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Dr. Thomas

How Long Can I Delay Wisdom Teeth Removal?

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Young adult man portraying wisdom teeth painHow long can I delay wisdom teeth removal? I am 26 years old and still have my wisdom teeth. The lower back and upper teeth began hurting two months ago, and the gums behind them are swollen. I have travel plans for the next two months and would like to know if I can continue taking ibuprofen and using numbing gel until late January/early February. I am concerned that my recovery will overlap with my travel plans. How long can I delay wisdom teeth removal? Micah from San Jose

Micah,

Thank you for your question. We understand your concerns about your wisdom teeth and how they will affect your plans. Dr. Thomas would need to examine and x-ray your teeth to verify their condition, but we will provide a general answer to your concerns.

How Long Can You Delay Wisdom Teeth Removal?

How long you can delay wisdom teeth removal depends on the condition of your teeth. If you are experiencing pain and swelling around your wisdom teeth, you have an infection. Although a dentist can prescribe an antibiotic, the condition will not wholly resolve unless a dentist or oral surgeon removes them. You will need an exam and x-ray to determine whether you can delay treatment or if it is best to get prompt care to avoid a dental emergency while you are traveling.

What Causes Pain and Swelling Around Wisdom Teeth?

You may experience pain and swelling around impacted wisdom teeth that are trying to erupt but are trapped in the bone or positioned at an angle that prevents full eruption. Trapped food debris and plaque around the teeth can cause pain, swelling, and infection.

Will You Need an Oral Surgeon?

You may need an oral surgeon or a dentist with advanced oral surgery training if your teeth are impacted. Although many dentists take emergency appointments, not all dentists are trained for complex oral surgery. Take time before you travel to get an exam, x-rays, and diagnosis for the condition of your wisdom teeth and how they are affecting your oral health. A dentist will explain whether you can delay tooth removal or if you need immediate care.

 

Dr. Siny Thomas, a Sugar Land, Texas dentist, sponsors this post. Dr. Thomas is a graduate of the surgical program of the Pikos Institute in Trinity, Florida.

Is It Too Late to Save My Knocked-Out Tooth?

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Brunette teenage boy covering his mouth, portraying a knocked-out tooth emergencyI got my tooth knocked out last night during a ball game. Someone on our team told me to put the tooth in milk, and I could do that since the game was at our high school. I still have the tooth, but my sister told me that she read online that it’s too late to save it.

Our game wasn’t over until 9:00 pm, so I wasn’t thinking about calling a dentist. My coach took me out of the game, and since the bleeding was not severe, I felt comfortable waiting to see a dentist. That was my mistake. I don’t have a regular dentist because my mom didn’t like the dentist that we saw last year for our checkup. Is it too late to save the tooth? Thank you. Austin from St. Paul, MN

Austin,

Thank you for contacting Cornerstone Dentistry. We are sorry to hear about your accident. Your efforts to save your tooth by putting it in milk were beneficial. Milk’s antibacterial properties, proteins, and sugars can help sustain a knocked-out tooth. Still, a knocked-out tooth requires immediate attention to save it.

Is It Too Late to Save Your Knocked-Out Tooth?

It is too late to save a knocked-out tooth that has been out of its socket overnight. According to the American Association of Endodontists, you should rinse off a knocked-out tooth and return it to its socket immediately. Then, see a dentist or endodontist within 30 minutes. Sometimes, a dentist may be able to save a knocked-out tooth that has been out of its socket for an hour or more, but the longer you wait, the risk of losing the tooth increases.

What Happens If You See a Dentist Right Away?

When you see a dentist immediately for a knocked-out tooth, a dentist will take these steps:

  • Apply a local anesthetic to the tooth socket
  • Sanitize the tooth
  • Place the tooth in the socket
  • Stabilize the tooth with a small wire bonded to the back of the tooth and secured by adjacent teeth
  • Allow several weeks for the tooth to reattach to the bone

As the tooth heals, eat foods that do not require a lot of chewing and chew away from the healing tooth.

