An infected tooth is a serious dental condition that requires prompt treatment. If left untreated, a tooth infection can spread to other parts of the mouth, face, and body, leading to serious health complications. Many people wonder if an infected tooth can be saved or if extraction is the only option. There are several factors that determine whether a dentist can save an infected tooth.
What causes a tooth infection?
A tooth infection, also known as a dental abscess, occurs when bacteria enter the pulp of the tooth. The pulp is the innermost part of the tooth containing blood vessels, nerves, and connective tissue.
Some common causes of tooth infections include:
- Untreated tooth decay – Cavities that are not filled can allow bacteria to infect the tooth’s pulp.
- Cracked or broken teeth – Fractures and cracks can expose the inner pulp of the tooth.
- Injuries – A knock or blow to a tooth can damage the pulp, leading to infection.
- Previous dental procedures – Issues with dental work like root canals or fillings can sometimes cause infections.
When bacteria infect the pulp, it becomes inflamed. The inflammation causes pressure to build up inside the tooth, creating a pocket of pus at the root or around the root. This pus pocket is called a dental abscess.
Signs and symptoms of a tooth infection
An infected tooth usually causes severe tooth pain and sensitivity. Other common signs and symptoms include:
- Throbbing, severe toothache that can radiate to other teeth, jaws, ears, head, and neck.
- Pain or tenderness when chewing.
- Sensitivity to hot and cold temperatures.
- Fever and chills.
- Swelling around the face, cheek, jaw, or neck.
- Redness and inflammation in the gums around the infected tooth.
- Bad breath.
- Unpleasant taste in the mouth.
- Gum abscess – a pus-filled sore on the gums.
- Drainage of pus around the tooth.
If the infection spreads, it can lead to complications like facial cellulitis, cavernous sinus thrombosis, Ludwig’s angina, and systemic illness. Prompt dental treatment is essential to stop the infection from worsening.
Factors determining whether an infected tooth can be saved
Several key factors influence whether an infected tooth can be treated and saved by a dentist or not:
Extent of infection
If the pulp inflammation and infection are limited within the tooth, the dentist can try to save it with a root canal treatment. A root canal removes the infected pulp, cleans the insides of the tooth roots, and seals the space.
However, if the infection has spread to the tooth root and surrounding bone tissue, extraction may be necessary.
Structural integrity
The tooth’s structural integrity is an important factor. If the decay and infection have damaged the tooth extensively, making it fragile and brittle, trying to save it may lead to further cracking and complications. Extracting the tooth may be the wiser option.
Restorability
After removing the infected pulp tissue, the dentist must be able to properly restore the tooth with a filling or crown. If too much tooth structure is already lost due to decay, the tooth may not be restorable.
Periodontal health
The gums and bone supporting the infected tooth must be healthy enough to withstand root canal treatment and restoration. Advanced periodontal disease weakens the tooth’s root and surrounding structures.
Patient’s symptoms
How severe the patient’s symptoms are is also considered. Unbearable throbbing pain, facial swelling, fever, and infection spreading indicates an urgent extraction.
Patient’s medical history
Patients with certain medical conditions like heart problems may be advised extraction to prevent complication risks. Those undergoing cancer treatment or organ transplants take medications that increase risks of infection. Extracting the tooth reduces infection risk.
Patient’s committed participation
Root canal treatment can be time consuming, requiring multiple dental visits and good patient compliance. The patient must also commit to proper dental care and maintenance after treatment. The prognosis is poorer in patients unwilling or unable to commit to the treatment and aftercare process.
Root canal treatment to save infected tooth
If the dentist determines an infected tooth can be saved, root canal treatment is done. This involves:
Medications
The dentist may prescribe antibiotics like penicillin, amoxicillin, or clindamycin to clear the infection before starting root canal therapy. Pain medications are also given to relieve symptoms.
Local anesthesia
The tooth and surrounding area are numbed with an anesthetic injection to prevent pain.
Tooth isolation
A rubber dam is placed around the tooth to properly isolate it from the rest of the mouth during the procedure.
Pulp access
A small opening is made through the biting surface of the tooth to access the infected pulp tissue.
Pulp removal
Special root canal tools and irrigants are used to remove all the diseased pulp, right up to the root apex. This effectively eliminates the infection.
Root cleaning and shaping
The hollow root canal space is cleaned, disinfected, and shaped in preparation for filling and sealing.
