During a Toothache, Do Not Apply Heat!

March 22, 2019 at 9:13 pm

Sylvia, I am sorry for this terrible dental experience you went through. You asked, “Should the dentist have, during my initial visit, prescribed an antibiotic?” This is very controversial.

I always prescribe antibiotics at the time I diagnose the need for root canal therapy and the patients never have post-operative pain. That is not what is taught in dental schools today. The treatment you received is considered the standard of care today, and unfortunately, the result you received occurs in one out of five patients. From my point of view, if the ratio was 1:5,000 or even 1:500, I might consider that approach. But because I know that one out of five is going to suffer, I pre-medicate with antibiotics. The downside is that some will have an allergic reaction to the antibiotic. I always tell the patient that if a rash or difficulty breathing develops, stop the medication and call me.

There is also concern about over-prescribing antibiotics and patients developing resistant strains of bacteria. While a valid concern, I still weigh that against what you had to go through. It’s not like I am suggesting antibiotics for the treatment of the common cold. If a tooth requires root canal therapy, bacteria are present. I want to reduce the number of bacteria before treatment. I want to “take the bees out of the hive before I stick my hand in it.” But I am in the minority. I hope that answers your question.

March 22, 2019 at 5:18 pm

Hi Deborah! Thanks for sharing. Warm salt water rinses are an easy and effective way of preventing the spread of infections

March 22, 2019 at 5:18 pm

Hello Robert! Thank you for commenting. We believe everyone, regardless of age, should be aware of sugary and acidic drinks or foods.

And great tip on waiting to brush! It is proven that you should wait to brush after having acid in your mouth or else it can further damage your enamel.

May 17, 2019 at 10:04 pm

Sorry you are going through this. The abscess tells me that there is no “feeling” in at least one root of the tooth. The pain is coming from the infection outside the tooth or from one of the other roots that still have feeling. A quick remedy is to hold Ice Water in your mouth in the area of the affected tooth. It should take away the pain for a while and can be continually reapplied as needed. Once the antibiotic kicks in, the frequency of the need for ice water should decrease. Hopefully, the other teeth are not sensitive to cold or this becomes a trade-off.

The reason ice water helps is because the bacteria inside the tooth give off a bi-product of gas. The gas is trapped and has no way to escape. When gas is heated it expands. Your body heat may be enough to cause it to expand and put pressure on the nerves causing the pain. The ice water gets the gas to contract and remove the pressure from the nerves. You may have to keep ice water on the night stand next to the bed if the pain wakes you. Take a swig and hold it around the tooth, then swallow and go back to sleep.
Where are you located?
I hope this helps. Good luck!

May 17, 2019 at 10:05 pm

Do not apply heat to your face. It will draw the infection to the surface and create severe swelling. It is OK to apply cold compresses. You should not have tooth infection drainage from the nose. There should not be communication between the sinus and oral cavities. Be sure you tell the surgeon at the time of the extraction that this has been your experience. It may be necessary to apply a membrane that will separate the extraction site from the sinus to create proper healing.

November 4, 2019 at 11:10 pm

Hello Thomas, I would call the dentist and explain what you are going through. It’s possible that a different type of antibiotic would be more effective. Also, I am having just as much, if not more success, avoiding opiods like Tylenol with Codeine. Try alternating two extra strength Tylenol with 2 200mg Motrin (Ibuprofen, Advil) every four hours. In other words, take two Tylenol, then four hours later take two Motrin. Continue to alternate as needed. If you are not having cold sensitivity, it is possible that there are gases building up in your tooth that are causing your pain. Take a glass of ice water and hold the water in your mouth until the pain subsides. If trapped gas in the tooth is the problem, it will be relieved by the cold water. It is a temporary fix, but it works great. The treatment of choice would be extraction or root canal therapy. Good Luck, Doc

November 14, 2019 at 12:46 am

Sounds like this was a cavity that was so deep, it caused an infection that your body was tolerating. The tooth was like a hornets nest of bacteria instead of bees. The dentist’s work stirred up the hive and you are feeling the result. The reason that the cold water helps is because there is gas that is trapped inside the tooth. The bacteria give off a by-product of gas and there is no escape. The cold water causes the gasses to contract and take the pressure off of the nerve endings. The treatment is to get the tooth numb and have the dentist open the chewing surface to allow the gas to escape. Once the gas is out, the pain will not come back after the numbness wears off. The next step would be to fill that space where the bacteria were, and that process is called root canal therapy. The alternative is extraction, but if you can save the tooth, try to do so. Good luck and I hope you have a happy and healthy baby. Doc.

November 14, 2019 at 12:52 am

If all of the canals of the root were filled, there should be no space left in which gasses can collect, so the ice water trick should not work. There are some possibilities. If the dentist did a partial root canal treatment and did not fill the roots, there could be gas build up and the cold water would work. Or if the canals were filled and one canal was overlooked, same holds true. Also, it is hard to tell if the pain is coming from the tooth that was worked on. It is possible that the tooth next to this one also needs root canal treatment, or one that is in the opposing jaw. Sometimes the brain gets confused and can’t tell if the pain is upper or lower jaw. I hope that helps.

Doc

November 14, 2019 at 12:56 am

Once the tooth is extracted, the infection will clear without the need for additional antibiotics. The infection will have “an exit route” though the extraction site. I hope that helps.

Doc

November 19, 2019 at 11:22 pm

Having half a root canal done is like delivering half the baby. Not good for you or your baby, or in this case, tooth. The roots of your tooth are like straws with a thick outer shell and a thin opening that runs down the center. These canals can be treated by being cleaned out and filled to prevent bacteria from growing in them. That is a root canal treatment. If you empty the canals and don’t fill them, there is no circulation or nerve in the tooth, so it will feel OK for a while. But without circulation, there is no way for your body to clean out the bacteria that will inevitably form in that dark, warm moist space in the canals. The bacteria build up in number and pass into the bone at the tip of the roots, causing pain and swelling. So here you are. If oral antibiotics are not working, you may need to be hospitalized for intravenous (IV) antibiotics. If the swelling is not too severe, you might be able to increase the antibiotic dosage orally. Consult with your dentist. Most importantly, do not apply heat to the swelling. It will dramatically make it worse. Good luck. I hope that helps. Dr. Silberman

March 21, 2020 at 11:08 pm

When a tooth is diagnosed with a root fracture, the only solution is to extract the tooth. The sooner, the better. It can be replaced in the future (implant, fixed bridge, etc). Minor swelling can occur with or without pus being present. The inflammatory response of the gum tissue can create minor swelling too. Warm salt water rinses on a tooth that has been previously treated for root canal therapy is fine as is rinsing with peroxide. Applying heat to a tooth that has not had root canal treatment is a bad idea.

December 3, 2019 at 10:50 pm

You are correct that a root canal won’t be possible if you can’t open very wide. Sometimes the antibiotic takes a while to be effective, especially on a lower tooth where the circulation is poor. It might be necessary if the swelling persists to go to the ER for IV antibiotics. You will need to work closely with your dentist to make that determination. This level of swelling happens very infrequently. It is usually associated with someone applying heat to the outside of the face in an attempt to get some relief. Heat is what brings out the swelling. It is possible to get the swelling without the heat though . . . . . it happens. The antibiotics you are taking are the same as what I would have prescribed. Hopefully your swelling has subsided, but if not, consider the ER. Good luck.

March 21, 2020 at 10:51 pm

The limited opening of the mouth is due to the swelling from the infection. Once the swelling and infections subside, you should be able regain the ability to open wide again. The root canal treatment might need to be postponed. Some infections take longer than others to be resolved with antibiotics. Oral antibiotics might not be strong enough to control the infection and IV antibiotics will do the trick. This is rare, but it can happen. Your dentist may want to increase the strength of the dosage of the antibiotics. And remember, do not apply heat to the swelling. It will make the swelling dramatically worse and increase the pain.

December 23, 2019 at 10:23 pm

Hi Amber, I’m not sure what you mean by a freeze test. If a filling is large, the tooth may eventually become sensitive to cold or hot or pressure, even though there are no symptoms immediately after placement. In your description, it has been a year since the filling was placed. To test the tooth we take an x-ray to see if there is visible infection at the tip of the root. We do a tapping test and compare it to other teeth to see if it feels different. And we do a cold test where we apply a cold stick to the tooth in question and compare it to the teeth around it or the mirror image tooth on the other side of the mouth. This could be what you mean by a freeze test. These tests help to determine if the tooth needs root canal treatment. Based on your description, it sounds like the tooth need root canal treatment. I usually put my patients on a round of antibiotics to calm the situation, and then to the root canal treatment. It’s best to remove as many bacteria as possible before doing the treatment. Take the bees out of the hive before you stick your hand in it. I hope that helps. Best, Dr. Silberman

January 3, 2020 at 11:25 pm

Hi Erin, Sorry to hear you are going through this. The source of your pain is coming from gasses that are trapped inside the decayed / infected tooth caused by bacteria. The antibiotic will decrease the bacteria present and the gas production will slow as a consequence. Your body heat is often enough to expand the gas and put pressure on the nerve causing the pain. Be sure to avoid heat (coffee, tea, saunas, direct sun, hot showers, etc) The cold water reduces the pain because it causes the gas to contract and takes the pressure off the nerve. Getting the tooth extracted will give you the relief you are looking for. The antibiotic helps gradually to relieve the frequency that you’ll need the cold water. But getting the tooth out will solve the problem. I hope that helps. Best, Dr. Silberman

March 21, 2020 at 10:05 pm

Confusing symptoms indeed. I’m guessing that the tooth needs root canal treatment or extraction. I am betting that this is a molar, or a two rooted bicuspid. If a tooth has multiple roots like a molar, each root has its own nerve supply. One root could be infected while another is irritated. Infection is not reversible while an irritation is. That is why you might get symptoms of both. The infection eventually will take over and the choices are still going to be root canal treatment or extraction.