What Happens After Your Knocked-Out Tooth Is Back in Place?

After your knocked-out tooth is back in the socket, your dentist or endodontist will monitor it to determine if the trauma affected the tooth pulp. If you need root canal treatment, your dentist will take impressions of the tooth for a customized dental crown to protect it. You may need root canal treatment to remove damaged tissue and replace it with a dental filler material.

What If a Dentist Cannot Save a Knocked-Out Tooth?

If a dentist or endodontist cannot save a knocked-out tooth, a dental implant is the most effective way to replace it. An implant is a titanium screw that replaces a tooth’s root. After the artificial root fuses with your jawbone, your dentist will attach a custom crown. If you choose an advanced cosmetic dentist, your implant crown will match the color and characteristics of the surrounding teeth. A dental bridge or a partial denture are alternatives to a dental implant, but they do not function as well as an implant or last as long.

Schedule an Appointment Right Away

Even if it is too late to save your tooth, see an advanced cosmetic dentist right away for an examination of your mouth and the teeth surrounding the missing one. After an exam and x-rays, the dentist will explain your treatment options.

Sugar Land, Texas, dentist Dr. Siny Thomas sponsors this post.

 

Does a Calcified Root Require Root Canal Treatment?

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African American man portraying concern of a calcified tooth root and root canal treatmentIn July, I noticed staining on my right incisor. When I had my dental exam and cleaning last week, my dentist took an x-ray. She said that the root canal is calcified and scheduled root canal treatment. What is root calcification, and is a root canal the only option? Thank you. Samuel from PA

Samuel,

Thank you for your question. Dr. Thomas would need to examine your tooth and take an x-ray for an accurate diagnosis, but we will explain root canal calcification.

What Is Root Canal Calcification?

Root canal calcification is a buildup of excess calcium in a tooth’s root channels. Calcification often occurs after trauma to a tooth, but it also appears as we age if we do not have enough calcium and vitamin C.

  • After trauma, calcium deposits help the tooth repair itself.
  • Sometimes the calcium deposits fill the pulp chamber and root canals.
  • Crowding inside the tooth makes it challenging to heal.

Does a Calcified Root Canal Need Treatment?

A calcified root canal requires a root canal if an x-ray shows signs of infection. An endodontist (root canal specialist) uses specialized tools and technology for treatment, including:

  • 3-D CT scan – Identify the calcified channels to treat only the affected parts of the tooth
  • Dental microscope – Helps locate the channels during treatment
  • Ultrasonic dental instrument – Minimizes the amount of structure removed to prevent weakening the tooth

What If You Decline a Root Canal?

If you decline a root canal, the infection from calcified channels will spread and affect other teeth and your jawbone. Without treatment, the condition will linger.

We recommend scheduling an appointment with a dentist with advanced root canal training or an endodontist (root canal specialist) for a second opinion. Please do not delay treatment until you have an emergency and risk more invasive treatment or tooth loss.

Dr. Siny Thomas, a Sugar Land, Texas dentist, sponsors this post. Dr. Thomas is a graduate of the surgical program of the Pikos Institute in Trinity, Florida.

 

Why Does My Root Canal Tooth Hurt?

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Man holding the side of his face, portraying a root canal dental emergencyA dentist completed a root canal on my top right premolar in 2018. I had no problems with the tooth until last month. Now the tooth hurts daily, although the pain is not nonstop. How long do I have before I need to see a dentist? Will I need a second root canal on this tooth? Thank you. Mark from Helena, MT

Mark,

Thank you for your question. Dr. Thomas would need to examine and x-ray your tooth to determine if it is reinfected and needs further treatment, but we will explain why a root canal tooth may hurt years after treatment.

Why Does Your Root Canal Tooth Hurt Again?

If your root canal tooth hurts again, it probably means that the tooth did not heal completely, and the infection flared up again. When a dentist does not remove all the infected pulp from a tooth or misses a hidden canal, you can experience future complications. According to the Journal of the American Dental Association, other factors that can contribute to root canal failure include:

  • Under- or over-filling a tooth with dental filler material
  • Perforations in the root canal systems
  • Dental instrument separation, or break off, into the root canal system

How Common Is Root Canal Failure?

