WIlliam F. Scott, DMD

Hello,

This is a very good question. Sorry to hear about your infected tooth. Yes, a dentist can pull (extract) an infected tooth; however, there are some times when a dentist has to wait for an infection to clear before he/she pulls a tooth.
A cavity is caused by bacteria on and then in the tooth. By definition a tooth with a cavity is an infected tooth. This cavity can get bigger to the point of reaching and going far beyond the nerve of the tooth. It is still an infected tooth.
However, it may get to the point of an abscess forming. This is when the bacteria have made it to the end of the root and the body is trying to fight the infection. Sometimes while the body is fighting the infection the tissues around the tooth will swell up. It is at this point that the dentist should not pull the tooth. When the gum tissues and some times cheeks swell up due to the infected tooth the swelling inactivates the local anesthesia that is used. This means that it is difficult to get numb. At this point the doctor will usually give a prescription for an antibiotic and have the patient come back in a week when the swelling is gone. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Sorry to hear about your fillings hurting. There are a few things that can cause the teeth with fillings in them to hurt, including; filling is slightly too high, filling is too close to the pulp chamber (center of the tooth where the nerve and blood vessels are), or there is a cavity or decay underneath of the filling.
First of all, if the fillings are relatively new, it is a good chance that the filling is slightly too high. When the filling was placed there was most likely local anesthesia (numbing) involved. By the time the fillings were completed the local anesthesia still had not worn off so it is hard to tell if the filling is a little high. This is especially possible if there were multiple fillings done at the same time. This common to realize right after the fillings are done, but it can be some time after as well.
Secondly, sometimes the cavity in the tooth gets too close to the pulp chamber (were the nerve and blood vessels sit). This usually causes discomfort all the time but it can gradually get worse over time when chewing (micro fractures can occur in the tooth around the filling). The filling moving around as well.
Finally, fillings can start to hurt if they get a cavity underneath of them. Most of the time the filling will look intact but there is a small cavity underneath of it allowing the bacteria to make the tooth sensitive. This is less likely if it is more then one filling.
These are just some of the common causes for filling to hurt. It is best to have them evaluated by a doctor. It could be as simple as a small adjustment that only takes a few seconds. Hope this helps.

William F. Scott IV, DMD

Hello,

Yes, it is possible for surrounding teeth to hurt after an extraction. To understand the reason for this it is helpful to understand how extractions work.
Teeth have long, sometimes curvy, and somtimes multiple roots on different angles. There are a few different techniques for removing teeth; however, the concept is still the same. The root of the tooth sits in a socket and is attached by ligament fibers (this is so they don't fall out on their own). In order to take the tooth out, these ligament fibers need to be separated and the socket the root sits in needs to expand ever so slightly. This process can cause irritation in the jaw or nerve that goes to the other teeth leaving them sore afterward. The discomfort should subside soon afterward though. If not it would be best to go back to the doctor who extracted the teeth for an evaluation. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

