned that I have a small tooth infection. My dentist wrote me a prescription for an antibiotic and told me to not start the medication until a week before my appointment, but he can’t see me for close to four weeks. I have read in several places that a tooth infection can spread to your brain. I asked him about this and he told me that my infection is so small it won’t matter to wait. Is this putting me in danger?

Avery

Dear Avery,

I am glad that you are reading about dental care and understand the danger of untreated tooth infections. While a tooth infection can get out of control and spread to your brain, or even spread to your heart, throat, or lungs, depending on where it is, I don’t think you are in danger.

Some tooth infections are so small that you will have no trouble waiting a few weeks before getting it treated. If you suddenly end up in some pain or swelling develops, that is a sign it is spreading. In that case, I would call your dentist and tell him there has been a significant change. In that case, he will probably have you start the antibiotic and then schedule you an urgent dental care appointment.

I don’t want you worrying, though. Almost every time, a small infection remains under control for quite a while before it becomes an issue. Yours was so small that you were not even aware it was there until your dental appointment. Unless something dramatically changes, which as I said is unlikely, you are perfectly safe waiting.

The danger comes with patients who avoid the dentist and either try to push through the pain they’re in or who think they can just take antibiotics and be done. Antibiotics do NOT cure a tooth infection. They simply temporarily hold it at bay.

If Dental Anxiety Keeps You From the Dentist

For the benefit of others who may be reading this, I have often found that most people who avoid the dentist do so because they have had a traumatic experience there. This makes the idea of a dentist terrifying to them. If you are in that position, I want to provide a great solution for you.

If you see a sedation dentist, they can provide you with a medication that will completely relax you. In fact, many people call it sleep dentistry because they end up sleeping throughout the entire procedure. You’ll also find that dentists who offer sedation options are more compassionate toward fearful patients. They will not judge you even if it has been years since you’ve been to the dentist.

This blog is brought to you by Lexington, KY Cosmetic Dentist Dr. Fred Arnold.

Do I NEED to Wait Three Weeks for My Tooth Extraction?

Posted on June 23, 2023 by writeradmin.

I have a tooth with a root canal treatment and a tiny fracture. Now there is an abscess and I am absolutely miserable. I went to see my dentist and he felt the tooth needed to be extracted. He does not do extractions himself, simply because he doesn’t enjoy them, but he did refer me to an oral surgeon, who took two more weeks before he could see me. All this time I have been miserable and the infection has been getting worse. I went to see him and he agreed that the tooth did need to be extracted. However, he cannot fit me in for over three weeks. It has only been a couple of days and now the side of my cheek is swollen. I don’t think I can make it three more weeks like this. Is it absolutely necessary for me to wait? Is it reasonable to try and find another oral surgeon?

Emily

Dear Emily,

There is absolutely no reason to wait. In fact, I think it would be irresponsible for them to make you wait. I would start by calling your dentist and letting him know of the situation. Insist he recommend someone who can get you in right away. These type of tooth infections, especially one that is spreading as yours is, are considered to be a dental emergency. It needs to be seen to.

If your dentist does not get someone for you, then take action yourself. This tooth needs to be extracted. You don’t necessarily have to see an oral surgeon. Many general dentists do tooth extractions regularly. In the meantime, someone needs to write you a prescription for some antibiotics. This will get the infection under control.

It will also protect you from it spreading even futher. You do not want it to spread to your brain. Bear in mind the antibiotics will not cure the problem. That will require the extraction. Once the antibiotics run out you will have no protection.

This blog is brought to you by Lexington, KY Dentist Dr. Fred Arnold.

Can An Infected Tooth Spread to a Salivary Gland?

Posted on July 11, 2022 by writeradmin.

I am grasping at straws. My daughter has had two salivary gland infections. Our doctor has done x-rays and CT scans and nothing has shown up to explain it. The only thing that I can think of is that she has had a root canal treatment on the lower jaw near the infections. Is it possible that the material is leaking into the gland area and causing an infection?

Missy

Dear Missy,

I am sorry your daughter has been going through this. It is always frustrating when there are seemingly unexplainable medical issues. It is always possible for a tooth infection to spread. In fact, people still die from untreated tooth infections because of how close the jaw is to our hearts, lungs, and brain. That is one of the reasons that we consider them an urgent dental issue and encourage patients to get treatment right away. However, for an infection to spread, there would have to be an active infection.

You mentioned that your doctor did not see anything on the x-rays or the CT scan. Root canal treatments can fail. One thing you can do is ask your doctor to send the x-rays to your daughter’s dentist. It could be that he doesn’t know how to read dental x-rays and is missing signs of an infection. Truthfully, that is also grasping at straws, but it couldn’t hurt. He shouldn’t charge you anything for sending the x-rays to your dentist.