Root canal failure occurs in about one in ten procedures. Infection may take months or years to flare up if a tooth does not heal completely. The infection lingers when a dentist cannot see deep inside tooth canals or reach curvy channels. Only dentists with advanced training and endodontists (root canal specialists) have the instruments needed for challenging tooth channels.

What Is the Treatment for Root Canal Failure?

Repeat root canal treatment or root canal surgery is the treatment for root canal failure. If your dentist does not have advanced root canal therapy training, they will refer you to an endodontist. The endodontist will take these steps:

  • Find the infected root
  • Remove the infection
  • Fill the tooth
  • Seal the tooth

During root canal surgery or apicoectomy, a dentist or endodontist will access the tooth through the bone and the root tip instead of the crown.

Schedule an appointment promptly. After an examination and x-rays, an endodontist or dentist trained in root canal therapy will determine whether your tooth is savable. Otherwise, they will recommend tooth removal and a dental implant.

Sugar Land, Texas, dentist Dr. Siny Thomas sponsors this post.

Why Does My Chipped Tooth Hurt?

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Man looking at his toothin the mirror, portraying why a chipped tooth hurtsTwo days ago, I chipped my left front tooth. The chip is noticeable, but it doesn’t look horrible. I feel slight pain in the tooth. I was not planning to go to the dentist for the chip, but I’m concerned now. Why does the tooth hurt if the crack is not large? Thank you. Xander from Nashville,

Xander,

Thank you for contacting Dr. Thomas’s office. Although a dentist would need to examine and x-ray your tooth to determine the cause of your pain, we will explain why it may hurt.

Why Does a Chipped Tooth Hurt?

A chipped tooth hurts if the damage affects the pulp or living tissue and nerves inside a tooth. Understanding tooth anatomy can help you discover the source of pain.

  • Enamel – The hard, thick protective covering around the crown of your tooth
  • Dentin – A slightly elastic living tissue beneath the enamel
  • Pulp – Tissue, blood vessels, and nerves inside the tooth, beneath the dentin
  • Cementum – The bone-like structure surrounding tooth roots that helps the roots attach to the bone

A chipped tooth can irritate tooth pulp, where the nerves signal sensitivity or pain. Also, trauma or impact to your face or teeth can irritate the pulp even if you do not see any external damage.

What Should You Do If Your Chipped Tooth Hurts?

If your chipped tooth hurts, schedule an appointment with a dentist for an exam and x-rays. Although a chip may seem minor, x-rays will reveal any internal damage. Root canal treatment removes damaged tooth pulp. The procedure is painless, and it helps preserve teeth.

Without prompt treatment, the tooth pulp will swell in your body’s attempt to fight infection. Eventually, the pulp will die, increasing the risk of losing your tooth.

Schedule an appointment with a dentist for your tooth chipped to determine the extent of the damage.

 

Dr. Siny Thomas, a Sugar Land, Texas dentist, sponsors this post. Dr. Thomas is a graduate of the surgical program of the Pikos Institute in Trinity, Florida.

Will I Lose My Tooth If I Don’t Get an Apico?

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Our family spent last week at the beach in FL. A toothache that has been bothering me for the past few months got worse, and my gums around it felt hot. I searched online for a dentist who was willing to see me the same day. The tooth is my lower right first molar that had a root canal two years ago. Although I was taking a chance to find a dentist online, she was pleasant, numbed my gums, and injected a pain reliever. The dentist said I probably need to see an endodontist for a procedure called an apico to save the tooth. The dentist did not give any details about the process but said an apico is like a root canal. Unfortunately, I have only seen a dentist once since COVID, and I moved to Arkansas in July 2021, so I don’t have a dentist here. What is this procedure, and do I need it to save my tooth? Thanks. Walton

Walton,

Thank you for your question.

It is good that the dentist was able to see you right away and relieve your pain. The dentist is referring to an apicoectomy.

