Child with abcessed tooth (maybe some TMI, but......

Factual Questions
1

…great for zit story lovers!
My nearly nine year old has been having work on a tooth. It is the first molar I think, or thereabouts. When the dentist discovered the cavity and drilled it, he said the nerve had already gone and the root was shortening ready for it to fall out. He reckons it has a year or so to go, but does not want to just pull it out, as it is holding the teeth for spacing purposes.

So he drilled it ready for filling but the kid said it hurt and there was a bit of blood (this is taking place in Japanese so these are approximations of what was said!!) The denstist said because the tooth is now hollow, the “meat” was sticking up through the hollow and he would put “medicine” in to “kill” the “meat” for a few weeks.Ok…

A week later, the temporary filling with whatever medication there was in there fell out, on the first day of a two week trip, and I realised we had forgotten to go to get it checked out the day before we left. Oops. I thought it would hold till we got back, as on looking I could see that only part of the filling had come away.

But the night before we were due to come back, BritKid’s face starts to swell till it looked like he was sucking a big candy, and he was crying with the pain. The next morning we went to a local dentist who removed the rest of the temporary filling and inserted what looked like a mini screwdriver into the hole, releasing a torrent of bloody pus. Instant pain relief, a prescription for three days of antibiotics and an order to go to our own dentist as soon as we got back, which we did.

It has been two weeks now, and we have been going every few days to have it checked and disinfected, but he has kept it open to drain. On Friday we went again and the dentist said he thought it had improved enough to put another temporary filling on. He said if it swelled or hurt then to flick it out with a toothpick, and relieve the tension.

Well tonight, 24 hours later, it did hurt and the cheek was beginning to swell again, so I got the filling out. It took quite a bit of digging, but eventually, (and this is the TMI zitty bit) I got a purchase on the rubbery stuff and this satisfying lump of rubbery filling with a little pointy bit just like a massive blackhead, came out. And with it, GLORP! Another mouthful of blood and pus. eep.

We will of course be going back to the dentists on Monday morning, and in the meantime are brushing very carefully and rinsing with salt water.

But I wanted to ask a couple of things -

In other countries, with a baby tooth so close to being lost, would the dentist try to keep it or just yank it out?

Is there any damage going on to the tooth waiting to emerge, with all this pus around it?

I don’t know what the antibiotic was, but I think three days is a bit short, and it certainly didn’t work. How long a course would dentists in other countries prescribe?

Hoping that these questions are general enough not to be construed as asking for specific advice - the situation just got me to wondering what happens in similar situations in other countries.

2

IANA dentist, but I have a couple of opinions on this. If you play around letting dental abscesses run their course, you’re risking the infection getting to the jawbone where they can cause all sorts of havoc that can cause problems for the permanent teeth. I speak for American practices, but I believe they usually just extract the tooth if they can’t heal the abscess. Of course orthodontics are more widely used in the US as well, so it doesn’t matter if the teeth were to get a bit crooked. Also, 3 days seems short for a course of antibiotics.

Also, you have to look around at the dental state of the Japanese around you, and ask yourself whether you really trust Japanese dentists. I have heard a number of stories from fellow expats who have visited Japanese dentists, and each of their stories have contained elements of dodginess bordering on frightening.

Anyway, I’ll just remind you again that I am not a dentist and I wish your young one the best.

3

The area between the roots of the primary tooth and the crown of the adult tooth easily becomes a protected “safe harbor” for infection. The body, even with the help of antibiotics and disinfectants, cannot always eliminate the infection. The retained infection can not only damage the bone and adult tooth, it can enter the blood stream and affect the whole body.

It sounds as though the best course would be to extract the tooth ASAP and use a space maintainer as necessary to prevent crowding.

Best Wishes

rwj

4

I commend you, by the way, for being able to find a dentist on vacation. As a child I had more dental problems on vacation than I ever had when we were 15 minutes from my orthodontist.

Here I believe they’d pull it and insert a spacer. I gotta say, though, thinking of the dental state of the Japanese people I’ve met, isn’t there an expatriate dentist somewhere? Say, from America, land of sparkly teeth?

5

We live in a rural area of Japan, and there are no western dentists around. I also could simply not afford to go to one if there was.

We have to hope that most Japanese people don’t walk round with mouthfuls of rotting teeth, so there must be good dentists somewhere!

Yes, they don’t go for orthodontics as much as Americans do, but the pace is increasing. Of about 25 elementary kids that I teach English to, I’d say 8-10 of them have some kind of braces. I did go for a while to one dentist who flies an American orthodontist out every three months, and works under his supervision. He was techincally a good dentist but I got SICK of the scare stories about how he was going to have to do jaw surgery on my kid in later life if I didn’t get a brace RIGHT NOW. Got a second opinion at a German-supervised clinic in another city, who said “??? The kid is seven and has lost 4 teeth - no need to worry about ANYTHING right now!” First dentist was mighty stroppy when I told him I’d got a second opinion, so we left. (I heard him pulling the “jaw surgery” spiel on another kid and mother as we left…)

Now we go to a young man whose surgery is filled with toys, has the patience of a saint, and who does what is necessary and no more - he will refer you on if you need orthodontics or want them.

I think it was my fault that the kid got the abcess, if I had taken him to the appointment and not left it nearly three weeks then the bugs would not have got in. I feel guilty about that.

When we go tomorrow I will ask for more and longer antibiotics, and suggest that if the infection hasn’t cleared up soon, that the tooth be pulled. Let’s see what he says…