May 6, 2020 at 3:18 am

Sorry to hear you are having this problem. Holding ice water in your mouth in this situation should help you. But it is a short term fix. It sounds to me like there is an additional root in your root canal tooth that needs to be cleaned out and filled. This can happen sometimes. You should do the ice water trick until such time that you can get an antibiotic prescribed by the dentist, and one that your OB/GYN approves of. You should be OK in that department as you are out of your first trimester. Once the infection is quieted, the dentist should look for the additional root to fix the problem. The alternative is to extract the tooth. I hope that helps. And I hope your pregnancy has an easier go of it than your tooth. Best, Dr. Silberman

June 18, 2020 at 5:38 pm

Hello LB, It is common for there to be some discomfort after root canal treatment. I recommend alternating Tylenol 500 mg x 2 every 8 hours, and Ibuprofen (Motrin, Advil) 200 mg x 3 every 8 hours. Alternate the medications so that you are taking Tylenol, then Motrin 4 hours later, then Tylenol 4 hours after that. . . .and so on. If there is swelling, there is infection. I would recommend going back on the antibiotic, and my drug of choice would be Clindamycin 150mg every 6 hours. It should not be taken if you have GI issues (Crohn’s Disease, IBS, etc). Once the infection clears, you’ll feel better.I hope that helps. Dr. Silberman

June 21, 2020 at 2:42 am

Hello Shaneka, Contact your local dental association or State dental association. Every State is different. In Maryland we have Donated Dental Services which can offer guidance. Some areas depend on local churches to refer patients who need care. Catholic Charities also have their Mission of Mercy program which may be able to help. The underserved community gets free dental care four times a year in Maryland through Catholic Charities. Clindamycin and ice water holds should help, but might take a few days. You should alternate the Ibuprofen with Tylenol. Alternate them every four hours. In other words, 4 hours after the Ibuprofen, take two extra strength Tylenol. Then four hours later, take the Ibuprofen. Hang in there. Hope this helps. Dr. Silberman

June 21, 2020 at 2:33 am

Hello Lisa, Depending on the circumstances of the infection, extracting a tooth while it is still infected can be problematic. But if you have been taking an antibiotic and it is in your system at the time of the extraction, it should be fine. Norco is a combination of a narcotic pain medication and Tylenol. You could also take 600mg of Ibuprofen (Motrin, Advil) every 8 hours. It would help with the pain as it is an anti-inflammatory. Do not take any additional Tylenol. Also, if the infection has created a trapped gas pocket in the tooth, you might get immediate relief with “ice water holds”. Take a swig of ice water and hold it around the tooth. If it’s a gas pocket, the cold water will cause the gas to contract and take the pressure off of the nerve ending, which would stop the pain. Any discomfort that would be created by the cold water would be short lived so hang in there. The severe pain should subside within a minute. You may have to do that regularly until the antibiotic kicks in. If you have been on the Amoxicillin for several days, you may want to switch to Clindamycin 150 mg four times a day. There may be bacteria that the Amoxicillin isn’t hitting, but the Clindamycin would. And remember, do not apply heat to your face or inside the mouth. Good luck and I hope that helps. Dr. Silberman

July 13, 2020 at 11:27 pm

Hi Maria, Sorry to hear you are going through this. There are two issues to discuss with you. First, it is not uncommon to have a “dry socket”5 days after an extraction. This happens when the healing clot that is in the extraction site is dislodged. Air hits the exposed bone and causes pain. The dentist can apply a medication into the site, without numbing and without difficulty, that can make it feel better. If you are unable to get back to the dentist, go to any pharmacy and buy some oil of cloves. Also get a plastic syringe that you can use to flush out the site with warm salt water. Take an eye dropper and put a drop or two of the clove liquid into the site after flushing with the salt water, and gently bite on some gauze. Having said that, I don’t think you have a dry socket because holding cold water in your mouth would not help it. Now let’s talk about the second issue. I think you have another tooth problem. You need to have the other teeth checked to see if there is an abscess. The cold water would make an abscessed tooth with gasses trapped in it feel better. Go back to the dentist and get checked for a dry socket and for another bad tooth. I hope that helps. Good Luck, Dr. Silberman

July 15, 2020 at 9:18 pm

Hello Stephen, I was an instructor in the Department of Oral Diagnosis at the University of Maryland Dental School for years. My private practice got too busy for me to continue working at the school. I miss teaching, so the internet affords me the opportunity to answer dental questions. Glad I can help you. To answer your questions: The cold test would indication that there is an abscessed tooth that needs root canal therapy. If you are very apprehensive, you could ask for something to relax you prior to your visit. There are always risks with “being put to sleep” so for something that is as relatively easy as a root canal treatment, I would not recommend that. Root canal treatments get a lot of bad press. My experience is that most of my patients doze off during the procedure because they are long and boring and NOT uncomfortable. I am in the minority of dentists, but I routinely put my patients on Clindamycin 150mg (an antibiotic) prior to treatment (unless there are medical reasons not to do so like a history of GI illness or allergy to the Clindamycin). It reduces the infection making it easier to get the tooth numb, and my patient’s post operative discomfort is almost none (no swelling, no pain). Most dentists who don’t prescribe antibiotics preventively, wind up putting one in five of their patients on antibiotics AFTER doing the root canal because of swelling and pain. If it was one in five thousand, or even one in five hundred, I might consider doing it that way. But 20% of patients suffering makes no sense to me. I can’t help you with your insurance questions. The dentist’s staff should be able to help with that. I hope this was helpful. Good luck. Dr. Silberman

September 20, 2020 at 2:52 pm

It sounds to me like your retainer may need to be adjusted to fit the new filling. I would try that first. If the problem persists, the tooth may be infected and require root canal therapy. The testing of that tooth over time will determine what treatment is necessary. If infected, the tooth will become gradually more symptomatic, indicating the need for treatment. I do not believe that your symptoms are related to the treatment you received 2 1/2 years ago. Good luck. Dr. Silberman

September 24, 2020 at 5:36 pm

Hello Madalyn, Sounds like you have had quite the dental journey, and had to deal with getting Covid 19 too. I hope your Post Covid Fatigue passes so that we only have to deal with your tooth. I would go back to the dentist who placed the crown and have him check your bite. From your description, your “excursive movements” may be off. By that I mean that when you chew from side to side, the opposing tooth is being blocked in some way by the new crown. This would cause hot and cold sensitivity in the new crown. The dentist will have you chew on some carbon paper. I usually suggest to the patient to “bite, chew, grind and slide” on the carbon paper. That covers all of the directions of chewing and will leave a mark on the crown to be adjusted off. The dentist will adjust and repeat until the bite is right. Hot and cold sensitivity is more common in teeth that have just received treatment, and especially those with an improper bite. Once the bite is adjusted, I would suggest using a desensitizing toothpaste (Sensodyne, Crest for Sensitive Teeth, Colgate for Sensitive Teeth, etc.). Between the adjusted bite and the desensitizing toothpaste, the sensitivity will go away if the problem is an irritation. If the problem is an infection, the sensitivity will get worse in spite of the bite adjustment and desensitizing toothpaste. Time will tell and you need to be patient for a couple of weeks. If the tooth starts to ache by itself or is sensitive to temperature with a lingering discomfort of a minute or so, it will probably need root canal therapy. The other issue is whether you should stay with this dentist. I would stay put for now, but you might call around to see if there is a dentist who will offer you a free consultation / second opinion. I have always provided that service to the public. If a patient has been diagnosed properly, I refer them back to their dentist for treatment. Getting confirmation on diagnosis and treatment plan gives us the peace of mind we all need at times. I hope that helps. Good luck to you. Dr. Silberman

September 26, 2020 at 9:57 pm

Hi Dean, It sounds like you have cracked a tooth. It is like a crack in a windshield of your car, if you can relate to that. A crack suddenly appears and stays until you hit a bump in the road, and the crack extends further. In a tooth, the crack can go vertically towards the nerve or away from it towards the gum. It sounds like yours is towards the nerve. If the crack is through the tooth to the root at the bone level or below, it may need to be extracted. If it is to the nerve but not to the bone level, it could be saved with root canal therapy and a crown. As to how to treat it until you see a dentist, I would do your best to avoid biting on it. And avoid cold. Do not apply heat as it will help create an infection. Pain medication can help. I would recommend two extra strength Tylenol (2x500mg) every eight hours. And 600mg Motrin every eight hours. Take them alternating every four hours for continuous relief. Use the eugenol drops as often as you need to keep it quiet. Bottom line: get to the dentist for a diagnosis and treatment plan. I hope that helps. Good Luck, Dr. Silberman