What Is an Apicoectomy?

An apicoectomy is a dental procedure that accesses a tooth from its root tip instead of through the crown, as with root canal treatment. If root canal treatment fails, a specialist may recommend an apicoectomy to save the tooth.

A root canal specialist may take these steps to complete the procedure:

  • Numb your gums
  • Make a small incision to expose the tooth’s root tip
  • Use ultrasonic instruments or a dental laser to remove infected tissue
  • Disinfect the area
  • Add bone grafting to fill in areas damaged by the infection
  • Seal the tooth root
  • Close the gum tissue with stitches

The jawbone will heal around the tooth root in a few months.

What Happens If You Delay Treatment?

Delaying an apicoectomy allows the infection to spread further into the bone and possibly to other teeth requiring more complex and costly treatment. If you are unsure whether you need the treatment, schedule a second opinion with an endodontist (root canal specialist) or a dentist with advanced root canal therapy training.

 

Dr. Siny Thomas, a Sugar Land, Texas dentist, sponsors this post. Dr. Thomas is a graduate of the surgical program of the Pikos Institute in Trinity, Florida.

Do I Need Another Root Canal on the Same Tooth?

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Man holding the side of his face, portraying a root canal dental emergencyHi. My dentist did a root canal on a top-right molar about 4 months ago, and I think it is infected again. It might seem crazy that I may have a root canal emergency and I am trying to get help by writing you. However, I do not trust my dentist and am afraid of going back to him to get my tooth fixed. I need some help within the next day or two because I am in so much pain that I have already taken sick time from work. Although I work from home, I cannot focus because of the intense pain. If I chew on the tooth that had the root canal, the pain is so severe that I am almost on my knees. So, I try to remember not to let anything touch the tooth. Is it unfair to switch to another dentist that can get it right this time? – Alec from Dallas

Alec,

Dr. Thomas would need to examine and x-ray your tooth for a diagnosis, but it does seem that your tooth is infected. It is important to see a dentist promptly to relieve your pain and then to re-do the root canal treatment.

It sounds as if the sealer material for the first treatment did not completely fill your tooth, or maybe your dentist did not remove all the infected tooth pulp. But your situation does not mean that your dentist is unable to correct it. If you are no longer comfortable with your dentist, you can get a second opinion.

It is important to see a dentist promptly to prevent the infection from spreading further. And it will continue to spread until a dentist removes it. You can do an online search for an emergency dentist and check their website to see whether the dentist has root canal experience. Otherwise, you can see an endodontist—a root canal specialist—for treatment.

 

Dr. Siny Thomas, a Sugar Land, Texas cosmetic dentist, sponsors this post.

Still Wearing a Temporary Crown. How Long Will It Last?

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I got a temporary crown three weeks ago. I saw my dentist last Thursday, and he re-cemented it back on. He doesn’t like me asking questions, but I want to know what in the world we are waiting for? Where is the permanent crown? How long do temporary crowns last? In two weeks, I will travel to Minnesota for family business. I don’t want to end up with an emergency dental appointment while away. –  Trey W.

Trey –

Thank you for your question. Dr. Thomas would need to examine your crown and its condition to estimate how long it will last. But we will explain some basics about temporary crowns.

How Long Does a Temporary Dental Crown Last?

Diagram of a molar tooth with a temporary crown

Find a skilled cosmetic dentist if you have an emergency with a temporary crown while out of town

How long a temporary dental crown lasts depends on whether it’s a routine temporary crown or a customized temporary crown made of semi-durable plastic materials. A typical crown can last several weeks. A customized crown can last a year or longer.

Your dentist will need to explain when you will receive your final crown. If you feel uneasy about whether your dentist sent impressions of your teeth and instructions to lab to make your crown, ask specific questions about the status of your new crown.

Consider Getting a Second Opinion

Your dentist may have a good reason for delaying your final crown. Maybe the lab did not make it correctly, or your dentist has another issue with the crown. Still, you deserve an answer. If you are dissatisfied with your dentist’s response, consider getting a second opinion from an advanced cosmetic dentist. Ask your current dentist for digital copies of your dental records and x-rays and send them to the second-opinion dentist.

