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Question:
The Background: I am what is described as a problem patient. In Germany they usually like you to 'suffer' and do not hand out Valium/Whatever like biscuits. I am Claustrophobic and it takes normally 2 strong dental assistants to strap a gas mask on me as I fight back, and so inhalation gas won't work for me. Tamazepam in tablet form calms me a little, but what has worked for me now is Valium Injected into the arm - which German Law does not allow anymore. I literally 'writhe' in a dentists chair and move away when he/she goes near me unless I know exactly what is going on (I realise I am a big baby, and there are people in the world with worse problems than me, but I can't help it, that's me..)
I have a generally low pain threshold, and just like my mother, even for things like teeth cleaning and minor 'pokes' around the mouth with a metal instrument, I need a valium injection in the arm. When I moved to Germany in 1997 I still had a 'back catalogue' of 2 further fillings that needed to be treated, I rushed straight to the German dentist when I got here, explained the situation of how I am, and he literally LAUGHED at me, and couldn't help me further. To cut a long story short it is now 2004, and I have not been to any German dentists (until recently) so I have neglected going to the dentist for about 7 years because of the way I have been treated.
I have been on a long-term dentist plan since I plucked up the courage to go to a dentist (I eventually found a dentist in Berlin who got his Dentist training back in the US) who was able to deal with me and who I was comfortable with. My list of treatments involves 3 new fillings, 2 re-fillings of old fillings made 15 years ago, and a professional 'propylaxe' deep teeth cleaning since the gums have developed inflamations over the course of the last 7 years.
The Abcess Problem:
My motivation for going to this dentist in the 1st place last October was a 'throbbing' (not really pain, but like a heartbeat) above a tooth that needed a deep filling - this started in August. The dentist took an Xray, looked at my teeth, and said the filling needed to be drilled away together with some actual tooth as it was getting dark - I was given an option of fillings, and I chose the ceramic inlay. This was last December.
Middle January I went back to the dentist to say that the throbbing was back for a few days, then stopped and that there was an inflamation and swelling starting near wher the inlay tooth was worked on. He looked at the inlay, looked at the X ray he took in October, and wasn't so sure if this was an abcess at that stage - he asked me about my 'bite' since the inlay was put there and it was slightly misaligned, so he shaved a fraction of a milimeter off the inlay, and suspected that the muscle was hardended at that point and that I should give it a few days to see what happens since he corrected the bite.
Now 2 weeks later I went back to the dentist again, because instead of it now just being inflamed above the inlay tooth (top left tooth towards the back)a growth had rapidly developed the size of a large pea. I was freaked out, I kept asking if he had to take the tooth out, and I didn't want that and it took him a while before I was willing to open my mouth and show it to him.
He immediately X-rayed again, drilled again into that same tooth did something with the nerve that was dead, and filled the hole with something that smells like hospitals - a disinfectant and closed it up temporarily - that was yesterday and said I should keep it under observation overnight. Today; I went back to see him - the actual pea-like growth had softened and reduced above the inlay tooth, but my cheek was swollen - it was as if the fluid in the growth was saying "Nope - I'm not hanging around here near the disinfectant - I am going to travel upwards towards my cheek/left eye where it is cosier".
The dentist removed the temporary plug, drilled a bit more to create a crater in the tooth (managing to avoid the ceramic inlay) any put a thin cotton swab in there. He gave me penicillin (Isocillin) and told me to take 6 tabs a day - he hopes that this will kill the bacteria/infection over the weekend. He told me to put cold compresses on all the time, and if the swelling did not go down, I had to go to the emergency dentist on the weekend to have them 'drain' whatever was in the growth. So far 5 hours later the swelling seems to be going down on my left cheek.
I am still VERY worried;
a)That the inlay tooth has to be taken out, despite the inlay just being applied late December, and me spending 300 Euros on a ceramic option which will obviously be wasted if the tooth has to come out anyway.
b) The fact that I am not in pain (yet) - maybe at the point of no return you just stop feeling pain anymore on an infected area.
c) If I have to go to the emergency dentist to have it drained, it will hurt, they will give no local/general, that they will not be sympathetic to me.
d) MOST IMPORTANTLY - that the problem is very serious, and the infection is deep in my skull and I need facial surgery and I am left with scars etc.. while they go right in there near my eye and fill the hole with bone cartilage. If the abcess fluid gets to my brain, I will have brain disease and will die if not treated.
I am sorry to sound overdramatic, but this is me, all the time. Please, please tell me something good. I do speak German, but I do not understand everything the German dentist says, and even if he said it in English for me, I would still freak all the same.
...Visitor from Berlin, Germany
Answer:
It seems that you have had some concerns with going to the dentist and that there must have been some bad experiences in your life. I can attest to the German dentist for I have never been to the country however I have seen some of the best work come from Germany.
Now to answer your questions. The tooth that had the inlay has most likely died and that is where the infection is coming from. A root canal treatment where they remove the nerve only will take care of the concern, If it does not then an apicoectomy will be the next step. This is when the
infection is removed from the end of the root. As a last resort the tooth will have to come out.
No matter what happens the inlay will be ruined and the final restoration should be a crown that will pull the tooth together when you bite down. The reason for no pain could be because the nerve is dead in the tooth and the inflammation of the infection deadens the nerve endings. The sensation in the nerves will return after sometime.
If the tooth needs to be drained then the hospital should use some form of numbing before doing the procedure. Abscesses can be dangerous and travel through the fibrous plains which separate the muscles in the body, however death form this type of infection is unlikely especially when it is being treated.
Good luck and if you have real concerns about the doctors then try traveling to Switzerland where the best dentistry in the world comes from.
Editorial Staff
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