long term tooth infection

i am a conscientious 57 year old.  a good oral surgoen has just successfully extracted one of my upper molars.  this molar was root filled 20 years ago following 18 months of sensitivity.  during those years a bit of sensitivity remained in the roof of my mouth to the touch of my tongue.  i was told this was a sort of phantom pain which could be ignored.  7 months ago the molar became so sensitive i couldn't bite on it.  the extraction followed after 2 sessions of antibiotics unsuccessfully trying to save the tooth.  so, now should i have my heart or anything else checked?


This discussion is related to Re: Tooth abscess and heart valve damage.

[skydnsr]

First of all, let me say that I agree with the comments of Yvette BG.  She gave you some good information.  Thank you, Yvette.  But I have a little bit of a different perspective on the same situation.  So take both of our responses, barnprill, and make your own decisions about what you want to do.

Personally, I have an arificial aortic valve that was congenitally bicuspid before it was replaced.  I have had tooth problems similar to barnprill's, plus I have had gum disease, and I have never gotten endocarditis.  There are other people out there who have gotten endocarditis out of the blue, with no known valve problems and no known dental problems.  

Based on my reading of the literature, absolutely any outcome is possible, in regard to dental infections and endocarditis.  You can get endocarditis or not get endocarditis from a dental infection.  You can get endocarditis or not get endocarditis in the absence of a dental infection.  Having pre-existing valve disease puts you at higher risk than people who don't have valve disease, but contracting endocarditis is not the norm, even for people with known valve disease.  In most of the cases in which it was presumed that endocarditis was of dental origin, the attribution of causation was just that -- a presumption.  Very rarely can the source of a heart valve infection be definitively proven.

In other words, the fact that you have been unfortunate enough to have a longterm dental infection does not mean that you are certain to get endocarditis.  It does not even mean that you will probably get it.  No need to panic.  Yes, you are at higher risk of getting endocarditis than someone who has never had a tooth infection -- but that is a long way from actually having endocarditis.  As long as the infection stayed localized in your jaw, you won't get endocarditis.  If you did not have any unexplained fevers, night sweats, or other symptoms of whole-body infection, the chances that you have contracted bacterial endocarditis are low -- especially if you do not already have some other sort of heart valve disease.  

People are tough, and the body tries very hard to keep local infections local.  Usually, the body succeeds at that.  It is amazing but true.  If you are worried enough to take further steps, there are two kinds of tests that I know of to rule out endocarditis.  One is a blood test in which a sample of your blood will be cultured for bacteria.  If someone does have bacterial endocarditis,  bacteria will circulate through the bloodstream with every heartbeat, so an absence of bacteria in the blood suggests an absence of bacterial endocarditis.  The other type of test is an echocardiogram to evaluate how well the heart valves are functioning and whether they look anatomically normal.  

Go ahead and talk to your doctor to see if he thinks you need to be tested for endocarditis, because you need to have your mind put at ease.  But it is not as easy to get endocarditis as you might think.  If it was that easy, then anybody who has chronic acne, for instance, would get endocarditis, because any localized infection would spread throughout the bloodstream.  It just doesn't usually work that way, at least not in otherwise healthy people.  

I don't mean to discount your concern or Yvette's advice, either one.  Barnprill, you should do whatever you think you need to do, medically.  I would never tell you NOT to go to the doctor.  In fact, it would be a good idea for you TO go your medical doctor about this.  But don't torment yourself with fear about it, because unless you have had symptoms that go beyond what you posted, you are, in all likelihood, fine.

As for Yvette's advice to find a better dentist, good luck with that.  I have been through this same situation with three different teeth and have changed dentists each time and have not yet found a dentist who understands this situation or can keep it from continuing to happen.  I have lost three molars, so far.  One of the dentists was my oral surgeon's dentist, and he didn't do any better than any of the others.  I'm still looking for a dentist who can keep me from losing teeth.  None of this was from my gum disease, which is mild.  It was from replacing fillings too many times over the years, rather than crowning the tooth instead of putting that last filling in.  Only after losing the first two teeth did I figure this out, with the help of my oral surgeon, and then it was too late to save the third tooth.  One of my remaining molars has already been crowned, and I plan to crown the rest when the fillings need to be replaced the next time.    

[Yvette BG]

Seven months seems like a long time to leave a problem tooth go, especially when antibiotic courses typically are 10-21 days each. Do they have you taking antibiotics now, after the extraction? (If not, did they say you don't need them?) And how does your mouth feel right now?

Did the oral surgeon or your dentist X-ray the molar area recently--like within the past 2 to 4 weeks (maybe at the time that the extraction was discussed/decided upon and the appointment was made)? If yes, did they show you the X-rays and did they mention anything about an infection being down in the bone, etc.? (This happened to me, under somewhat different circumstances than what you are describing here.)

Personally, if you've had problems with that tooth for a long time, I would suggest seeing your regular medical doctor and asking if he/she would look at your heart and make sure you haven't developed any sclerotic areas on the leaflets of your heart valves as a result of the infection or inflammation. They can determine this with an echocardiogram (ultrasound/noninvasive test.)  

