An Eleven Year Tooth Abscess?
Posted by WhiteCoat on December 26, 2007
A 28 year old patient comes in at 1AM for a toothache. Well, it really isn’t a single tooth - all his teeth hurt. Upper gums and lower gums. Everything is sore. And he can’t sleep at all. He was seen in the ED a couple of weeks ago for a “tooth abscess” and was given a prescription for antibiotics and Vicodin. Unfortunately he was now out of both.
“OK, so how long has this been going on for?”
“Since I was seventeen.”
“Wait a minute. You’ve been having toothaches for 11 years?”
“Yeah. I take antibiotics and the abscess goes away, but it comes right back when I stop taking the antibiotics.”
A quick look inside his mouth reveals multiple black tooth remnants and a moderate case of smoker’s breath, but no abscess.
“All the other ER doctors tell me I have an abscess and send me home on antibiotics and pain medications.”
“You’ve just got really bad teeth. You’re going to need to see a dentist to get these teeth pulled.”
“I tried, but no dentists will see me because I don’t have insurance.”
“In eleven years?”
“Yeah.”
I considered giving him a simple lesson in economics about how saving a dollar a day for the next year would probably give him enough money to have his teeth pulled next year, but neither one of us was in the mood. I shot up his gums with Marcaine (longer acting anesthetic) so he could sleep and sent him home on Motrin.
Am I now a bad person?
December 26, 2007 at 9:55 am
Why you evil person! How dare you expect that this man should be ultimately responsible for himself!
Gross. Has this guy ever seen that new invention, the toothbrush?
December 26, 2007 at 10:12 am
In all fairness to bad-teeth people out there, there are some very valid reasons for terrible teeth other than poor hygiene or meth use.
My youngest daughter, age 8, has had 2 root canals this year on her primary molars. She has a condition called enamel hypoplasia. She will also need more crowns on her baby teeth to hopefully protect her adult teeth now forming (iffy, at best due to the enamel, but we’ve got to try). With this condition, the enamel basically crumbles away bit by bit.
My oldest daughter has perfect chompers, not one filling.
Go figure.
As far as the abscess goes, I think this guy might be telling you the truth. An endodontist (or a general dentist) is not going to do any work while there is an active infection, antibiotics on board or not. So, he’d have to time everything perfectly in terms of antibiotics, consultations and treatment dates.
FWIW, our endodontist charged 980.00 for the ONE root canal and that does not include the crown. She has to return to her pediatric dentist for the crown portion which will be another 500.00 or so.
December 26, 2007 at 12:29 pm
When I was eighteen I was working as a printing press operator and the guy next to me used to smoke 3 packs of reds a day and drank three or four 1 liters of Mountain Dew. One day he had a tooth ache, and reached in pulling out a fragment of rotten tooth. I was appalled and I told him he needed to go to the dentist. He informed me that he didn’t need any dentist and boasted that he hadn’t been in seven years. I resigned within the month. Sadly he wasn’t the only one at the company that shared his hygiene skills.
December 26, 2007 at 3:33 pm
At least he doesn’t think he’s got a tooth abcess anymore.
December 26, 2007 at 8:59 pm
well you can’t blame someone for not having insurance…
December 26, 2007 at 9:40 pm
Nope, you are not a bad person. Sometimes, people just have to take responsibility for themselves. The fact that this one didn’t is no reflection on you.
December 27, 2007 at 2:33 pm
No not a bad person. Obviously he has dental issues but if he is getting used to the pain meds then how will he have incentive to go get the help he needs?
Unfortunately dental work is very expensive and if you are fortunate enough to have dental insurance it still doesn’t cover as well as health insurance although there are varying degrees.
Our ED has recommended such pts go to the dentistry teaching clinics although a lot of those pts don’t have transportation either.
It is sad too when someone doesn’t have money for cosmetic dentistry and have to go around sporting an obvious missing tooth.
BTW…would he just come back every 2 weeks for more meds? Your ED popularity stats would skyrocket!
December 27, 2007 at 11:31 pm
No, you are not a bad guy. I understand your frustration though. I also understand this guy’s ‘minimalist’ approach to his own care. He does not know better. I was there once.
I was cursed with bad teeth. It is in the genes. When I was a young adult without insurance I lost two molars to the “just pull ‘em, I have no money.” Less than $50 each visit. A bit older and liking my beef steak, I went to a dental teaching school and let the undergrads work on me. Pricey for me at the time but I saved a few.
