Dentistry -wisdom teeth and infection

[4horses]

I have been searching for a new dentist. My trustworthy dentist who had been treating me for a decade retired, unfortunately. I tried staying with his practice but they changed hands several times and were very pushy regarding sales.

I tried a new dentist last year and they were very non-aggressive and gave me a very light cleaning in about 20 minutes, but I wasn’t super impressed.

Tried a new dentist this year. He says I have an infection by my retained wisdom teeth (still under the gumline) and recommended antibiotics as well as scaling and root planning for 1-3 teeth. Estimated bill is $400 with insurance covering the rest.

Those wisdom teeth have been sitting there for years, and occasionally I get a little bit of infection in the pocket of the gum but nothing that has caused pain or required anything more than some chlorhexidine and a water pick. I’m not sure I need to be super aggressive with treatment and I do wonder if treatment will just aggravate the area. (Chronic pericoronitis I believe is the name for it).

Or perhaps I should just get those teeth removed? I was originally told to leave them be, as the root is right next to the nerve and their are risks in getting them removed. Of course, the surgeon who removed my top wisdom teeth disagreed and said they could cause all sorts of problems and I was better getting them out.

But so far, they have not caused issues.

Maybe I need to see another doctor and get a second opinion. Obviously if it’s going to be $400 or more per year to maintain the area, it may be better to just get them removed and be done with the issue. But then I could risk nerve damage given the location of the roots.

Any thoughts or suggestions?

[HorseLover65]

I am a bit OCD when it comes to “dental care”… but I know of two different family members who are now going through significant dental work to fix little problems that became big problems. They became big problems because of ignored infection. I am not sure the best route to go - removal or treatment, but I wouldn’t ignore it. My poor college aged nephew went 9 months ignoring swelling in his jaw and now needs surgery. Find a dentist you like and then trust their judgement. Just my two cents
Good Luck!

[LCDR]

There are way too many unknown factors here for even a trained and board certified oral and maxillofacial surgeon to offer you internet advice. You need a consultation appointment with one of them.

Before anyone responds with “their business is doing surgery so naturally they will advocate removal,”" neither do they want you to have complications such as a permanently numb tongue or lip. Benefits and risks need to be studied, considered and explained to you.

[4horses]

It is just a bit surprising because no one else has mentioned this being an issue other than to treat with chlorhexidine. Not sure if the other dentists were ignoring the issue or didn’t think it was anything serious. I have noticed in the past and requested that they don’t probe that particular pocket too aggressively because they can force the probe in too deep and inflame the area. I mean we know there’s a pocket there, do they really need to probe as deeply as possible? At any rate, I’m feeling quite sore tonight, and before my appointment I was not sore at all. It’s aggravating to change practices. You just don’t know what you are going to get as far as care.

These people, let’s just say I have never had such a time consuming, thorough exam from the hygienist in my life. They spent over an hour taking pictures, bite wings, and measuring pockets. Like very very thorough. My previous hygienists in the past 10 years have never spent that kind of time looking. So I honestly don’t know what to think. If I had been going to that practice and knew them a bit better perhaps I would feel more trusting.

The other practices are all bustling with patients and this place has plenty of openings. It does make you wonder. I’m thinking I should hold off, treat with chlorhexidine as I usually do and perhaps see a different practice, just to get a different opinion. If they agree then I have my answer.

[goodhors]

I would second another exam by a oral surgeon, to compare the two diagnosis’. I still have my wisdom teeth, though my childhood dentist REALLY wanted to pull them. They came in quite late, my early 20’s, so Mom was not involved in making the choice. They have not ever caused problems except for needing fillings.

Second the viewpoint of high risks of nerve damage, jawbone damage, by removing your wisdom teeth now. Have you ever looked at an extracted wisdom tooth? They have LONG roots!! Heck the surgeon doing my kids wisdom teeth removal listed those possible issues on the removal agreement!! Their teeth were impacted, badly positioned, so no alternative except removal. My regular dentist showed me their X-rays, there were were obvious problems. First kid was about 16yrs when his were removed, bigger with definate long roots. Still growing, roots were not finished when removed. Second was about 14yrs, dentist was checking kids at much younger ages the 8 years later. Still in the “bud stage,” no roots yet. Buds were not straight up, not enough room for them to grow to full size (she got her Dad’s smaller mouth). Her removal was much less traumatic, faster healing with smaller holes, MUCH less pain after. I recommend early age checking to friends with kids, to see if wisdom teeth may need removal. Younger at removal is easier on the kid!

When at the oral surgeon, ask about a change in how you brush or clean your teeth, to prevent these recurring infections by the wisdom teeth! Possibly a simple toothbrush change, adding a water-pic to daily routine, a different toothpaste, getting teeth checked and cleaned more often will help.

But absolutely, get a second opinion before doing anything drastic like tooth removal!!

[candyappy]

If it is not bothering you I am of the mind to let it be until it does. Then you know for sure it needs to come out. There are some dentists who always find something that needs to be done on a new patient…

[RAyers]

Oral bacteria and fungi migrate all over the body. There is a rich body of literature that shows oral microbes migrate to cardiac tissues causing cardiomyopathy, cause joint infections, and in my work I find oral fungi (candida) in the spine causing osteomyelitis. My opinion is that infections in the mouth are indicators of possibly other health issues and should be treated aggressively. But that is just me.

[4horses]

I have heard different opinions from every dentist I see. Most say don’t touch them unless they are causing issues. I spent today checking with insurance and I can both get a second opinion from a different dentist and I can go to the oral surgeon for a consultation.

[SummerRose]

@RAyers

oral fungi (candida) in the spine causing osteomyelitis.

That’s a bit horrifying. But good to know! Thanks for the insight.

[hoopoe]

@4horses

My previous hygienists in the past 10 years have never spent that kind of time looking. So I honestly don’t know what to think.

I would say your previous care is stunningly substandard

[hoopoe]

@4horses

I can both get a second opinion from a different dentist and I can go to the oral surgeon for a consultation.

see the surgeon they will have the largest number of cases to draw knowledge and experience from. They can make a clearer example as to why or why not do the extractions

[forwardmarch]

Small recurrent infections can also cause bone loss in that area. Whoever reviews your xrays should comment on whether that’s occurring. Good luck!

[hoopoe]

and contribute to cardiac disease