October 15, 2020 at 12:52 pm

Hello Phillip. Sorry to hear you are experiencing this toothache. The ice water trick works, but is a short term fix, as you’ve come to learn. Unfortunately, there is no way to resolve this other than seeing a dentist to numb the tooth and make an opening in the chewing surface to release the trapped gas. That would be the first step in the root canal treatment necessary to save the tooth. The alternative treatment would be to see a dentist, or oral surgeon, to extract the tooth. Probably not the answer you wanted to hear, but those are your two choices. Good luck. Dr. Silberman

October 31, 2020 at 3:51 pm

Hi Christy. My answer to your question is simple. Never apply heat to your face when dealing with tooth infection. It dramatically increases the swelling and makes the infection much worse. If you have already done so, you can start applying cold compresses. But you will also likely need to get some antibiotics. If the swelling is severe, you may need to go to an emergency room where antibiotics can be administered intravenously, directly into your bloodstream. Severe swelling can be lethal and nothing to play around with. If the swelling is under your jaw and crosses the midline of your face, it can impact your breathing. If the swelling is in the upper jaw in the front of the mouth, the infection can flow up to the brain (Cavernous Sinus Thrombosis) and can be lethal too. So go for treatment immediately, and good luck. Dr. Silberman

November 5, 2020 at 10:58 pm

Hello Mandy, The infection will gradually drain through the extraction site. There is no need for antibiotics at this point. I recommend very warm salt water holds in your mouth in the area of the extraction. No swishing. Just hold it in the area of the extraction to draw the infection to the surface. It will either drain or gradually dissipate on its own. Give it a few days. I hope that helps. Good luck. Dr. Silberman

December 5, 2020 at 6:23 pm

Hi Cristina, Sorry to hear you are going through this. There are a few possibilities regarding the source of your pain. #3 may have an additional root that needs to be filled. It is not uncommon for a root to fill up with gas, a bi-product of bacteria trapped inside. The gas expands with heat and puts pressure on the nerves outside the tooth in the bone, or any remnant of nerve in the root. Your body heat could be enough to cause the expansion. That is why the cool water makes it feel better. It could also be that #3 is not the problem and that the roots have all been filled. It could be coming from #2 or #4. It is very hard to identify which tooth is the culprit. Other factors could be causing you pain, like a vertical fracture of the tooth. But if the CT scan did not show it, and if both #3 and #31 are crowned, it’s not likely. Plus the fact that cold makes it feel better is pretty conclusive that it is gas trapped in a root somewhere. I would definitely not wait on the antibiotic. Amoxicillin is popular but Clindamycin works better for this type of pain. You can’t take it if you have any GI issues (irritable bowel syndrome, Crohn’s disease, ulcerative colitis, etc.) Taking antibiotics is controversial in dentistry and, in my opinion, it shouldn’t be. If you have a hornets nest, don’t stick you hand in the nest without making sure the bees are gone. Clindamycin does a good job of reducing the bacteria (the bees) which are the source of your pain. It’s not a cure, but it should make it feel 80% better. Meanwhile, use the cold water to keep it quiet and start taking the antibiotics ASAP. Good luck and I hope that helps. Dr. Silberman

December 15, 2020 at 5:44 pm

Hello Muriel, Sorry that you are going through this. It is very unusual to not be able to numb an upper premolar. If an infiltration injection (numbing on the cheek side of the tooth) is not sufficient to numb the tooth, then certainly a palatal injection on the roof of the mouth behind the tooth would numb it. Also, though it is controversial among dentists, I always prescribe antibiotics for root canal treatment. My go to is Clindamycin 150mg 4 times a day for 10 days. You did not mention if antibiotics have been tried yet. After a round of antibiotics with the tooth out of occlusion (shortened to be out of contact from the opposing tooth), I would re-evaluate. At that time I would check the tenderness to tapping on the tooth and possibly take another x-ray to see if there are any new changes. If there are new changes, it’s likely that there is a crack in the tooth and it would have to be extracted. My gut tells me it’s not neural, but you can’t rule it out. Try other treatment first and see how it goes. Good luck. Dr. Silberman

December 16, 2020 at 10:59 pm

Thank you Kristin. You are a real mensch for saying so ….. LOL Warm Regards, Paul B. Silberman, D.D.S., MOT

January 10, 2021 at 6:59 pm

Hi Mike, Sorry that you are having to go through this. To stop the pain immediately you can hold ice water in your mouth next to the tooth. You may have read my thoughts on this in other posts, but if not, it’s worth repeating. Your tooth is on a classic trajectory. When the tooth was refilled, it was probably already damaged by decay, even though it was asymptomatic. Now that the bacteria from the decay has taken over the tooth, they have created a by-product of gas that is trapped inside. Ice water will get the gas to contract and take the pressure off the nerve endings and stop the pain. Your body heat is enough to get the gas to expand and cause the pain. You can’t keep ice water in your mouth until the 19th, so I would recommend asking your dentist to see you tomorrow on an emergency basis. He can drill open the top of the tooth to release the gas and stop the pain. It is not a difficult nor painful process. Releasing the gas will give you relief until you can get to the endodontist (root canal specialist) on the 19th. As long as the dentist has numbed the tooth to open it and relieve the gas, I would ask that the height of the tooth be reduced so that you can bite together more comfortably. The tooth will need to have a crown placed on it anyway, so doing this will help you now, and less tooth reduction can be done later when you get the crown. I am not a fan of Penicillin for tooth infection. Clindamycin 150mg every 4 hours is better against the type of bacteria found in a tooth abscess. If you have any GI issues, I would stick with the Penicillin. You might suggest switching to your dentist and get his / her opinion. It’s just my opinion having done this type of work for decades. And a reminder, avoid applying heat to your face and stay away from hot food and drink until you have resolved this problem. I hope that helps. Good Luck. Dr. Silberman

January 19, 2021 at 2:27 pm

Hi Brittany, Sorry to hear you are going through this, and thank you for your kind words. It sounds like this tooth is in a multi stage of deterioration. Because this tooth has several roots, at least one of them is resisting the infection and holding on to being able to feel a cold stimulus. When there is infection visible on the x-ray (a dark area in the bone outside the tip of the root of the tooth), that indicates that the infection is fairly advanced. With at least one root in early stage and at least one in late stage of infection, you get the worst of both worlds. In late stage, applying ice water provides immediate relief. But in your situation, the early stage root says NO! Here are your options. You can call your dentist or endodontist and ask if they would do a pulpectomy. This is stage one of root canal treatment wherein the nerve of the tooth is removed and a temporary filling (or just cotton) is placed until such time that the root canal treatment can be completed. That would stop the pain. Another option is to continue on the Clindamycin and give it a few days to kick in. It is a much better antibiotic than Amoxicillin for tooth infection. If it isn’t better in a few days, ask if a higher dose would make sense. Typically, 150mg four times a day is normal, but in stubborn cases, going to 300mg four times per day is an option. This is more true for lower teeth than upper teeth due to the comparatively less volume of circulation in the lower jaw. Also, you should talk to your OB/GYN about using Tramadol short term until you can get out of pain. I would not use it in the first trimester, but because you are past that, it may be okay to use it. It is stronger than Tylenol and is not considered a true narcotic, which I would not use during pregnancy. And because you won’t be on it for long, the chances of addiction for you or the baby are remote. Those are your choices as I see them. Good luck to you and your baby. Dr. Silberman

January 31, 2021 at 1:40 am

Hi Angie, You really didn’t give me much information for me to help you. Your best bet would be to see a dentist as soon as possible. You can take up to 600mg of Ibuprofen (Also known as Motrin or Advil) every 8 hours. You can also take two Tylenol 500mg each every 8 hours. Don’t take them together. Alternate the every four hours. If the problem is caused by decay, the cavity would have to be quite large for there to be any pain, and it is likely you will need either an extraction, or if you want to save the tooth, a root canal treatment. But again, see a dentist to resolve the problem, or write to me with more details. I’d be happy to help. Dr. Silberman

February 1, 2021 at 9:22 pm

Hi Courtney, Sorry to hear you are going through this tooth problem, especially while pregnant. It sounds like you have an infection in your tooth. If the infection has been there for a while, it won’t be sensitive to cold water. Take some ice water and hold it in your mouth next to the tooth. It will either make it worse for a minute, or it will stop the pain completely. The advice you were given is correct: you need either a root canal treatment to save the tooth, followed by a crown to preserve it, or you will need to have the tooth extracted. I hope the ice water trick works for you. If you are going to save the tooth, antibiotics will help to quiet it. Clindamycin is my antibiotic of choice, but you will have to get that prescription from the dentist. Amoxicillin is not a very good option because it takes longer to work, if at all. Remember to avoid applying heat to your face or drinking hot liquids until the problem is fixed. Heat can cause severe swelling to your face. Good luck and I hope you have a happy healthy baby. Dr. Silberman

February 2, 2021 at 3:11 pm

Hi Cindy, If your mouth is sore, there may be some damage to the soft tissue, as suggested by the endodontist. For now, let’s rule out the tooth as the source of the problem and that the root canal treatment looks good on x-ray. Let’s treat the soft tissue injury. I recommend Chlorhexidine mouth rinse twice a day to help with the healing. It is a prescription rinse and the endodontist could prescribe it for you. Swish for 30 seconds twice daily and don’t eat or drink afterwards for an hour. At other times during the day, I recommend warm salt water holds where the tissue has been damaged to help keep down the swelling. You could also buy some over the counter numbing gel and apply it with a cotton swab (Q-tip) to the damaged tissue. I agree with alternating the Ibuprofen and Tylenol, but these other treatments will get the site comfortable and heal more quickly. Good Luck. Dr. Silberman

