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Suggest Treatment For Severe Lower Right Wisdom Toothache

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Posted on Fri, 17 Jun 2016
Question: Hello,

December, 2015 I experienced severe lower right wisdom toothache as it was still erupting. As a result of this I went to a dentist (Dentist A) who advised that I take pain killers while allowing the tooth to come in fully. During that same visit with Dentist A I did a cleaning and after about two days I noticed a red swollen area (resembling a pimple) close to the lower right wisdom tooth.
I went to another dentist (Dentist B) to check it out and was told that the swollen area was an abscess and the only solution to get rid of it was to extract the lower right wisdom tooth so I was given an antibiotic (Clindamycin) for 5 days. At my follow up visit Dentist B examined the area and the abscess was still oozing pus and blood so I requested that the wisdom tooth be x-rayed to be certain that it had to be removed (if I really don’t need to remove it I would rather not). The x-ray was done and Dentist B insisted that I extract the tooth. I wanted a second opinion so I drank onion and garlic tea for some time and noticed that the swelling reduced drastically then I went to another dentist (Dentist C) for another assessment of the tooth.
Dentist C x-rayed the lower right wisdom tooth and I was told that to prevent the abscess from recurring I needed to remove the upper right wisdom tooth as it wasn’t allowing space for the lower right wisdom tooth to erupt without injuring the gum. Dentist C also told me that the lower right wisdom tooth is bent at the root and would be difficult to extract so if I really don’t have to extract it I shouldn’t. I didn’t extract the upper right wisdom tooth and decided to continue with my home remedies after which the abscess was gone completely in a few days.
However, on April 5, 2016 the abscess recurred at the same area and it oozed pus and blood and I noticed that the lower right wisdom tooth was bigger and more defined than the last time when it started to erupt. I wasn’t experiencing any pain in the area. I went to a different dentist (Dentist D) on April 18, 2016. Dentist D x-rayed the lower right wisdom tooth and said that the abscess was on the surface (gingival abscess) and advised that I remove the upper right wisdom tooth to allow space for the lower wisdom tooth to fully erupt. I was given an antibiotic (Metronidazole 400mg) for 5 days. At the follow up visit Dentist D said that the size of the abscess was reduced so a dental tool was used to grind the upper right wisdom tooth to allow space for the lower wisdom tooth to come in and my antibiotic prescription was extended by 2 days. At the next visit to Dentist D, anaesthetics was injected in the gum around the lower right wisdom tooth and scaling was done. Dentist D trimmed the gum to basically cut away the abscess and advised me to use warm salt water to rinse. I went back to Dentist D after a week and there was a little red swelling at the side of the wisdom tooth (same area where the abscess was before) and it oozed blood and pus. Dentist D then suggested that I extract the lower right wisdom tooth, however, I expressed my concern about extracting the tooth now as I will be traveling outside the country in 3 days and will be away for about 2 months. Dentist D then advised that I continue using the warm saltwater to rinse until I return to have the extraction done. At this point I am not sure what to do and would appreciate your responses to the following questions:
1.     Barring all other evaluations, based on the information and pictures provided, what would be your diagnosis and intervention plan?
2.     Since I am not so comfortable doing the extraction before traveling, would it be ok to wait until I get back?
3.     Is it safe (health-wise) to leave it as is for that length of time (2 months)?
4. A few days after taking the antibiotics prescribed by Dentist D my throat was paining like a sore throat. I saw tiny pockets at the back of my throat but not sure if it is normal or not. I uploaded a picture of the back of my throat, can you please tell me if this is normal?

Thanks in advance for your advice.
doctor
Answered by Dr. Mahesh Kumar T S (1 hour later)
Brief Answer:
recurrent pericoronitis, pericoronal abscess, medication, extraction

Detailed Answer:
Thanks for your query. I have gone through your query and images.
As per the images and the history, you are suffering from repeated pericoronitis or pericoronal abscess associated with a partially erupted tooth.
If i am your treating doctor, i would have advised prophylactic extraction of the lower and upper wisdom tooth since there is no space for the wisdom tooth to erupt.
Following are the answers for your questions.
1. My diagnosis for your problem is pericoronitis or pericoronal abscess associated with a partially erupted tooth. I advise prophylactic removal of both the wisdom teeth to prevent future complications.
2. Since you are telling, you are not comfortable, you can postpone the tooth removal procedure. But the infection can recur.
3. It is not safe to leave it for 2 months, we cannot predict the recurrence of the infection. So you need to manage it with a course of antibiotics like systemic doxycyline (if you are not allergic) and topical metronidazole. You can take the antibiotics for a 5 day course. Do warm saline gargling.
4. The soreness of the throat is common following antibiotic administration. Nothing to worry. Do saline gargling.
I hope i have answered your query. If you have any queries reply me back. Take care.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Mahesh Kumar T S (2 hours later)
Thank you for your response.

If I am unable to get the prescription for the systemic doxycyline medication will taking metronidazole 400mg (Flagyl) tablets be just as effective as what you prescribed?
doctor
Answered by Dr. Mahesh Kumar T S (1 hour later)
Brief Answer:
Metronidazole as effective as doxycycline

Detailed Answer:
Thanks for your reply..
You can take metronidazole as an alternative drug for doxycycline. Metronidazole is as effective as doxycycline. Do saline gargling along with these drugs.
I hope I have answered your query. Take care.
Above answer was peer-reviewed by : Dr. Prasad
doctor
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Follow up: Dr. Mahesh Kumar T S (14 hours later)
Thank you very much for your assistance. Take care.
doctor
Answered by Dr. Mahesh Kumar T S (12 hours later)
Brief Answer:
Take care

Detailed Answer:
take care..
Note: Find out which dental treatment will work best for your teeth. Ask here.

Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Mahesh Kumar T S

Dentist, Oral and Maxillofacial Surgery

Practicing since :2007

Answered : 3377 Questions

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Suggest Treatment For Severe Lower Right Wisdom Toothache

Brief Answer: recurrent pericoronitis, pericoronal abscess, medication, extraction Detailed Answer: Thanks for your query. I have gone through your query and images. As per the images and the history, you are suffering from repeated pericoronitis or pericoronal abscess associated with a partially erupted tooth. If i am your treating doctor, i would have advised prophylactic extraction of the lower and upper wisdom tooth since there is no space for the wisdom tooth to erupt. Following are the answers for your questions. 1. My diagnosis for your problem is pericoronitis or pericoronal abscess associated with a partially erupted tooth. I advise prophylactic removal of both the wisdom teeth to prevent future complications. 2. Since you are telling, you are not comfortable, you can postpone the tooth removal procedure. But the infection can recur. 3. It is not safe to leave it for 2 months, we cannot predict the recurrence of the infection. So you need to manage it with a course of antibiotics like systemic doxycyline (if you are not allergic) and topical metronidazole. You can take the antibiotics for a 5 day course. Do warm saline gargling. 4. The soreness of the throat is common following antibiotic administration. Nothing to worry. Do saline gargling. I hope i have answered your query. If you have any queries reply me back. Take care.