Dental Issues: Cracks, Root Canals, Infections, and Allergies

Q: Dental Issues: Cracks, Root Canals, Infections, and Allergies

Hello： If you have already received dental treatment at Taipei Chang Gung or Linkou Chang Gung, it is advisable to follow the diagnosis and treatment plan provided by the dentists at the medical center for your dental issues. <br>For concerns related to dental cleaning infections

Dental cleaning infections, how to check for cracked teeth, root canals, toothpaste allergies, and individual constitution?

--Regarding Questions on Tooth Fractures and Root Canals--
1.
What examinations can detect tooth fractures in various locations? What are the costs?
2.
If a tooth is suspected to be fractured but is already necrotic, what methods are recommended: root canal treatment, ignoring the tooth, or extracting it directly? The tooth can still chew but causes pain when biting.

3.
Does a dark shadow on the root X-ray combined with a negative electric pulp test indicate that the tooth is necrotic? Why, then, does the gum still experience pain, percussion sensitivity, and biting pain?
● After deep cleaning, the back tooth became completely non-functional and developed an infection with pus for half a month, followed by a dark root X-ray (normal before cleaning).

● The dentist mentioned that if there is a fracture, performing a root canal may lead to immediate collapse (requiring extraction), but he did not check for fractures before recommending a root canal...
I am unclear about the rationale.
If there is a root fracture, shouldn't it be extracted directly? Why perform a root canal first before extraction...
Currently, I can still chew, but after a month of swelling, I sought external medical treatment and stabilized with medication.
I wonder if it would be more appropriate to keep it and manage it for eating.

--Regarding Questions on Deep Cleaning Infections--
1.
What causes infections and swelling with pus after each deep cleaning?
2.
If my gums swell and become painful when using toothpaste or mouthwash, could this be considered an allergy?
--Regarding Questions on Facial Swelling and Anesthesia--
1.
I feel a round, non-painful bump on my cheek near the jawbone; what could it be? A tumor? Lymph node? What examinations do you recommend?
2.
After receiving anesthesia for a filling on a lower back tooth, I still feel pain a day later when touching it, and it hurts more when I touch it (there's a swollen area there).
It hurt immediately after the procedure, but the doctor did not respond and then administered more anesthesia...

--Regarding Questions on Immunity--
Chang Gung Dental Clinic mentioned that I might have a condition or disease affecting my immune system, as my periodontal health and surgical wounds are unstable.
They advised me to get checked; what could cause this issue, and what specific tests should I request? (They mentioned immunology, but I'm unsure how to communicate this to the doctor.)

bei ya tong kun rao, 40~49 year old female. Ask Date: 2023/08/17

Dr. Lin Jiayong reply Dentistry

Hello: If you have already received dental treatment at Taipei Chang Gung or Linkou Chang Gung, it is advisable to follow the diagnosis and treatment plan provided by the dentists at the medical center for your dental issues.
For concerns related to dental cleaning infections or allergies, it is more appropriate to discuss these directly with the examining physician.
If you are worried about lymphadenopathy in the neck and potential cancer-related issues, you may request an ultrasound or fine needle aspiration from an otolaryngologist, or have blood tests done by a hematologist-oncologist.
For systemic immune issues, you can consult a rheumatologist or family medicine physician for blood tests to confirm conditions such as Sjögren's syndrome or systemic lupus erythematosus.

Reply Date: 2023/08/17

More Info

Understanding dental issues can be quite complex, especially when it comes to conditions like cracks, root canals, infections, and allergies. Let's break down your questions systematically.

1. Detection of Dental Cracks
Dental cracks can be challenging to diagnose. Common diagnostic tools include:
- X-rays: These can reveal underlying issues, but they may not always show cracks unless they are severe.

- Transillumination: A light is shone through the tooth to detect cracks.

- Cone Beam Computed Tomography (CBCT): This advanced imaging technique provides a 3D view of the tooth and surrounding structures, making it easier to identify cracks.

The cost of these diagnostic procedures can vary widely depending on your location and the specific dental practice, ranging from $50 to several hundred dollars.

2. Treatment Options for Cracked Teeth
If a tooth is suspected to be cracked but has already lost its vitality (the nerve is dead), the treatment options typically include:
- Root Canal Therapy: This is often the first line of treatment to remove the infected or dead tissue and seal the tooth. However, if the tooth is severely cracked, this may not be effective, and extraction might be necessary.

- Extraction: If the tooth is too damaged, it may need to be extracted. This is often the last resort, especially if the tooth can still function without causing pain.

- Monitoring: In some cases, if the tooth can still bite without pain, it may be reasonable to monitor it closely before deciding on more invasive treatments.

3. Understanding Pain Despite Dead Nerve
If an X-ray shows a dark area at the root and electric pulp testing indicates no response, it typically suggests that the nerve is dead. However, persistent pain can arise from:
- Periodontal Issues: Infection or inflammation in the gums surrounding the tooth can cause pain.

- Cracks: Even if the nerve is dead, cracks can still cause discomfort when biting or chewing.

- Residual Infection: If there is an ongoing infection, it can lead to pain and swelling.

4. Deep Cleaning and Infection
Experiencing infections after deep cleaning can be due to:
- Bacterial Overgrowth: If the cleaning dislodges bacteria that were previously contained, it can lead to an infection.

- Underlying Conditions: If there are existing periodontal issues, deep cleaning can sometimes exacerbate them temporarily.

If you consistently experience infections post-cleaning, it may be worth discussing with your dentist to explore alternative cleaning methods or additional treatments.

5. Allergic Reactions to Dental Products
If you notice that your gums swell or become painful after using certain toothpaste or mouthwash, it could indicate an allergic reaction. Ingredients like sodium lauryl sulfate (SLS) in toothpaste can cause irritation for some individuals. Switching to hypoallergenic dental products may help alleviate these symptoms.

6. Facial Swelling and Anesthesia
If you notice a lump near your jaw after dental work, it could be:
- Localized Swelling: This can occur after anesthesia or dental procedures due to inflammation.

- Infection: If the swelling persists or worsens, it could indicate an infection that requires further evaluation.

For persistent pain or swelling, it’s crucial to follow up with your dentist for a thorough examination.

7. Immune System Concerns
If your dental professional suspects underlying immune issues affecting your oral health, it may be beneficial to consult with an immunologist or a rheumatologist. They can conduct tests to check for autoimmune conditions or other systemic issues that could be impacting your dental health. Common tests might include blood tests for inflammatory markers or specific autoimmune diseases.

In conclusion, dental health is interconnected with overall health, and persistent issues should not be ignored. Regular check-ups and open communication with your dental care provider are essential for maintaining both oral and systemic health. If you have ongoing concerns, seeking a second opinion or further evaluation may provide clarity and peace of mind.

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