A week after the extraction of a tooth discomfort should be settling down. This is if everything is normal and there are no complications. An extracted tooth with be sore for a few days, but it should be gradually getting better.
However, there are some other things that can cause discomfort. First thing that one should consider is the possibility of dry socket. Dry socket simply means that the blood clot that forms after the tooth is extracted is lost. This can make the color of the gums look different or look completely normal; however, often times there is more pain then when the tooth was there. This is because the clot that was lost protects the healing tooth socket and now it is exposed.
Secondly, the peak onset for swelling after an extraction is 4 days. This means that swelling can start up to 4 days after the extraction of the tooth and then start to taper after that. Again the discomfort should be tapering off. Swelling causes pressure on everything around it which causing discomfort.
Finally, depending on the circumstances there could be a little tiny bone chip that is trying to exfoliate (make its way out of the gums). This tends to happen as the jaw bone is trying to re-structure itself after the tooth is removed.
All of this depends on the tooth that was extracted, how it was extracted, the amount of trauma during the extraction, and situation of the tooth extracted. It would be best to contact the doctor who extracted since he/she is the one that was there and knows what happened during the procedure. This is usually free of charge since it is part of the extraction procedure. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Yes the hole from a pulled (extracted) tooth will close. It takes a few weeks for this to happen because the jaw bone needs to restructure itself since it no longer needs to support the tooth. The jaw will no long big as big or robust so replacement of the tooth in the future will be more difficult. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Depending on what tooth it is a toothache can cause discomfort that feels like it is coming from your ear. This usually does not mean there is anything wrong with your ear. It just means that the toothache is radiating outward and the nerves carrying the signal travel close to your ear. Of course this does not usually happen for teeth that don't have nerves that travel near the ear. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Yes a dentist can fill a cavity on the gum line (gingiva). These cavities usually dip below the gum line as well. The gums sit around the tooth much like a shirt sleeve sits around your hand when you make a fist. At some point the gum will be attached to the tooth but it is important to get the cavity (decay) out. This gum is no longer attached where the cavity is. So special instruments are used to reach below the gum line and remove the cavity completely without disturbing the gum line. The filling is then put in where the cavity was and everything is smoothed and polished. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Good question! First it would be best to verify that you have a tooth with an abscess. A lot of people just make the assumption that because they have pain in a tooth for a day or two they have an abscess. In fact, a number of people wake up with pain for a couple days in a row and assume they have an abscess only to find out that they were grinding their teeth in the middle of the night.
However, if there is an abscess this would get treated much differently. First off, if treatment can not be started that day and there is swelling an antibiotic would be recommended. The type of antibiotic would depend on a couple of factors. Amoxicillin or clindamycin are usually the top two antibiotics used. Which one depends on a few factors including allergies and stomach irritation. Any history of issues with medications would be helpful here.
Finally, the doctor may give you something for immediate pain control. This varies by the patients ability to take medications and the doctors comfort level with giving medications. The medications that usually do the best is a combination of ibuprofen (advil or motrin) and acetaminophen (tylenol). The usual dose is 600mg ibuprofen with 500mg acetaminophen every 6 hours as needed. Again, this depends on the person's ability to take medications without side effects.
Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Dental implant surgery can involve a variety of different procedures, from simply having an implant put in to having multiple implants put in, or an extraction of a tooth followed by an implant, or a bone graft with the implant. For the placement of one implant without an extraction of a tooth or bone graft a patient is usually scheduled for 1 hour. Most of this time will be used for paper work and local anesthesia (getting numb). It is likely that it will only take 40 minutes or so. If more needs to be done the patient will be scheduled for 1 hour to an hour and a half.
Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Great question! Antibiotics are not commonly used until the immune system has a major reaction to the infected tooth. After all, a cavity is an infected tooth, technically speaking, but we cannot treat a cavity with antibiotics. Antibiotics are usually prescribed when there is swelling of the gum tissues (gingiva) or face (facial cellulitis). This is not a cure for the infected tooth, antibiotics only work with the immune system to fight the infection. The infection is still there; but the antibiotics help keep the the infection down and minimize the swelling. Swelling tends to inactivate local anesthesia (the person will not be able to get numb). It usually takes the antibiotics 48 hours to get up a therapeutic level and start working; however, it will normally take about week to get down to normal and proceed with removing the infection.
Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Yes a decaying tooth can cause jaw pain. A cavity in a tooth starts out small and if left untreated usually gets bigger and grows toward the pulp chamber of the tooth (where the nerve and blood vessels are). As it gets closer the blood vessels in the pulp chamber swell up and interfere with the nerve inside the tooth. These nerves send pain signals to the brain. If this persists the decay (cavity) will get bigger and form a hole into the pulp chamber and the nerve will be exposed to everything that goes in the mouth. This will cause the nerve to send even more pain signals to the brain and eventually the pain will radiate into the jaw. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

There are only a few ways to relieve the pressure of an abscessed tooth. The first way is simple: Remove the tooth. If the tooth is removed, the empty socket will relieve the pressure at the tip of the roots. More importantly, it will remove the infection which will allow the abscess to heal.
The second way to remove the pressure from an abscessed tooth is to do a root canal or pulpectomy (cleaning of the root canal system to clean an infection). Cleaning out the inside of the tooth by doing a root canal or pulpectomy will relieve the pressure as well as clean out the infection that is causing the abscess.
Finally, the third way to relieve the pressure from an abscessed tooth is to have an incision and drainage done. This means having a doctor make an incision through the gums (gingival tissue) to give the abscess a place to drain reducing the pressure. This does not remove the source of the infection and further treatment like a root canal or extraction will be needed. This is the usual course of action if there is a lot swelling and the patient can not open wide enough to have a different procedure done.
Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Front tooth pain can be caused by a number of things; which is why a dentist generally asks a lot of questions when someone first comes in with tooth pain. Some of the question include; Sharp or dull pain? When did the pain start? Where you eating when the pain started? Does anything make the pain worse or better? Have you taken any medication for the pain? These questions in addition to an exam and X-rays will help determine the cause of pain. For instance, if it is sharp stabbing pain and the X-ray shows a cavity that is close to the pulp chamber (where the nerve is) it is likely that the pain is from a cavity that is irritating the pulp chamber of the tooth. Or, if the X-ray shows the tooth is intact but the pain started while eating after something hard was bit down on, then it is likely that the pain was caused from trauma and perhaps treating it medically will get rid of the pain. The best thing would be to go to a dentist and have an evaluation done. Knowledge that it is nothing major could at least ease the burden. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