Before seeing your medical doctor, I would follow up with your oral surgeon to make sure they check how that molar area is healing. And I guess I would find a new regular dentist.
It sounds like they've been fooling around for a long time with that tooth (18 months of sensitivity is a long time not to get to the bottom of the problem, not to mention years later having a long period of "phantom pain.") Have they X-rayed that tooth on a yearly basis to keep an eye on it? In my opinion, they should have been X-raying it regularly.

I know a man in his late 20s who got infectious endocarditis (infection in his heart and bloodstream) and he almost died--all from a dental problem that was not properly treated.
You need a dentist you can count on. Maybe the oral surgeon can recommend someone else....

Good luck.

---Yvette

[skydnsr]

First of all, let me say that I agree with the comments of Yvette BG.  She gave you some good information.  Thank you, Yvette.  But I have a little bit of a different perspective on the same situation.  So take both of our responses, barnprill, and make your own decisions about what you want to do.

Personally, I have an arificial aortic valve that was congenitally bicuspid before it was replaced.  I have had tooth problems similar to barnprill's, plus I have had gum disease, and I have never gotten endocarditis.  There are other people out there who have gotten endocarditis out of the blue, with no known valve problems and no known dental problems.  

Based on my reading of the literature, absolutely any outcome is possible, in regard to dental infections and endocarditis.  You can get endocarditis or not get endocarditis from a dental infection.  You can get endocarditis or not get endocarditis in the absence of a dental infection.  Having pre-existing valve disease puts you at higher risk than people who don't have valve disease, but contracting endocarditis is not the norm, even for people with known valve disease.  In most of the cases in which it was presumed that endocarditis was of dental origin, the attribution of causation was just that -- a presumption.  Very rarely can the source of a heart valve infection be definitively proven.

In other words, the fact that you have been unfortunate enough to have a longterm dental infection does not mean that you are certain to get endocarditis.  It does not even mean that you will probably get it.  No need to panic.  Yes, you are at higher risk of getting endocarditis than someone who has never had a tooth infection -- but that is a long way from actually having endocarditis.  As long as the infection stayed localized in your jaw, you won't get endocarditis.  If you did not have any unexplained fevers, night sweats, or other symptoms of whole-body infection, the chances that you have contracted bacterial endocarditis are low -- especially if you do not already have some other sort of heart valve disease.  

People are tough, and the body tries very hard to keep local infections local.  Usually, the body succeeds at that.  It is amazing but true.  If you are worried enough to take further steps, there are two kinds of tests that I know of to rule out endocarditis.  One is a blood test in which a sample of your blood will be cultured for bacteria.  If someone does have bacterial endocarditis,  bacteria will circulate through the bloodstream with every heartbeat, so an absence of bacteria in the blood suggests an absence of bacterial endocarditis.  The other type of test is an echocardiogram to evaluate how well the heart valves are functioning and whether they look anatomically normal.  

Go ahead and talk to your doctor to see if he thinks you need to be tested for endocarditis, because you need to have your mind put at ease.  But it is not as easy to get endocarditis as you might think.  If it was that easy, then anybody who has chronic acne, for instance, would get endocarditis, because any localized infection would spread throughout the bloodstream.  It just doesn't usually work that way, at least not in otherwise healthy people.  

I don't mean to discount your concern or Yvette's advice, either one.  Barnprill, you should do whatever you think you need to do, medically.  I would never tell you NOT to go to the doctor.  In fact, it would be a good idea for you TO go your medical doctor about this.  But don't torment yourself with fear about it, because unless you have had symptoms that go beyond what you posted, you are, in all likelihood, fine.

As for Yvette's advice to find a better dentist, good luck with that.  I have been through this same situation with three different teeth and have changed dentists each time and have not yet found a dentist who understands this situation or can keep it from continuing to happen.  I have lost three molars, so far.  One of the dentists was my oral surgeon's dentist, and he didn't do any better than any of the others.  I'm still looking for a dentist who can keep me from losing teeth.  None of this was from my gum disease, which is mild.  It was from replacing fillings too many times over the years, rather than crowning the tooth instead of putting that last filling in.  Only after losing the first two teeth did I figure this out, with the help of my oral surgeon, and then it was too late to save the third tooth.  One of my remaining molars has already been crowned, and I plan to crown the rest when the fillings need to be replaced the next time.    

[ed34]

I fully agree. I had to have a tooth extraction last year, and when I questioned my dentist he simply laughed. He said I have as much chance at getting heart infections from brushing. To make me feel easier, he got me to rinse a lot more.

[kenkeith]

There doesn't seem to be any risks with antibiotics and the heart in the negative sense. There has been some thought that antibiotics is benefical for heart patients. Treatment for painless inflammation from such things as lingering respiratory or urinary infections or even chronic gum disease triggers heart attacks by contributing to the formation of clots in the blood vessels (Sudy does not confirm).

"Smaller studies have suggested that antibiotics targeting such infections might reduce the risk of heart disease, and some doctors have begun to give heart patients antibiotics based on those findings". You shouldn't be concerned about any ill effects.

I

[ed34]

I can't remember the source, but did I read last year that a scientists believed he had found a bacteria that seemed to be associated with the presence of atherosclerosis?

[barnprill]

many thanks to you all especially you and yvette: your replies were just what i needed to feel set up for a chat with my oral surgeon when i see him for follow up this week.  i'll also have a chat with my gp soon.  

[skydnsr]

Sounds good.