May 30, 2021 at 11:49 am

Hello Macey, You have an infected tooth. The likely cause is either a large cavity that allowed bacteria to enter the middle of the tooth where the nerve and circulation are, or it could have been from some earlier trauma where the tooth was hit. Coldwater relief is a classic way to diagnose the problem. The fix is to see a dentist ASAP. The tooth will either need to be extracted or saved with root canal treatment followed by a permanent crown. Meanwhile, continue with ice water holds to get relief. Also, a prescription for Clindamycin 150mg would help to quiet the tooth. And also alternating 2 extra strength Tylenol with three 200 mg Advil (Motrin, Ibuprofen) every four hours will help with the pain. Don’t take them together. Alternate them four hours apart. If you can’t reach a dentist, you can get the prescription for Clindamycin from an emergency room or urgent care. Good Luck, Dr. Silberman

May 30, 2021 at 6:52 pm

Hello Joseph, Lockjaw is not usually something that you would get from a tooth with a missing filling. If that tooth has an infection and there is significant swelling, it may cause a limitation to opening wide. The term Lockjaw would indicate to me that you are having pain in front of your ear at the point where your lower jaw meets the skull, resulting in having difficulty opening. We refer to this as a TMJ problem. Whether the problem is TMJ or a tooth infection, you need to see a dentist to make the right diagnosis and treatment plan. It couldn’t hurt to take 600mg of Ibuprofen (Advil, Motrin) every 8 hours to reduce the pain and inflammation. Avoid excessive chewing, like chewing gum. A prescription for a muscle relaxer could be very helpful and you can get that from either a dentist or an emergency room / urgent care. I hope that helps. Good Luck, Dr. Silberman

June 4, 2021 at 12:29 pm

Hello Lenn, I’m not sure what you are asking. If you are asking if the application of cold to an inflamed tooth will help, the answer is “maybe”. If there is inflammation but no infection, the tooth can be sensitive to cold but usually, the pain does not linger. Application of cold would not be advised in this situation. If the tooth is inflamed and infection is present, application of cold could produce lingering pain and is also not advised. But if the inflammation has triggered an infection that is more advanced, application of cold may stop the pain. In no case is actual “freezing” a treatment. I hope that helps. Good Luck, Dr. Silberman

June 4, 2021 at 9:04 pm

Hello Sana, Toothache is not usually associated with gastric issues. If stomach acid is reaching the mouth (reflux) it can damage the teeth. But it doesn’t sound like that is what is happening with your mom. She should see a dentist as soon as possible. With Gastric Issues, she should not take Advil (Motrin, Ibuprofen). She should take Tylenol Extra Strength every 8 hours (two 500 mg pills). She could also try holding ice water in her mouth to lower the temperature of the bad tooth to see if that stops the pain. Good luck. Dr. Silberman

June 6, 2021 at 9:49 am

Hello Adriana, Usually dental swelling and pain are reduced with antibiotics. If taken repeatedly, the bacteria develop a tolerance to that particular antibiotic. For the same reason, we do not prescribe antibiotics for the common cold. Overuse of antibiotics has led to resistant strains that are far more difficult to treat. Antibiotic treatment for dental swelling helps with the symptoms (pain and swelling) but not with the underlying problem. The circulation inside the tooth has been damaged by tooth decay. The antibiotic can’t make its way into the tooth to kill off the bacteria because of this damaged circulation. The inside of the tooth is dark, warm, and moist, and perfect for bacteria to breed. The first time you took the antibiotics, the swelling went down. The bacteria learned from the experience and developed a tolerance, and the bacteria that were unaffected inside the tooth continue to grow in strength and numbers. You need to have this tooth treated as soon as possible with either an extraction or a root canal treatment. A different antibiotic may help in the short run, but putting off treatment and exposing yourself to more antibiotics is not the cure and it’s more detrimental to your overall health in the long run. I hope that helps. Good luck, Dr. Silberman

June 9, 2021 at 2:32 pm

Hello Justin, You should go to a dentist. The ER will prescribe an antibiotic and narcotics, but that would be masking the symptoms, not treating the problem. You have an infected tooth that needs to be treated with either root canal therapy or an extraction. Don’t waste your time in the ER. Keep applying the ice water as needed to keep the tooth quiet for now. If the dentist doesn’t have time to do the root canal or extraction, they could numb the tooth and open it up to allow the gas that is causing the pain to escape. That would prevent the need for constantly using the ice water. Good Luck, Dr. Silberman

June 12, 2021 at 5:49 pm

Hello Alicia, I can’t tell from your description if this is a tooth, muscle or joint issue. Try cold compresses on the area, and alternate two Extra Strength Tylenol with three 200mg Motrin (Advil, Ibuprofen) every four hours. Apply the cold compress 20 minutes on and 10 minutes off. By alternating the pain medication, you are taking something every four hours. If you can’t get to a dentist, go to an ER or urgent care. Good luck, Dr. Silberman

June 19, 2021 at 2:22 pm

Hello Beverly, You really don’t provide me with much information to help you. Try holding ice water in your mouth to stop the pain. Of course, if your teeth are sensitive to cold, this won’t work. Alternate taking Tylenol and Motrin four hours apart. Take two extra-strength Tylenol, then four hours later take three 200 mg Motrin, and alternate them every four hours. And most importantly, see a dentist as soon as you can. Good Luck, Dr. Silberman

July 8, 2021 at 9:55 am

Hello Nikki, It sounds like you have an infection in one of your teeth. It may have had no symptoms two weeks ago and now is symptomatic. It happens. The bacterial infection in the tooth gives off a gas that is trapped inside. When you drink something cold, the gas contracts and takes the pressure off of the nerve which then stops the pain. Your body heat is enough to expand the gas and start the pain back up again. Your dentist can take a cold stimulus and apply it to one tooth at a time to identify the culprit. Then you have to decide if you want to have the tooth extracted, or save it with a root canal treatment and crown. I am sure the dentist will go over your options, and you have to decide which is best for you. For now you need to keep ice water handy, call the dentist for an appointment, and avoid any heat (no hot compresses, heating pads, direct sunlight, no hot food or drink). Good Luck, Dr. Silberman

July 9, 2021 at 8:38 am

Hello Maria, Hold warm salt water in your mouth to reduce the swelling. Don’t swish. Just hold. Also, apply cold packs on the outside of your mouth on your face in the area where you have swelling. This should help but it may be necessary for the doctor to call in a prescription for antibiotics if he/she hasn’t already done so. I hope that helps. Good Luck, Dr. Silberman

July 9, 2021 at 8:49 am

Hello Abigail, Yes, I think it best to call your dentist. Sometimes it is difficult to identify where the pain is coming from. In your case, it could be either tooth pain or TMJ. Once a diagnosis is made, the treatment will become obvious to the dentist. In either case, it is OK to alternate Tylenol and Motrin (Advil, Ibuprofen, Motrin are all the same drug under different names). Take two extra-strength Tylenol. Four hours later take three 200mg Ibuprofen (600mg total), and alternate the Tylenol with Ibuprofen every four hours. I hope that helps. Good Luck, Dr. Silberman

July 10, 2021 at 10:40 pm

Hello Meranda, Each state and locality may or may not have charitable services available to you. The resources vary tremendously. Hopefully, you are in an area that has a “dental safety net.” You’ll have to do some investigating on your own. I can make some suggestions. Contact these places and explain your situation to them and see if they can help, but expect some quirkiness in the rules. For example, if you are living in the state of Maryland and you are pregnant, your dental needs are covered by Medicaid at 100%. The day you deliver your child, your dental benefits end if you are over age 18. Anyway, check with your representative in your state government and see what your state provides in the way of dental coverage for those in need. There are charitable organizations that may be able to help like Catholic Charities. Also, look into Mission of Mercy in your area. In my area, we have Donated Dental Services which screen the patient’s needs and then asks local dentists to volunteer their services. Also, see if there are any dental schools in your state that have a sliding scale based on need. Dentists in training are closely supervised and the patients get excellent care at a reduced fee. Another option is to ask clergy for help. Go to your church or synagogue and see if they have a system in place to handle this type of need. Unfortunately, there is no universal answer. It just depends on where you live. Good luck, Dr. Silberman

July 11, 2021 at 6:27 pm

Hello Melissa, So sorry to hear you are going through this. If you have the late stages of a tooth infection, holding ice water in your mouth will help stop the pain. If it is in the early stages of infection, it won’t help. But it is worth a try. Getting to a dentist to be diagnosed and treated is most important. It is OK to have x-rays taken now that you are no longer in your first trimester. Stay away from heat . . . . no hot foods or hot drinks, no hot compresses, no direct sunlight and stay cool inside. Check with your OB but alternating Tylenol and Motrin every four hours to help with the pain. Good luck and have an easy delivery. Dr. Silberman