Your family members or their acquaintances may be able to recommend a reliable cosmetic dentist. If you have an issue with the crown while out of town, look for a dentist with advanced cosmetic dentistry training. Check patient reviews and the dentist’s website to read about their credentials. You can also look for a smile gallery of patient photos to help you choose a dentist.

Best wishes.

Dr. Siny Thomas, a Sugar Land, Texas cosmetic dentist, sponsors this post.

Face Still Swollen After Tooth Extraction and Antibiotics Don’t Help

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Brunette woman holding the side of her face portarying sweling after tooth extractionLast week, my dentist removed my lower right second molar. The tooth was infected, and my gums were swollen before the extraction. Before the extraction, I picked up a prescription for amoxicillin that my dentist prescribed. I am taking the medication as prescribed, but the swelling is worse. My dentist also prescribed pain meds, but they do not work. My jaw is swollen and stiff. Should I keep taking this antibiotic, or does it sound like my dentist might need to switch me to another one? Thank you. Ariana

 

Ariana,

Your description sounds like the antibiotics are not helping your infection, and it is getting worse. Sometimes, infection will not respond to an antibiotic because the bacteria strain is resistant to the medication. Yes, you should call your dentist, and they will switch you to another antibiotic.

According to the Center for Disease Control (CDC) each year in the U.S., almost three million people get infected with an antibiotic-resistant fungus or bacteria. Do not worry. Your body is not becoming resistant to antibiotics. It is the fungi or bacteria that is resistant. Still, antibiotic-resistant infections keep growing without proper treatment.

After your dentist switches you to a new medication, continue to take all of it even if the swelling improves. Stopping an antibiotic too soon can cause the infection to return and develop resistance to the medication. Then, your dentist would need to find a third antibiotic for you.

Please call your dentist’s office right away to get a new medication that will control the infection.

Siny Thomas, DDS, a Sugar Land, Texas cosmetic dentist, sponsors this post.

Do I Need a Root Canal Apicoectomy Second Opinion?

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My dentist did a root canal and crown on my top right first molar, but it failed. He referred me to an endodontist in late August, and I had an apicoectomy. I had a checkup this morning, and although the bone is rebuilding, I have a small pus sac on my gum. The endodontist prescribed an antibiotic to take for seven days. Is there anything else I can do to get rid of the infection? I was thinking about calling another dentist and getting an urgent appointment within the next two days. Thank you. Paxton from Dallas

Paxton,

Thank you for your question.

We want to provide our readers with an overview of the difference between root canal treatment and an apicoectomy.

What Is the Difference Between Root Canal Treatment and Apicoectomy?

Stage of apicoectomyStandard root canal treatment is non-surgical, but an apicoectomy is root canal surgery. One accesses a tooth from the top. And the other treats the tooth from its roots.

  • Root canal treatment – A dentist or endodontist makes an opening in the crown, or top, of your tooth to remove infected tooth pulp.
  • Apicoectomy – An endodontist makes an opening through your gums to access the tooth roots. They will remove any infected tissue and the root tip. Sometimes, the doctor will seal the root tip with a small filling. After stitching the root tip closed, the endodontist will allow time for your jawbone to heal around the root.

Do You Need Antibiotics After an Apicoectomy?

The key to healing after an apicoectomy is removing the source of the infection and sealing the root tip. A doctor may prescribe antibiotics to promote healing.

When the bone around the end of the root is healing, the infection is likely gone. Your endodontist prescribed the antibiotic to promote healing. But there is nothing you can do to speed up the process.

Do You Need a Second Opinion?

You only need a second opinion after an apicoectomy if your pain and swelling increase despite antibiotics and the area is not improving. Your description sounds like your tooth is stable, and you do not need to schedule a prompt appointment with another dentist.

Siny Thomas, DDS, a Sugar Land, Texas cosmetic dentist, sponsors this post.