I hope you find out what is happening. I am sure your daughter is tired of getting these infections.
This blog is brought to you by Lexington Dentist Dr. Fred Arnold.
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Terrified of Seeing the Dentist

Posted on December 12, 2019 by writeradmin.

I am in a massive amount of pain. I’m pretty sure there is something pretty seriously wrong. The thing is, I am terrified of the dentist. I haven’t gone for years because of that fear. I know that’s why I’ve probably now having this problem. I have tried going. I just start shaking whenever I think about it. The last time I went, I actually bolted from the chair because I panicked and left. Is there any help for someone like me?

Morgan

Dear Morgan,

You are not alone in this anxiety. Don’t be too hard on yourself. What you need is a dentist who understands the fear you’re going through and have the compassion to make your experience a positive one. They won’t judge or lecture you. Instead, they’ll work with you through the fear in a way that helps you be able to stay in the chair without bolting. While some dentists don’t like dealing with anxious patients, others are anxious to say that they cater to cowards.

That being said, it seems you likely have some type of dental emergency. You have to get it treated before it becomes a life-threatening emergency. People still die from tooth infections. Before you panic about having to go in, I know a way you can have an anxiety-free experience even during this emergency.

I’d like you to do an internet search for dentists in your area who describe themselves as a sedation dentist. Given the level of your particular anxiety, you need one who offers oral conscious sedation. This is administered by a pill and will completely relax you. However, it is so strong you will need someone to drive you to and from your dental appointment.

Dealing with Your Emergency While Setting Up Dental Sedation

Because you will likely need oral conscious sedation, a dentist will want to do a consultation with you and go over your medical history as well as any medications you are on and allergies you may have. The medications will include over the counter meds too, so don’t leave those out.

In the meantime, when you call the office, explain your position and condition. Ask them to prescribe some antibiotics for you. This will keep the infection under control and help with the pain.

This blog is brought to you by Lexington, KY Dentist Dr. Fred Arnold.

Lost a Tooth During Dental Sedation

Posted on October 5, 2019 by writeradmin.

I’ve always had anxiety in the chair, so I have dental sedation for most of my appointments. Pretty much anything that extends beyond a cleaning, I request sedatives. It’s not all that often that I need extra work done because my teeth are pretty good, but I had a two-year stint without insurance and I apparently built up a nasty cavity during that period.

Anyway, the dentist did the normal routine, including x-rays and exam, and told me I had a big cavity, but that he felt it could be fixed with a crown. We booked the appointment and took care of all the arrangements. I should preface this by saying that I have gone through similar procedures with this exact same dentist, so I didn’t think anything of it going into everything. I mean, I was anxious, but I’m always anxious. We had a good relationship and I trusted him.

I don’t know what happened in the dental chair. Most of that day is a total fog to me. I remember coming out of the grogginess at home and realizing that, instead of prepping for a crown, the doctor had pulled the tooth. I called the office right away and they told me that the dentist got in there and there wasn’t enough tooth left to save.

First, how did he not know this in advance? Secondly, I did not consent to this. I was sedated, so I couldn’t consent to anything anyway. I’m heartbroken and upset that he pulled my tooth without waiting to discuss the issue with me. Maybe I would have decided to pull it, but the decision should have been mine to make. How am I supposed to go forward? Frankly, I’d really like to take this to the board, but I don’t know if I have a case or not. And, I’d also like him to fix it and give me a replacement tooth, but I also don’t know if I can trust him again nor not.

Thank you,

Betsy

Dear Betsy,

So sorry to hear this happened to you.

Sometimes it’s Difficult to See the Depth of Decay on an X-Ray

X-rays are usually 2-D images of 3-D shapes. While dentists are typically quite adept at overcoming the challenges associated with technology, it’s never 100%. Any dentist could have started to prep the tooth and wound up in the same situation.

You May Have Consented to the Extraction Ahead of Time

You should have signed a waiver or liability release before going in for the appointment. This would have likely been given to you at your first appointment when you got the diagnosis and started planning treatment or possibly when you had your consultation for your dental sedation. You would have signed it while you were in an unmedicated state, giving official consent. You can ask to see your consent form if you don’t remember.

However, you may or may not have consented to additional treatment depending on the way the release was written. Chances are, they also walked you through what was happening when it happened, but if you don’t remember the encounter, ask someone who was in the room with you to walk you through it. You’ll probably be comforted to know what steps were taken.