July 15, 2021 at 5:18 pm

Hello Neha, The likelihood is that you have an infected tooth. The infection could have been caused by a cavity or trauma, allowing bacteria to get inside the inner workings of the tooth. The bacteria are increasing in number and they give off a by-product of gas. The gas is trapped in the tooth with no way to escape. The gas expands in heat and contracts in cold. Your body heat is enough to cause the gas to expand and put pressure on the nerves in your tooth and/or jaw. This causes the pain you are experiencing. The cold water reduces the temperature causing the gas to contract and take the pressure off of the nerve, stopping the pain. You need to see a dentist to either have the tooth extracted or save the tooth with root canal therapy. Meanwhile, keep ice water handy to keep the tooth quiet. I hope that helps. Good Luck, Dr. Silberman

July 16, 2021 at 11:11 pm

Hello Larissa, You aren’t providing me with much description of your problem to enable me to offer any advice. But you should see a dentist as soon as possible for a proper diagnosis and treatment plan. Good luck, Dr. Silberman

July 16, 2021 at 11:09 pm

Hello Candace, You should definitely call your dentist and explain what is happening. Knowing your needs, they may be able to prescribe medication to quiet the teeth until such time that they can get you in for treatment, or they may be able to get you in sooner. Good luck, Dr. Silberman

July 17, 2021 at 2:09 pm

Hello Joshua, Sorry to hear you are going through this. Depending on the infection in the tooth, it could be in the early stages or the late stages. I am going to assume you have late-stage infection. Try holding ice water in your mouth. It will stop the pain if you have late-stage infection. If not, it will hurt for a moment and go back to the same level of pain. It is definitely worth trying. As for the pain medication, alternate extra-strength Tylenol with the Ibuprofen. Take 2 Tylenol, then four hours later take 600 mg of Ibuprofin (3 over-the-counter 200mg tablets). Switch back and forth between them every 4 hours as needed for pain. Good luck. I hope that helps. Dr. Silberman

July 18, 2021 at 9:42 am

Hello Husna, It is difficult to make a diagnosis that is absolute, but it sounds like you have an infected tooth. Because the filling is many years old, it is likely a late-stage infection. For immediate relief, hold ice water in your mouth. That should stop the pain. It sounds like the tooth is going to need to be extracted, or treated with root canal therapy. Also, alternate taking the paracetamol with Motrin (also called Advil or Ibuprofen). Take them four hours apart. That would also help with the pain. But the ice water should do the trick. Remember to avoid applying heat to your face and stay out of the heat outside. I hope that helps. Good luck, Dr. Silberman

July 19, 2021 at 2:31 am

Kailyn, I need more specific information in order to offer advice. If you are in your late teens or early twenties, you could be teething – your wisdom teeth may be trying to erupt through your gums. Hold warm salt water in your mouth. If you have a large old cavity, holding ice water in your mouth could help. I need more clues to help me help you. Dr. Silberman

July 19, 2021 at 8:00 am

Hello Avani, Sounds like you need to see a dentist. You didn’t really ask a question, but feel free to do so. Good Luck, Dr. Silberman

July 19, 2021 at 3:55 pm

Jan, Bruxism can cause a vertical fracture in a tooth, allowing bacteria from the mouth to enter the isolated circulation inside the tooth. That would be the likely source of your pain. The endodontist should be able to determine the extent of the fracture. If advanced, the tooth may need to be extracted. If you were my patient, I would put you on Clinamycin 150mg (antibiotic) every 6 hours. Because the infection has not advanced to the abscess stage that would show up on an x-ray does not mean that an antibiotic is not warranted. The antibiotic would help to get the infection under control. Also, I would shorten the height of the tooth so that when you bite together, you would not cause more pain, and ultimately you would get some relief. If the tooth can be saved, it will need to have a crown placed on it. Shortening the tooth now will make it feel better and would need to be done at the time of the crown preparation anyway. If the tooth is not sensitive to cold, hold ice water in your mouth for instant relief. Good Luck, Dr. Silberman

July 25, 2021 at 6:14 pm

Hello Janet, To summarize, #14 had the filling replaced followed by symptoms of intense pain and throbbing, swollen gum. If I am reading you correctly, this was followed by root canal treatment of #14. But your sharp shooting pain persisted intermittently. It is possible that there is a fourth canal that needs to be filled. It is possible that there is just a stubborn infection that is in the bone outside the tooth that needs another round of antibiotics. My go-to is Clindamycin 150 mg dispense 40 taken every six hours for 10 days. I would make sure that the tooth is out of occlusion. By that I mean the height of the tooth is reduced so that when you bite together, there is no contact with the opposing tooth. This will aid in the healing process and the tooth will gradually come back down into contact with the opposing tooth naturally. It is possible that there is a neurological component, but it is low on my list of possibilities. I wouldn’t rule it out, but it is not as common. I would look for these other clues first. I would also double-check the other teeth to make sure they aren’t showing symptoms of needing root canal treatment, either adjacent to this tooth or opposing it. Upon ruling out the other teeth as the source of the problem, and taking a round of antibiotics, a Medrol Dosepak would address nerve inflammation that could be the source of the pain. That is where the neurologist would come into play. I hope this isn’t too much information, and I hope that one of these suggestions fixes the problem. Good Luck, Dr. Silberman

December 3, 2021 at 8:34 am

Hello Chad, Cavities and gum problems are treated differently. Gum problems can develop if you don’t have your teeth cleaned by a dentist regularly, and it sounds like you don’t have that option. Your dental home care is critical to your overall health. Typically, a round of Amoxicillin 500mg taken every 8 hours for 10 days, along with an antimicrobial mouthwash like Peridex, will get the immediate problem under control. There is likely a buildup under your gums around your teeth that needs to be removed by a dentist/hygienist. Once that is done, you can maintain it with diligent home care. As for the cavities, again, you must see a dentist ASAP. For a temporary fix, you can apply clove oil to open areas of decay to quiet the problem. It can be store-bought or you can make it at home by crushing cloves and applying the paste to the open cavities. For pain, I would recommend alternating Tylenol and Motrin (Advil, Ibuprophen). Take two extra-strength Tylenol. Four hours later take two 200mg Motrin. Alternate them every four hours as needed for pain. I hope that helps. Try to get to a dentist soon. Good Luck, Dr. Silberman

December 7, 2021 at 10:03 am

Hello David, I believe you are correct. You have a tooth infection. When ice water stops the pain, you have an abscessed tooth. There are bacteria that are in the root of your tooth that have a biproduct of gas which becomes trapped. Your body heat is enough to expand the gas and cause pain. Hot drinks or compresses make it even worse. Ice water causes the gas to contract and stop the pain. The treatment will be to either extract the tooth, or save it by root canal treatment. Your dentist can open the top of the tooth and release the gas as a temporary measure until the root canal can be performed. Good Luck, Dr. Silberman

December 7, 2021 at 6:02 pm

Hello McChristian, There is a nerve that runs through the center of your lower jaw, starting from under the ear all the way to your front tooth. If #30 and #31 are infected and need root canal treatment, the pain can radiate along this nerve. Sometimes the pain can even feel like it’s coming from an upper tooth too. Stay away from heat (hot drinks, heating pads, hot compresses, direct sunlight, saunas, etc). If your teeth can tolerate ice water, hold that in your mouth to get some relief. Get your root canals done ASAP. Good luck, Dr. Silberman

December 8, 2021 at 8:59 am

Hello Chris, If you can’t see a dentist, go to an urgent care or emergency room. A round of antibiotics will quiet things down until such time that you can see the dentist. The treatment options will vary depending on the degree of infection and the amount of remaining tooth structure. Good Luck, Dr. Silberman

December 8, 2021 at 12:41 pm

Hi Connie, My experience has been that Clindamycin is the drug of choice for an abscessed tooth. But your bacteria have had a year to develop into a very resistant strain. If 150mg four times a day seems to be working, you can increase it to 300mg four times a day. The chin has the least amount of circulation in the mouth and is the most difficult for controlling infection because getting the antibiotic to the infection site takes longer. I would stay with the Clindamycin. Augmentin is also a good option if you aren’t having complete success with Clindamycin. I suggest 10 days post-operatively, so continue the Clindamycin through December 16th. Do not apply heat to your face (no heating pads, saunas, hot compresses, etc) as this will draw out the swelling. Goldenseal can’t hurt, but I’m not sure how effective it would be. It sounds like it works for you, so I would continue using it. If the problem extends past the 16th, a decision can be made based on your progress. If you are significantly better by then, that should be enough antibiotic. If you are less than 50% better, switch to Augmentin. Good Luck, I hope this helps. Dr. Silberman

December 11, 2021 at 12:50 pm

Hello Manisha, It is unusual to have a problem with a root canal tooth that was done four months ago and looks normal on an x-ray, and has bleeding. It sounds to me like your problem is the wisdom tooth. Once it is extracted, I believe the problem will be corrected. You should schedule the extraction as soon as possible. Rinse with warm salt water to control the bleeding and swelling. If your appointment isn’t for a while, a round of Amoxicillin 500mg taken three times a day should keep it quiet. Good luck, Dr. Silberman

December 12, 2021 at 9:14 pm

Hello Ar, The black area on the tooth sounds like it is decay. Your symptoms indicate the decay probably caused an infection which is what’s causing your pain. The cold water holds in your mouth will stop the pain temporarily and confirm the diagnosis. Treatment by root canal will stop the pain and correct the problem permanently. The antibiotic of choice is Clindamycin 150mg taken four times per day. It will help control the pain until you can get to a dentist for the root canal treatment. Good luck, Dr. Silberman