The short answer to whether someone can get a filling if they are pregnant is yes; however, it does require some extra thought and work. Things to consider when a filling is needed during pregnancy is local anesthesia, radiographs (X-rays), anxiety, and any complications of the pregnancy. The first step that should be done is to inform your OB/GYN about the need for a filling and the dentist about your pregnancy. At this point, the OB/GYN will make some recommendation based on how complicated the pregnancy is going. Most of the time, with no complications, the OB/GYN will make these recommendation: 1) only treatment that can not wait until after delivery. This just means no elective dental treatment beside routine cleanings. This is something to keep in mind if it has been a difficult pregnancy so far, or if conception was difficult. Remember, in the end it is a tooth and not a baby. 2) Avoid dental X-rays if possible. If this is not possible use a double shield technique (2 lead vests). 3) Use local anesthesia without epinephrine in it. Other than this, the safest time during pregnancy for dental work is the second trimester. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Yes, a deep cavity can be filled; however, it depends on how deep and the location of the cavity. In dentistry, when we refer to a deep cavity we usually mean that is close to the pulp chamber (where the nerves of the tooth reside). One could imagine that it would be painful to put a filling on top of a nerve. If the cavity goes right into the pulp chamber then it is too deep to fill and a root canal would be required provided the tooth is able to be restored. On the other hand, if the cavity does not go into the pulp chamber, then a good dentist will remove the cavity and the bacteria that have caused it. At this point, an assessment will be made about whether there is enough tooth structure over the pulp chamber to support a filling. If not, then a root canal would be required. If there is the filling would be placed and the tooth would be closely examined at the following dental check ups and cleanings. If the tooth becomes sensitive in the future then a root canal may be needed at that time. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Cavities on the side of a tooth can be filled. In fact they are filled every day. The specific tooth, specific side of the tooth, and the position of the tooth determines how the cavity is filled.
Most fillings done in a given day are on the side of back teeth. These type of fillings are usually associated with inadequate amount of flossing which usually is a reflection of the population. Most people brush their teeth daily but few floss daily or at all. That being said it is still possible to get a cavity between the teeth even with flossing as it is harder to clean between teeth. Hope this helps.

My best to you!

William F. Scott IV, DMD

Hello,

Sorry to hear about your complication to surgery. It would be best to call the surgeon since he/she is the person that knows the most about what type of surgery was done. It is po

My best to you!

William F. Scott IV, DMD

Hello,

The longevity of a filling is one of the hardest things to predict in dentistry. The reason for this is because there are so many variables: The specific tooth the filling is on, how many surfaces of the tooth the filling replaces, the type of bite on the filling, what material is being used for the filling, the person doing the filling, etc. It goes on and on.
The goal of any good dentist is to get the filling to last as long as possible. A lot of studies have shown that the average amount of time a filling lasts is 10-12 years. However, these studies do take years to complete and newer materials come out every year (sometimes better, sometimes worse). It is also interesting to note that most studies show that silver amalgam fillings last longer then tooth colored composite fillings.
When studying the average length of a dental filling it is important to consider that this average of 10-12 years has a range. Some of these fillings can last 30 years while some may only last 2 years. Hope this helps

My best to you!

William F. Scott IV, DMD

Hello,

Cavities can be treated in a few different ways. However, cavities should be treated or at the very least closely watched (which is a form of treatment). Fissure simply refers to an area of a tooth; for example, a cavity in a fissure of the tooth. A cavity in there are is common but it is also very tricky to diagnose. The pits and fissures of teeth tend to pick up staining which may look like a cavity. They also may have the characteristic "stickiness" to them (sticking instruments into pits an fissures is no longer recommended) which may have more to do with the anatomy (shape) of the tooth then a cavity.
As stated above there are a few ways to treat cavities depending on the type and severity of the cavity. One is to remove the cavity and bacteria that cause it with a drill or laser. Another way is if they are small to treat them with fluoride. If someone is really unsure about whether a cavity needs to be treated, it is always best to get a second opinion (usually are free of charge). Hope this helps.
My best to you!

William F. Scott IV, DMD

Hello,

Gaps between teeth (diastemas) can get bigger with age. To know where the gaps will get bigger with relative certainty, it would be helpful to know what has been causing the gaps.
Gaps between teeth are formed from a variety of different things from overgrowth of the jaw, large frenum (muscular gum attachment under the lip) pulling on the gums, teeth tipped out too far for one reason or another, or simply the need of a retainer. Which ever the reason, teeth balance the forces in the mouth. If the gaps between teeth are caused by the overgrowth of the jaw it is less likely that the gaps will get bigger as the jaws do not grow much after age 22. However, if there is a frenum pulling on the gums and a retainer is needed, the gaps are more likely to get bigger with age. The best thing someone can do for themselves is to have a free consultation with a dentist/orthodontist and discuss the likelihood of the gaps growing. Hope this helps.

My best to you!

William F. Scott IV, DMD