Root filling
The clean root canal is precisely filled with an inert rubber-like material called gutta-percha. This seals the canal space completely.
Temporary restoration
A temporary filling is placed over the access hole made in the biting surface of the tooth.
Permanent restoration
Once the root canal treatment heals and resolves the infection, a permanent dental crown or filling is placed on the tooth to restore optimal function and aesthetics.
Aftercare following root canal treatment
Proper aftercare is vital for long term success after root canal treatment on an infected tooth. This involves:
– Taking prescribed antibiotics and pain relievers per directions
– Practicing good oral hygiene with regular brushing, flossing, and antiseptic mouth rinses
– Following up with the dentist as needed for monitoring, temporary replacement, and permanent restoration
– Avoiding chewing or biting on the treated tooth until it is fully restored
– Getting regular dental checkups and maintenance cleanings
With proper care and restoration, a tooth that has had root canal treatment has a good long-term prognosis.
Advantages of saving infected tooth
The benefits of undergoing root canal treatment and saving an infected tooth include:
- Preserves the natural tooth structure
- Maintains chewing ability and tooth function
- Prevents bone loss from tooth extraction
- Avoids jaw changes that happen after extractions
- Prevents shifting or tilting of nearby teeth
- Saves cost and time of tooth replacement procedures
- Restores dental esthetics with natural appearance
Disadvantages of tooth extraction
Extracting an infected tooth has several disadvantages compared to root canal therapy:
- Loss of the natural tooth permanently
- Reduced chewing capacity depending on the tooth/teeth extracted
- Jawbone loss and changes in facial structure
- Higher chances of developing dental problems with remaining teeth
- Need for prosthetic tooth/teeth replacement
- Inconvenience and expenses of implants, bridges, dentures etc.
- Esthetic issues related to missing teeth
When tooth extraction is necessary
Despite potential disadvantages, extraction is sometimes the only viable option in severe tooth infections. Extraction is usually advised when:
- The tooth cannot be restored due to extensive decay or damage
- The infection has spread extensively to tooth roots, bone, and surrounding tissues
- The tooth fracture is severe and cannot be repaired
- Gum disease has severely damaged the tooth’s supporting structures
- Medical conditions put the patient at high risk of complications
- Other teeth are damaged or infected beyond repair
- The tooth has a poor long-term prognosis even with treatment
- The tooth is interfering with radiation or cancer treatment
- Patient is unable to tolerate long root canal treatment
- Patient refuses root canal therapy due to fear/cost
Surgical tooth extraction procedure
Tooth extractions are done under local anesthesia. Infected teeth usually require a surgical extraction:
Incision
The dentist makes an incision in the gum tissue around the tooth to access the bone.
Bone removal
Some bone tissue around the tooth may be removed with a drill or chisel. This is done carefully to avoid damaging nearby teeth.
Tooth loosening
The dentist uses an elevator tool to loosen the tooth from its bony socket and surrounding gum attachment.
Tooth removal
Once sufficiently loosened, the dentist uses forceps to extract the entire tooth out of the socket.
Debridement
The socket is cleaned out thoroughly of any infected or damaged tissue.
Sutures
The gums incision is closed with sutures that dissolve over time.
Medications
Antibiotics, pain relievers, and mouth rinses may be prescribed to prevent complications as the socket heals.
Healing and recovery after tooth extraction
Proper aftercare helps minimize complications when healing post-extraction. Patients must:
– Take all medications as directed
– Apply ice packs to reduce swelling
– Eat soft foods for a few days
– Avoid strenuous activity for 24 hours
– Practice gentle oral hygiene around the surgery site
– Avoid smoking, drinking through a straw, or disturbing the blood clot
– See the dentist promptly if excessive bleeding, pain, or swelling occurs
Full healing typically takes 1-2 weeks. Dentures or bridges may be placed after several months once the site has healed completely. The dentist will monitor healing and determine when the gap can be properly restored.
Conclusion
With prompt treatment, an infected tooth can often be saved through root canal therapy. However, tooth extraction may still be required in cases of severe infection, extensive decay, or when the tooth cannot be properly restored. By carefully assessing the tooth’s condition, the infection’s extent, and the patient’s overall health, a dentist can determine the best treatment approach to deal with an infected tooth – whether tooth-saving root canal or extraction. With proper care after treatment, the site can heal well and be effectively restored to maintain dental function and aesthetics.