December 15, 2021 at 5:23 pm

Hello Jessica, Sorry to hear you are having this problem. Heat is not a good thing to apply to your face in this circumstance. Though it may feel soothing at the time, it is merely drawing out the infection towards the heat and will likely cause swelling in your cheek. That will become a lot more difficult to control with oral antibiotics. The better antibiotic is Clindamycin for tooth infection, but it is harsher on the GI system and it sounds like it might not be the drug of choice given your medical history. You could try it and see how well you handle it. If it upsets your GI system, stop taking it. You should also have the dentist check the occlusion. When you bite together, there should be no contact between the root canal tooth and the opposing tooth. The tooth height can be reduced by the dentist to allow for quicker healing, and your body will gradually push the tooth back into occlusion over several months as the healing continues. There are prescription pain medications that the dentist can offer you that are stronger than the over the counter medications. This type of pain after root canal therapy is not uncommon in patients who do not get antibiotics prior to treatment, preferably Clindamycin. One in five patients who have not been premedicated with antibiotics wind up with pain and swelling. Taking the antibiotics after the fact is playing a catch-up game with the infection. Most dentists do not prescribe antibiotics until symptoms require them. I preventatively prescribe them to avoid post-op complications. I hope this helps. Good luck.
Dr. Silberman

December 22, 2021 at 11:40 am

Hello Joletta, It’s complicated, but yes, the tooth can look fine on an x-ray and still have a problem. It sounds like you are getting good care. Having the neurologist check to see if it is a non-tooth neurologic issue was a good call. I would test all the teeth on that side for thermal sensitivity. Sometimes another tooth can be causing the pain and it’s difficult to tell where it’s coming from. If your teeth are not too sensitive to temperature changes, try holding ice water in your mouth followed by a hot drink. Alternate between the two and see if it elicits the pain. If it does, the problem is not the root canal tooth (which cannot feel temperature change). The dentist can apply a cold stimulus to each tooth individually, or an electric pulp tester to identify the problem tooth. If the cold/hot alternating test has no effect, I would assume the problem is coming from the root canal tooth. Does it hurt to chew on it? I would have you chew on something solid on each tooth individually and see if it’s this tooth. Take a Q-Tip and bite on the stick on each tooth and see if one stands out. If it is the root canal tooth and it is a lower tooth, the dentist can check your bite with articulating paper (carbon paper). There should be no balancing side interferences. If there are blue markings on the chewing surface toward the tongue side of the tooth (balancing side), the dentist can adjust them so that they are out of contact with the opposing tooth. If it is the root canal tooth and nothing shows up on your x-ray and you have done all of these tests, I would reduce the height of the tooth slightly so that it does not contact the opposing tooth at all. I would prescribe a round of antibiotics like Clindamycin 150mg four times a day for 10 days. Sometimes this works so it’s worth a try. In a few months, the tooth will move back up into contact to overcome the slight bite adjustment. I told you it was complicated. I hope this helps. Good Luck, Dr. Silberman

December 26, 2021 at 9:23 am

Hello Marie, The first thing I would do is test yourself to see if there is a communication between the sinus and the oral cavity (oroantral fistula). Pinch your nose closed and gently try to blow out your nose. If you can feel air coming into your mouth from your nose through the extraction site, the surgeon will have to repair this. So prepare yourself for one more surgery. If you cannot feel the air coming into the mouth, it is an easier fix. Your instructions should have included rinsing with warm saltwater. I would continue to do so. That should help with the tenderness. Check to see if the surgeon has an emergency contact number. They should be able to prescribe an antibiotic if they feel it is necessary by calling it into a pharmacy. Or go to an Urgent Care that has hours and have them evaluated and prescribe if they feel it appropriate. Good Luck and Merry Christmas. Dr. Silberman

December 26, 2021 at 10:48 pm

Hello Ronaline, Never apply heat to your face when you have a tooth that is causing pain. If there is infection present, the heat draws the infection to the surface and dramatically increases the swelling. It makes it much more difficult to get the infection under control. You will need an antibiotic to get the swelling down. Clindamycin 150mg every six hours is the one I recommend if you are not allergic to it. If the swelling is large, you may need an intravenous antibiotic and possibly a surgical procedure to reduce the swelling. Hopefully taking the Clindamycin every six hours will quiet the problem. One or both of the teeth will need root canal treatment to save them. Contact your dentist and explain what is happening. Alternate Tylenol and Motrin every 4 hours for pain. Take two extra-strength Tylenol, and four hours later take three 200mg Motrin (Ibuprofen, Advil). Switch every four hours. And do not apply heat to your face again. If the swelling continues to increase, go to a hospital emergency room to avoid a cavernous sinus thrombosis. Google it. Good luck. Dr. Silberman

January 1, 2022 at 7:39 am

Hello Rahul, You have presented enough clues to solve the mystery. You have an infected tooth. It hasn’t advanced enough to show up on an x-ray according to your dentist. Due to your grinding habit, a tooth has cracked allowing bacteria that are normally in the mouth to creep into the tooth. The inner workings of the tooth are normally sealed and protected from these bacteria. Once they have access to this area of your tooth, they are now in a warm and moist and dark environment . . . . perfect for growth. The bacteria take over and kill off the nerve and circulation that is inside. They give off a by-product of gas which is now trapped inside. Applying cold water will stop the pain because the gas contracts as you lower the temperature, taking the pressure off any nerve endings that remain in the tooth, or those in the jawbone. Do not drink or eat anything hot as the heat will have the opposite effect and expand the gas, causing pain. Do not apply heat to your face as this will draw the infection towards the heat source causing swelling and more pain. Use ice water to keep it quiet. There are two ways to identify which tooth is causing the problem. The dentist should have an Electric Pulp Tester. It is applied to each tooth individually to measure the amount of life in each tooth via very low voltage from a battery. It feels like a tingling sensation. The bad tooth will either not register, or will score a higher number than the other teeth. The other way to identify the tooth is with ice. When the tooth is hurting (you can make it hurt with warm water if you need to hold some in your mouth), apply a small piece of ice to each tooth individually for 30 seconds. Do not touch the other teeth. The bad tooth will stop hurting. The other teeth will be unaffected. The bad tooth can be saved by root canal treatment followed by a post and core, and crown. The post and core will strengthen the tooth and the crown will hold the tooth together to prevent further cracking. It is possible that the crack is too advanced to save the tooth. It may need to be extracted. The dentist should be able to advise you on this. Good luck and I hope that helps. Happy New Year, Dr. Silberman

March 23, 2022 at 12:28 pm

Hello Melinda, I’m glad that my advice helped. The heat that you applied to your face may cause some delayed swelling in the area of the abscessed tooth. If that happens, you will need a prescription for antibiotics ASAP. You should definitely get to a dentist and have this looked at and treated appropriately. Also, it’s not uncommon for pain to worsen at night. When we are relaxing and trying to sleep, our mind is drawn to the area of pain and without other things going on to distract us, the pain feels more intense. Now, go see a dentist. Good Luck, Dr. Silberman

March 24, 2022 at 3:11 pm

Hello Sylvia, Now you know what happens when you apply heat to an infected tooth. It draws the infection out into the face next to the tooth and causes severe swelling. Stop using heat. Apply cold compresses off and on every 15 minutes. You need to be put on antibiotics. If the swelling is advanced and is causing you any difficulty breathing, you need to go to an emergency room for intravenous antibiotics. If you are breathing OK, you should go to the dentist as soon as possible, or an urgent care, where oral antibiotics can be prescribed. The best oral antibiotic for tooth infection is Clindamycin 150mg taken four times a day for 10 days. Once the infection is controlled, you will need to address the tooth problem. Good Luck, Dr. Silberman

March 27, 2022 at 6:41 pm

Hi Kimberly, A dentist will x-ray your broken teeth and decide what would be the best way of removing them. It isn’t difficult for a dentist to numb the are where the teeth are and removing them painlessly. The sooner you do so, the better. Tooth infection can be hazardous to your overall health. Good Luck to you, Dr. Silberman

March 27, 2022 at 6:47 pm

Hello Zaheer, It is common for tooth pain to be more pronounced at night when the body is not being distracted by other activity. If there is no decay present there could be other underlying dental related problems: a cracked tooth, or a wisdom tooth that is partially erupted, or a chronic gum problem. It is also possible that a sinus infection can feel like a toothache. You should see a dentist for x-rays and evaluation to see what’s causing the problem. Good Luck, Dr. Silberman

March 31, 2022 at 1:14 pm

Hello Don, It sounds like this tooth is going to need root canal therapy. The type of pain you are describing is consistent with tooth nerve pain that is infected and needs treatment. The key to controlling the pain is by controlling the infection. An antibiotic will quiet the pain as much or more than pain medication. My “go to” for an infected tooth is Clindamycin 150mg taken every six hours. Alternate the Tylenol and Motrin every four hours to take the edge off. Remember not to apply heat to your face. If the tooth is not sensitive to cold, you could get instant relief by holding ice water in your mouth. Good luck, Dr. Silberman

March 31, 2022 at 9:03 pm

Hello Nicole, Not much information to go on here. For swelling associated with an abscessed tooth: Do not apply heat to your face. See a dentist for a proper diagnosis. It is likely that you need to be taking antibiotics to help reduce the swelling. If a dentist isn’t readily available, go to an urgent care or emergency room for appropriate antibiotic therapy. Good luck, Dr. Silberman