Going to a dental school to help provide education to students at a reduced cost is something I had not even considered. I’m going to look up the dentistry schools in the area and add those to the list of referrals we give out. Thanks for the idea!
December 28, 2007 at 5:00 am
I had a similar problem in that my teeth went bad from the inside out. I had to replace the uppers before I was 25. Unfortunately, in my state if you have Medicaid (in my case coupled with Medicare) a dentist cannot bill you for work done. So most of the dentists will not take a new patient if they are on Medicaid. The nearest dentist to me who will take Medicaid is 200 miles from here. So I’m basically screwed. I know I’m not the only person around here in that situation. This is truly the downside to rural life.
December 30, 2007 at 2:47 pm
This patient is not a bad person just for having bad teeth, and berating him for not taking responsibility for himself is probably unfair.
Most people suffering from multiple decayed teeth just don’t have enough money to fix them appropriately. Dental treatments are extremely expensive.
When I was a teenager my family was very poor. When I developed several cavities I went to see a dentist. Supposedly friends of my parents recommended him. The guy proved to be a quack, a criminal. In less than three months all the fillings developed infections underneath, right into the root. The pain I had to endure was incredible. The ?=)=(/#~!! did it on purpose, just for me to return for another round of dental work and more fees. I ended up losing several pieces (with a better dentist) that should have remained sound for years.
Dentists often subject patients to needless suffering and total teeth loss just to swell their bank accounts. Shame on them.
December 30, 2007 at 7:34 pm
My youngest daughter, age 8, has had 2 root canals this year on her primary molars. She has a condition called enamel hypoplasia.
Tell me about it.
There are now some coatings the dentist can apply to newly erupted teeth that help, but she’s gonna have a long expensive road.
I’m 62 and am on my third set of crowns now, on all my teeth. The glue fails after 20 or so years, there is decay under the crown and it all has to be done over, sometimes with root canal and this time with some extractions, titanium studs and gold/ceramic teeth.
She and your bank account have my sympathy.
December 31, 2007 at 1:22 am
Funny how Medicaid will cover someone who would rather put the government on the hook for $500 because they don’t want to pay out of pocket for a drug store pregnancy test (re your next post), but there is absolutely no support for people with legitimate dental problems. I’ve seen tons of people who present with toothaches and we really can’t do much more for them than give them a scrip for pain meds and refer them to a dentist which they prob’ly can’t afford in the first place. Either that, or the dental college.
Of course, if they let it get to the point that it requires oral surgery, it suddenly becomes a (very expensive) medical problem and will be covered.
January 3, 2008 at 11:31 pm
A person I once knew thought he would have to pay US$1200 for a dental problem. Goes to Bulgaria with his wife to visit her family, another dentist there said he could do the same operation for $80 in our money. Friend has no problems to this day he told me.
January 22, 2008 at 2:31 am
Hi Whitecoat,
At the outset of winter each year I would have a gum abscess flare up under the current weaker side - could be left or right.
I had teeth pulled because of it left, right and centre. After I had four teeth pulled on the left lower side an eruption started on the right side.
During Remedial Therapy training I made a conscious decision that the lymph system was the most influential management tool for correcting muscular disorders, organ disorders, head and brain disorders.
Tight neck passages restrict neural, hormonal, spinal, vascular and lymphatic circulation.
The lymph nodes block and sinusitis, memory loss, gum disease etcetera, manifest themselves courtesy of stagnant circulatory systems.
When I first started self massge of the neck with a massage machine I bought, the gum disease started flaring up quite haphazardly. I’d dig the point into the lymph nodes under the jaw and slowly lymph movement started improving and the jaw rehabilitated to where I am today - no hot or cold sensitivities - no debilitating toothache.
The teeth have just kept breaking down where excess drilling had undermined the structure of the tooth and I’ll lose a point every six months or so. My plan in about five or ten years is to have stem cell transplants to grow some beaut little baby teeth at about 70 years of age - aint science great.
With this lymph management program I am now able to side step toothache, the toxic lymph environment at the root of the teeth where tooth decay starts.
I hope this helps someone.
Francis
July 27, 2008 at 6:58 am
I have been seeing a dentist, and two specialists for my abscess. I have been waiting two months to have the tooth pulled and in pain every night. I already had a root canal on the bad tooth and now I am going to lose it. So how the heck can really poor people pay all this money!!! I had to take it from my now non existant savings account. Total as of today 1600, plus another 300 to have it pulled!