The Sedation Dentist May Have Been Negligent to Leave You with a Broken Tooth

Obviously, courts decide whether actions were negligent or not, but as a general rule, a negligence case requires that the practitioner must have deviated from the normal standard of care and that the deviation directly resulted in your injury. Since it sounds like he followed protocol in the diagnostic phase, the only potential issue is what happened during treatment. We don’t know what happened while you were in the chair. However, imagine, for just a moment, he had left you with a sharp, broken, decayed tooth that offered a direct port to the pulp. You’d be in pain. You’d probably develop an infection, which is considered a dental emergency. The list goes on. It’s safe to say that he could not, in good conscience, leave the tooth as it was. Doing that might have been negligent. Extracting the tooth, probably not.

Follow Your Heart on this One

You say you’ve been a patient with this doctor for years and you’ve trusted him in the past. Talk to him. Tell him how you feel and how the visit impacted you. If, after talking to him, you genuinely believe he was negligent or didn’t treat you in a respectful way, and he’s unwilling to try to make things right, you can forward your complaint to the board and let them sort out whether he acted inappropriately. As far as costs go, bear in mind, that if you had let it fester and it broke on its own outside the office, you wouldn’t have expected the dentist to cover the replacement. There’s some chance this tooth was a ticking timebomb that went off in front of the dentist, but perhaps it could have happened anywhere. He may well be willing to do it since it broke while he was treating you, either out of sheer kindness or the desire to keep a patient happy, but there are no guarantees.

You didn’t say where this lost tooth is, but it may be important you get a tooth replacement in there fairly soon so your other teeth don’t shift.

This blog is sponsored by Lexington, KY Dentist Dr. Fred Arnold.

Antibiotics Not Working

Posted on August 7, 2019 by writeradmin.

I don’t know what to do. I have a tooth infection. I went to the dentist and he prescribed me antibiotics. I’ve been taking them regularly. While things seemed to get better for a short time, it seems to have gotten worse again. The area under my eye is beginning to swell. I’m worried this is spreading. Do I need a different antibiotic? When I talked to my dentist he said I need to finish the antibiotic. I’m getting worried.

Denna

Dear Denna,

You have a right to be concerned in this situation. I’m truly hoping there is some miscommunication between you and your dentist. If the only thing he’s doing for your treatment is antibiotics then you are going to a dentist who doesn’t understand tooth infections. As this would be dentistry 101, you’d definitely need a new dentist.

Antibiotics Don’t Work for Tooth Infections

When a tooth becomes infected the tissue inside the tooth dies, this means the antibiotic doesn’t even reach the infected pulp because there is no longer any circulation in the tooth. While the infection will seem to get better at first, it will again begin to spread. This is what is happening to you.

The only way to get rid of a tooth infection is to physically remove the infected tissue. This can be done one of two ways. The first is to open up the tooth and remove the infected portions, then seal it so the bacteria can’t return. This is a root canal treatment. The second way to remove the infected pulp is to extract the tooth. I’d only recommend that as a last resort.

Tooth Infections are Dental Emergencies

Think about how close your tooth is to your brain and heart. As your infection spreads, and it will spread, if it reaches those areas it can become life-threatening quickly. This is why tooth infections are considered a dental emergency and needs to be treated physically by a dentist.

You need to see a different dentist and have a root canal treatment done. Hopefully, there is still a way to save your tooth. If not, you’ll need to have an extraction and then a good replacement for your tooth. The best tooth replacement option is a dental implant. There are other options, though. Make sure your dentist gives you all of them.

This blog is brought to you by Lexington Dentist Dr. Fred Arnold.

Dental Sedation and the Elderly

Posted on December 31, 2018 by writeradmin.

My mother needs a crown, but she’s afraid to go to the dentist to get it. I’m thinking dental sedation might be a good idea for her, but she uses a walker and has some incontinence issues. Is this a valid option for her? I don’t want to suggest it and get her hopes up if it’s not really possible. What are your experiences with this?

Hannah

Dear Hannah,

The elderly can have dental sedation

It’s great that you are looking out for your mother. It’s also great that you’re compassionate of her special considerations. Sedation dentistry is still a possibility for her with some planning. First, you’ll need to have a consultation with her sedation dentist. When you have that appointment, make sure to bring all of her medications. This way the dentist is sure not to use any medication which will interfere with what she already is taking.

While there, let him know about her mobility and incontinence issues. This way he’ll know to expect you in the operatory with her. You’ll need to be available for the day. First, to help her to the restroom should it become necessary and second to help her during her recovery time. It normally takes a few hours after the procedure for her to become lucid again.

Using her walker is not advised while she’s under the influence of sedation. Your dental office will have a wheelchair on hand to get her to and from the car. However, you’ll want to arrange to have one for her home at least just for that day.

Avoiding Dental Emergencies

While her tooth only needs a dental crown at the moment, the decay will spread. It is much better both for her and her budget to get this cared for sooner rather than later.