April 2, 2022 at 10:39 am

Hello Kala, It is possible that a toothache can cause gums to ache, but it’s also possible that you have both a tooth problem as well as a gum problem. There are different home treatments that you can do to get some relief. If you can see on open cavity in a tooth, you can grind up some cloves and place it in the cavity. There are products you can buy at the pharmacy that has clove, or clove oil, that are already made. If the tooth is not sensitive to cold, hold ice water in your mouth to help with the pain. For gum pain, there are over the counter gels that have numbing agents in them. If your teeth are not sensitive to heat, swish with warm salt water to make the gums feel better. If doing so causes tooth pain, follow with ice water to cool down the teeth and take away the pain. DO NOT APPLY HEAT TO YOUR FACE. The heat application to the skin can draw infection towards it and cause swelling. Try to get to the dentist sooner. If necessary, go to an Urgent Care where they can prescribe antibiotics if indicated. Good Luck,
Dr. Silberman

April 3, 2022 at 8:16 pm

Hello Harley, Sorry to hear you are dealing with this tooth pain. It sounds like the treatment proposed in February was a root canal treatment. That would have dealt with the infection, and now it has strengthened. Amoxicillin is the standard of care but it is usually prescribed three times per day, not twice. There is also an extended release that is administered once per day. I don’t think you are getting enough antibiotic in your system. Though it is considered standard, I prefer Clindamycin over Amoxicillin. You should consult with your dentist. I have had much better results with it. It is important to remember not to apply heat to your face because that will increase the swelling. If your teeth are not sensitive to cold, holding ice water in your mouth around that tooth could give you instant relief. It just depends on the state of the infection. It works on advanced cases extremely well. You can supplement Motrin for pain relief in addition to the hydrocodone. It has an anti-inflammatory approach that can help with the pain. Once you have the infection under control, the pain will subside. Good Luck, I hope this helps. Dr. Silberman

April 8, 2022 at 7:30 pm

Hello Levi, The reason the ice water is controlling the pain, even for a short period of time, is that you have an infected tooth. The infection has a by-product of gas that is trapped inside the tooth. Your body heat causes the gas to expand and put pressure on the nerve endings resulting in intense pain. The ice water causes the gas to contract and take the pressure off of the nerve, and the pain stops. The treatment is to see a dentist who can either extract the tooth, or numb it and open it to let out the gas. The tooth will need root canal therapy to fill the spaces in the roots where the gas has been trapped so that there is no void for bacteria to regrow. Unfortunately, you’ll have to keep the ice water handy until you can get to the dentist. An urgent care could prescribe and antibiotic like Clindamycin which would reduce the infection and possibly help with the pain. Do not apply heat to your face and do not eat or drink hot foods. I hope this helps. Good Luck, Dr. Silberman

April 10, 2022 at 11:13 pm

Hello Johnnie, I would increase the dosage of Clindamycin from 150mg every six hours to 300mg every six hours. Your dosage and schedule for Tylenol / Ibuprofen is correct, so I wouldn’t change that. Cold compresses to the face will help lower the overall temperature and help stop the pain. Do not apply heat to your face. I have no further advise for you. I have been treating cases like this for a long time so my next thoughts are for your dentist. The key to getting complete anesthesia is twofold. Articaine is a better anesthetic than Lidocaine. I would then suppliment the Articaine with Carbocaine. The combination works better than with either Articaine or Lidocaine alone. Also, when necessary, a few drops of Articaine can be placed inside the tooth, and that will numb it completely. Also, it is critical to complete the root canal filling at the next visit. The half empty roots provide a perfect breeding ground for bacteria making it even more difficult to get the infection under control. I hope this helps. Good luck, and keep the ice water nearby for a while longer. Dr. Silberman

April 12, 2022 at 7:42 pm

Hello Justin, So sorry to hear you are going through this. Did you apply heat to your face? That could be the source of moderate to severe swelling. If you have not applied heat, it would be an indication of a strong infection. The Clindamycin 300mg is the correct antibiotic for this condition. At 36 hours, you might not be feeling improvement. By 72 hours you should be feeling improvement. Hold ice water in your mouth around the lower left area where you have the swelling. This should give you some relief. You could also apply cold compresses which would help relieve the pain. It should not be difficult for the endodontist to diagnose which tooth is the culprit. Good luck. Dr. Silberman

April 17, 2022 at 10:02 pm

Hello Felicia, Do you have a question for me? Dr. Silberman

April 18, 2022 at 10:27 pm

Hello Elaine, It sounds to me like the lower right tooth that was refilled has an infection and will need root canal therapy. It is not uncommon for a lower tooth to cause pain in the tooth above it. The brain gets confused. The upper and lower teeth get their feeling from different nerves. If you went to the dentist with upper jaw pain and the dentist thought the pain was from a lower tooth, a sure test would be to numb the lower jaw and see if the upper pain stops. In your case, when the upper pain starts, immediately put ice water on the lower tooth and see if the upper pain stops. That would validate the diagnosis that it is indeed the lower tooth. The dentist can’t always make a diagnosis from an x-ray. Early infection cannot be seen on an x-ray. The dentist can perform other tests to confirm the diagnosis. Cold test, heat test using a polishing cup, percussion test and vitality tests are all tools the dentist can use to make the diagnosis. This is probably more information than you need but it is what I would tell my students in the department of Oral Diagnosis at the University of Maryland when I taught there. I hope this helps. Good luck to you, Dr. Silberman

April 29, 2022 at 11:54 pm

Hello Martin, Your tooth could be either inflamed or infected. Use a desensitizing toothpaste. Make sure it has no tartar control and no whitening. Those agents are irritants and will prolong the inflammation. If the tooth is infected instead of inflamed, it will gradually get worse. By waiting a month, time will decide for you whether it is inflamed or infected. Inflammation will heal. Infection will require root canal therapy. Good Luck,
Dr. Silberman

May 3, 2022 at 11:17 am

Hello Jigyasa, Sorry to hear you are having a severe toothache. Do you have a specific question for me? Good Luck, Dr. Silberman

May 5, 2022 at 8:08 pm

Hello Janice, There are many possibilities for having jaw pain coming from an area where there was once a tooth.
1) The most common cause is that the pain is coming from the tooth in the opposing jaw (directly above or below it). Check to see if you have a cavity in the opposing tooth.
2) If it is an upper “non-tooth” pain, it could be sinus related. If you have had a head cold in the last 4 weeks, it may have developed into a sinus infection. Antibiotics, decongestants, and antihistimines will treat this condition.
3) If the pain is in the left lower jaw and there are no teeth there, it could be referred pain from a heart condition. If the pain is worse upon exertion, you should get that checked with a cardiologist.
4) The pain could be caused by nerve inflammation. A neurologist could treat this condition.
5) It is possible that a fragment of tooth or bone from a prior extraction is working its way to the gum surface. It is comparable to teething for a baby . . . . super irritating.
I hope this helps. I would be interested to know what happens. Please write back and let me know when you get a proper diagnosis from a dentist. Good Luck, Dr. Silberman

May 21, 2022 at 5:25 pm

Hello Valerie, You sound quite well versed so kudos for that. If a tooth that has had a root canal is quiet and then flairs up, and then goes quiet again after a bite adjustment, I too suspect a cracked root. Bacteria grow in the crack and can force up the tooth to be a bit taller than the other teeth. The bite adjustment prevents the chewing pounding that brings on the pain. A crack is sometimes not visible on an x-ray. But over time, bone changes often take place next to the crack, so even if the crack itself isn’t visible, the bone change is. Clenching exacerbates the pain, but it is not the cause of it. The taller tooth pushed up by the infection is the cause. My guess is that this tooth will need to be extracted. It can likely be replaced with an implant. Or if there is a tooth on either side of it, a fixed bridge can be placed. Both options can treat the problem with something that stays in the mouth permanently, rather than something that can be taken in and out. As for the pain, to tide you over until your Monday appointment, you can take Advil (3x200mg)every 8 hours, and Tylenol (2x500mg) every 8 hours. Alternate them every four hours. Good luck, Dr. Silberman

May 25, 2022 at 12:49 pm

Hello Lisa, You asked how long to wait before contacting the dentist. Don’t wait. Call now. It sounds to me like you have a tooth infection. It is not uncommon to be without symptoms until the filling is placed. The bacteria in the decay that have made their way into the circulation of the tooth are stirred up like bees in a hive. You will probably need root canal treatment to save the tooth. I expect the dentist will adjust the height of the tooth so that when you bite you won’t be hitting it, and prescribe an antibiotic like Clindamycin to quiet the tooth. Or if he has time on his schedule, he could do the root canal today. Good luck, Dr. Silberman

May 30, 2022 at 11:25 am

Hello Aleksandra, I find that the cillins (i.e. Amoxicillin) do not do as good a job of attacking the infection as Clindamycin. I recommend 150mg taken four times a day to quiet the infection and reduce the pain dramatically. Meanwhile, ice water is your friend. Remember to avoid heat. No direct sunlight or hot compresses on your face, and stay away from hot foods. A root canal will stop the pain too, so the sooner the better. Good luck, Dr. Silberman