If it gets to the pulp of her tooth it will turn into a dental emergency. Then, she’ll be in a lot of pain and need a root canal treatment in addition to the crown.

Best of luck to both of you.
This blog is brought to you by Lexington, KY Dentist Dr. Fred Arnold.

I Think the Dentist Misdiagnosed Me

Posted on April 7, 2018 by writeradmin.

I had a cavity which I already knew about. My old dentist told me about it but I decided I didn’t like her. She wasn’t very compassionate and I grew tired of her pressure tactics. So, I decided to switch dentists. I kept meaning to take care of it but other things would get in the way. Then my tooth seemed to suddenly get worse. I went to an emergency dentist. I did call ahead of time and let them know what was wrong. For some reason, I thought that meant they’d leave time to fix it. But, when I got there, he seemed in a huge rush. I realize it was the end of the day, but I did give them a heads up for what I needed. He knocked the teeth around a bit and told me the wrong tooth needed a filling. When I reminded him it was the tooth next to it he just peeked and said, “Yeah. That one too.” He then told me to come back tomorrow for the fillings, but I was in so much pain I refused to leave. He sighed but did give me the fillings. I left thinking things would get better, but they didn’t. I’m still in pain. Did he misdiagnose me?

Caitlyn.

Dear Caitlyn,

I’m sorry you’re in so much pain. There are few pains as distracting as tooth pain. You’re right that he did seem rushed and it concerns me that he missed one of the cavities in his examination. You didn’t hint that he did any x-rays. That should be a standard part of the examination. If he took x-rays, a tooth infection should have been pretty obvious. I’d be surprised if he missed that. However, if he was so rushed that he skipped the x-ray then he could very likely have missed an infection.

If that’s the case, you’ll need further treatment. Fillings aren’t enough to take care of the infection if there is one. A dentist has to physically go in to remove the infected pulp.

If he did do x-rays and there wasn’t an infection, it could be that he rushed your dental fillings. When a dental filling isn’t done correctly it could cause pain.

Before You End Up with a Second Dental Emergency…

I think it’s important you get a second opinion. If there’s an infection lingering underneath your dental fillings, it will spread. Before you know it, you’ll be in even more pain and needing another emergency dentist.

Most people don’t realize this. It sounds ridiculous in 2018 but people still die from tooth infections. The reason for that is the proximity of your jaw to your heart and brain. Tooth infections spread. If they happen to make it to your heart or brain, things can get life-threatening very quickly. In your place, I’d be rather proactive about this.

You’re looking for a new dentist anyway. It’s obvious your first emergency dentist wasn’t a good option for you, so getting your second opinion serves a dual purpose: taking care of the pain your in while giving you an opportunity to evaluate another dentist.

This blog is brought to you by Dr. Fred Arnold.

Can You Convince My Parents a Sedation Dentist Is Important For Me Right Now?

Posted on April 18, 2017 by writeradmin.

I’m 16 and have never been to a dentist. Lately, several teeth have been hurting and it’s hard for me to drink anything cold. When I look in the mirror, I feel certain there are some cavities, especially toward the back. I asked my parents to take me to the dentist and I think I need a sedation dentist, because I’m pretty sure they’re going to need to do a lot. My best friend goes to the dentist every year, she said when she switched to a sedation dentist her visits were so much easier. My parents said I’m just being melodramatic. They’ve never needed a dentist and if I took care of my teeth neither would I. They also said that even if they were to waste money on a dentist, they wouldn’t spend extra so I could get high. Is there any information you can point me to that could change their mind?

Stephanie – Alabama

Stepanie,

It sounds like your parents have been very fortunate when it comes to having healthy teeth. However, you can do everything right and still get cavities. If you want to, you can print this out of send them the link to the url. Based on what you’ve described you’ve got some cavities and they may be extensive given your sensitivity to cold. You’ll likely need a root canal treatment, a crown, or (worst case scenario) an extraction. For a couple of those treatments, sedation is a very useful, and in some cases, necessary.

Preventative dental care is an essential part of your overall medical health. Dental problems are linked to diabetes, heart disease, and a myriad of other issues. As secondary effects of poor dental health, many children have low self-esteem and trouble eating or sleeping. It’s important to regularly see a dentist to catch problems before they blow up to where you get gum disease or need to replace teeth.

If it turns out any of your teeth need to be extracted, you’ll need to be advised on tooth replacement options. Given your youth, I’d do a temporary replacement, then once your jawbone is fully developed the best procedure would be a dental implant. It’s the closest to having your natural teeth back.

It’s possible your parents are acting like they don’t care because they’re worried about finances. It’s easy to lash out or make excuses when we’re scared. Most dentists have some type of payment plan options, either in-house or through Care Credit.

This blog is brought to you by cater to cowards dentist Dr. Fred Arnold.