May 30, 2022 at 11:21 am

Hello Joanne, There are two possibilities that stand out as the cause of your problem. One is that your bite is off. The dentist should have you bite on carbon paper to leave marks on your teeth to determine if you are striking certain spots too firmly. It would take a minor adjustment by the dentist to fix this problem and remove the marks and the high spots. It is also possible that you are using a whitening toothpaste. Any time you have dental work done where veneers or fillings are bonded to your teeth, they can be sensitive to temperature change. But whitening toothpaste prolongs the problem. Switch to a desensitizing toothpaste with no whitening agent. The problem should pass in four to six weeks, but not overnight. Be patient. Good Luck, Dr. Silberman

May 30, 2022 at 6:15 pm

Hello Samantha, OMG this sounds awful. So sorry to hear you are dealing with this. Amoxicillin is not my first choice for tooth infection with swelling, but it’s better than nothing. It should be taken 500mg every 8 hours. If you have access to Clindamycin 150mg, I would prescribe one every six hours for 10 days instead of the Amoxicillin. But if all you can get is the Amoxicillin, stay with it. Once the antibiotic kicks in, you will feel better. It’s best not to have the root canal until the infection quiets down, but two months is a looooong time to wait. For pain, alternate Tylenol (2x500mg) with Ibuprofen (3x200mg) every 4 hours. Do not take them together. If you have been taking Ibuprofen, take the Tylenol four hours later. Then alternate the two of them until the pain stops. Do not overdose on either of them. 8 hours between Ibuprofens and 8 hours between Tylenols. Avoid applying heat to your face which makes the swelling much much worse. Don’t eat hot foods and stay out of direct sunlight. I’m guessing dentistry isn’t always this difficult in the UK? Good luck to you. Dr. Silberman

May 31, 2022 at 5:50 pm

Hello Stephen, If you applied heat to your face, it drew the infection to the surface which caused the swelling. Stop applying heat and the antibiotics should quiet the situation. My “go to” antibiotic is Clindamycin in situations like this instead of Amoxicillin. The secondary antibiotic would be for a different type of bacteria and is usually something like Flagyl. If you have not applied heat to your face, that is a more serious problem. You should go to the ER and they may have to put you on an IV antibiotic. Be proactive and get attention as soon as you can. Good luck, Dr. Silberman

June 6, 2022 at 1:55 pm

Hi Danny, The Colgate Painout will be a temporary fix. It controls the pain for a while, but the underlying problem is a cavity. You need to see a dentist to have the tooth decay cleaned out and the tooth filled. Do not postpone treatment because the next step will be root canal therapy to save the tooth. It’s not uncomfortable, but it is expensive to have that done. Good luck, Dr. Silberman

June 9, 2022 at 4:04 pm

Hello J.R., When a tooth is extremely sensitive to cold causing a lingering pain, it is in the early stages of infection. In that situation, you naturally want to avoid ice water or anything even moderately cold. Even inhaling cold air through your mouth can set it off. The nerve of the tooth is being irritated by the bacteria present. As the infection progresses, the nerve dies and the sensitivity to cold passes. The bacteria take over the space inside the tooth (the canal of the root) and they have a biproduct of gas that can build up. Once that happens, anything hot will cause the gas to expand and cause pain. That is when ice water application helps and you need to avoid applying heat to your face. At your present stage of the infection, the best treatment is an antibiotic like Clindamycin 150mg taken four times a day, along with alternating doses every four hours of Tylenol and Ibuprofen. Take two extra strength Tylenol and, in four hours take three 200mg Ibuprofen (Motrin, Advil). Alternate these two medications every four hours. Between the antibiotic and the pain medication, it should help quiet the tooth. It needs to be treated with root canal therapy to save it, or have it extracted. Good luck, Dr. Silberman

June 12, 2022 at 10:24 am

Hello Fiona, If the problem is the wisdom teeth erupting, it is like a baby teething. You can apply a numbing gel to help stop the pain. Also, the tissue over the wisdom tooth often swells preventing you from biting all the way down. Take warm salt water and hold it over the area of the swollen tissue. This will help to draw out some of the fluid in the tissue and reduce the swelling and the pressure that is causing the pain. It may also me necessary to take some antibiotics like Amoxicillin to help relieve the discomfort. The idea is to use these suggestions until such time that the wisdom teeth can be extracted. Good luck, Dr. Silberman

June 17, 2022 at 12:17 pm

Hello Songezile, You haven’t provided me with much information. I would encourage you to see a dentist to get a proper diagnosis. When you say you have inflammation in other teeth and a headache, it is possible that your problem is gum related. Let a professional tell you what the source of the problem is and how to fix it. Good luck, Dr. Silberman

June 26, 2022 at 6:45 pm

Hello Ashley, When the dentist saw you and took an x-ray, did he run any other tests? An x-ray is one tool that we use but sometimes, it doesn’t provide the information we need to make a diagnosis. We also tap gently on the teeth to see if one feels “different”. It doesn’t have to hurt . . . . just different. We tap from the top of the tooth and then the face of the tooth to see if there is any difference. We also can test with a cold stimulus. We compare all the teeth in the area where there is pain. If one tooth responds differently to the cold, that helps us make a diagnosis. We also press the gum area above the tooth to see if one spot is different. We also have an Electric Pulp Tester. It is a small battery operated instrument that measures how much life is in a tooth. Again, the one that registers differently is often the culprit. Any two of these tests that narrow it down to a specific tooth enables us to make a diagnosis. If your dentist only took an x-ray, it is almost impossible to identify the tooth. These tests can still be done and I’m sure the correct tooth will stand out in a crowd. You could do your own cold and tapping test to identify the tooth. Now you have swelling. Icing the area is the correct thing to do to help minimize the swelling. Also, holding ice water in your mouth around the tooth will stop the pain, but it’s a short term fix. It will help until the antibiotic kicks in. If the antibiotic is Amoxicillin, it will take longer to work than if it is Clindmycin. The only thing an emergency room would be able to do is prescribe Clindamycin over Amoxicillin. If you are already taking Clindamycin, you can increase the dose from 150mg 4 times a day to 300mg four times a day. I hope that helps. You will either need to have the tooth extracted, or have root canal treatment to save it. Good luck, Dr. Silberman

June 27, 2022 at 4:01 pm

Hello Joe, Stop applying heat and switch to cold compresses. The heat might make it feel better temporarily, but it dramatically increases the speed at which the infection can spread causing major swelling. Hopefully, the swelling hasn’t started yet and you can get to a dentist ASAP to help diagnose the problem and fix it. Good Luck, Dr. Silberman

July 13, 2022 at 12:43 pm

Hello Jose, It sounds like you have had terrible dental experiences. So sorry to hear this. Most times, when there is intense pain, it is tooth related and a root canal solves the problem. It sounds like they have diagnosed the first molar as the source of the problem. If they do the root canal and the pain persists, it is possible to have inflammation of the nerves going to that area of the face. You may want to see a neurologist for an evaluation. I hope this root canal treatment solves the problem. Good luck, Dr. Silberman

July 14, 2022 at 10:07 am

Hello Jessa, It sounds like you have a tooth that has an infection. You need to see a dentist ASAP. Meanwhile, if the tooth isn’t sensitive to cold water, hold some ice water in your mouth around that tooth. It could stop the pain instantly. Of course if you are sensitive to cold water, it won’t work. Try it and see how it goes. But get to a dentist as soon as possible to get the proper diagnosis and treatment. Good Luck, Dr. Silberman

July 18, 2022 at 8:02 am

Hello Angela, The upper right and upper left teeth get feeling from different nerve sources. The pain you are having from chocolate on the left side is unrelated to the root canals done on the right side. When a tooth is sensitive to chocolate, there is some exposed area that needs to be sealed. Sometimes a filling is necessary, but the dentist might be able to apply some desensitizing liquid to fix the problem. Good luck, Dr. Silberman

July 18, 2022 at 8:33 am

Hello Shania, With the limited information you have given, I would recommend seeing a dentist as soon as possible. If you have an open cavity, you can crush up some cloves and place it in the hole in your tooth. Or you can go to a pharmacy and by some clove oil. That might help take away some of the pain if it is a cavity. It is difficult to know how to advise you. I can’t tell if the source of your pain is tooth or gum or something else. Good luck, Dr. Silberman

August 13, 2022 at 12:36 am

Hello Joseph, The tooth needs a root canal treatment. The ice water helping the tooth also helps me diagnose the problem. There is an infection in the tooth. The bacteria trapped inside are giving off a byproduct of gas that cannot escape. The gas builds up pressure and causes pain. The ice water reduces the temperature which prevents the gas from expanding, and the pain stops. When you remove the ice water, your body heat is enough to warm the tooth back up and cause the pain. A root canal treatment opens the chewing surface of the tooth allowing the gas to escape. The canals of the root are then filled to prevent the bacteria from growing in that space again. See your dentist and have the root canal done or the tooth extracted. Good luck, Dr. Silberman

August 16, 2022 at 10:33 pm

Hello John, “What is good for sudden tooth pain?” The answer is, “It depends”. If this is the first time you are having pain and you can see there is a cavity, you can buy clove oil or tooth ache drops from a pharmacy and place it in the hole. If the cavity has been there a long time, it is possible that ice water held in the mouth might make it feel better. If the problem is a gum issue and not pain from a tooth, warm salt water holds on that gum area could help. Your best bet is to see a dentist as soon as possible to have the correct diagnosis and treatment. Good Luck, Dr. Silberman

August 17, 2022 at 9:47 pm