Could Antibiotics Prevent Infection from showing up on CBCT (Cone Beam) scan?

[EmBee]

Hello!

I am about to start a round of antibiotics for a possible tooth infection. The infection has not been confirmed by x-rays yet - xrays have come back clear but the symptoms persist, so I think I might have a hidden tooth infection that's not yet showing up on xrays. Tooth is very painful to chew on, and hurts a lot after I eat. I have spontaneous pain in my teeth through the day - quite painful, but not excruciating.... pain also radiates to my ear and temple. I had a slight fever/chills a few days ago, and tooth pain has woken me up from sleep two nights in a row now.

I will likely have an opportunity to get a cone beam scan done soon (at my request). It's not covered by insurance so I have to pay out of pocket. I thought this would be the best way to confirm if I do have an infection anywhere in my mouth, since the x-ray is coming up clear. My question is, say I preemptively start the antibiotics today. If I get the scan done in the next 1-4 days, will there still be any sign of infection on my tooth if there was one there to begin with? Or will the antibiotics make the abscess/infection go away temporarily and make the results from the scan useless at that point?

Is there any harm in starting the antibiotics now, in advance of the scan?

Thank you very much!!

 

[Busybee]

You may have a cracked tooth. It doesn't always show on x rays. I've had symptoms like yours in the past and no infection has been present. Either the tooth has been sensitive or had a slight crack (in my case). It's been fixed by changing a filling or adjusting the bite. Or the tooth ligament could be bruised. It's really best in such situations to try to find someone who will attempt to manage the situation by the most conservative approach first. It's worth trying antibiotics but it's not good for your body to take them unless you really need to. You also have to finish the course if you start one. If you have a real infection in the root it won't just disappear from antibiotic use. The antibiotics won't "cure" a dental infection ether. You need treatment for that.

 

[MattKW]

Xrays don't always show infection unless there has been bone loss, so you will prob waste $ getting a CBCT. If you think you have a dental problem and your dentist can't find the cause, either go for a 2nd opinion, or ask for referral to endodontist. In general, you shouldn't be taking antibiotics without clear signs of infection.

 

[EmBee]

Thank you very much BusyBee. I really appreciate it! I pray I don’t have an infection. But my body feels so weird. And this has been going on for so long. I also wear a mouth guard as they say I grind my teeth at night. I recently switched dentists and the new dentist has tried adjusting my bite. That seemed to help some but it still feels like there is something seriously wrong. Just woke up again about a half hour ago: can’t sleep, body feels feverish.

Question for you please - how did you eventually discover you had a slight crack on your tooth? Did the crack finally show up on an X-ray? Or was it discovered a different way?

Thanks again.

You may have a cracked tooth. It doesn't always show on x rays. I've had symptoms like yours in the past and no infection has been present. Either the tooth has been sensitive or had a slight crack (in my case). It's been fixed by changing a filling or adjusting the bite. Or the tooth ligament could be bruised. It's really best in such situations to try to find someone who will attempt to manage the situation by the most conservative approach first. It's worth trying antibiotics but it's not good for your body to take them unless you really need to. You also have to finish the course if you start one. If you have a real infection in the root it won't just disappear from antibiotic use. The antibiotics won't "cure" a dental infection ether. You need treatment for that.

 

[EmBee]

Thank you so much Matt. Really appreciate it! This is the second opinion I am getting from a dentist. The new dentist also can’t find anything that would be causing me all this pain. They do have a CBCT machine in their dental office though, so I thought I would call them tomorrow morning to try to schedule a scan just to confirm or rule out an infection. Oh boy, I didn’t realize the CBCT also had those limitations (I.e infection not showing up unless there is bone loss)? I thought that was just for regular xrays. I thought the CBCT would show an infection (and more), bone loss or not. Sigh.

Thank you so much once again!

Xrays don't always show infection unless there has been bone loss, so you will prob waste $ getting a CBCT. If you think you have a dental problem and your dentist can't find the cause, either go for a 2nd opinion, or ask for referral to endodontist. In general, you shouldn't be taking antibiotics without clear signs of infection.

 

[MattKW]

Cracks don't show up on Xrays either. Diagnosing a medical/dental problem is like putting a jigsaw puzzle together; sometimes you get a complete picture easily, other times you simply don't have all the pieces to make a good diagnosis. If you start treatment without a clear diagnosis, it can sometimes make things worse because any intervention will have its own adverse effects. That's like throwing in more jigsaw pieces from a totally different puzzle.
Even taking antibiotics when an infection hasn't been found can confuse the situation because if you then get some relief, you will think this confirms an infection, when really it may just be a lull in the pain for other reasons.

 

[EmBee]

Gotcha. Thanks so much. Really appreciate you taking the time to respond!

Two questions for you please -

1. Tooth pain waking a patient up at night - have you encountered cases you can remember this happening in the absence of an infection, but instead has been due to something else - E.g a crack? Clenching/grinding? Other examples very welcome please.


2. Is the clarity/usefulness of a CBCT scan result highly dependent on the skills of the operator, or is it a pretty straightforward process that should garner similar results regardless of who takes the scan?

Thank you!

Cracks don't show up on Xrays either. Diagnosing a medical/dental problem is like putting a jigsaw puzzle together; sometimes you get a complete picture easily, other times you simply don't have all the pieces to make a good diagnosis. If you start treatment without a clear diagnosis, it can sometimes make things worse because any intervention will have its own adverse effects. That's like throwing in more jigsaw pieces from a totally different puzzle.
Even taking antibiotics when an infection hasn't been found can confuse the situation because if you then get some relief, you will think this confirms an infection, when really it may just be a lull in the pain for other reasons.

 

[MattKW]

Cracks usually cause pain upon eating, so not normally at night. But pain waking you at night indicates something definitely going wrong, and a dentist can at least hopefully see if it's tooth-related.
CBCT scans do not show the same detail as ordinary 2D dental Xrays; CBCT are ~1/10-1/20 as finely detailed. The advantage of a dental CBCT is being able to look deeper into the bone to find things that might be "hiding" on a 2D Xray.

 

[EmBee]

Yes and Yes. Thanks.

Just wondering if there is a difference between CBCT scan quality depending on who actually operates the machine when the scan is being taken. Does it matter who does the scan, or is the process fairly automatic? Hope that makes sense.

Cracks usually cause pain upon eating, so not normally at night. But pain waking you at night indicates something definitely going wrong, and a dentist can at least hopefully see if it's tooth-related.
CBCT scans do not show the same detail as ordinary 2D dental Xrays; CBCT are ~1/10-1/20 as finely detailed. The advantage of a dental CBCT is being able to look deeper into the bone to find things that might be "hiding" on a 2D Xray.

 

[MattKW]

CBCT depends upon quality of machine and some operator skill. But I wouldn't suggest it for you until you've exhausted other more likely possibilities.

 

[Busybee]

Thank you very much BusyBee. I really appreciate it! I pray I don’t have an infection. But my body feels so weird. And this has been going on for so long. I also wear a mouth guard as they say I grind my teeth at night. I recently switched dentists and the new dentist has tried adjusting my bite. That seemed to help some but it still feels like there is something seriously wrong. Just woke up again about a half hour ago: can’t sleep, body feels feverish.

Question for you please - how did you eventually discover you had a slight crack on your tooth? Did the crack finally show up on an X-ray? Or was it discovered a different way?

Thanks again.

EmBee in my case the dentist could see the cracks when treating the teeth. They tend to go on symptoms. Usually hot food really affects a cracked tooth.

How long ago did you have the bite adjusted? It can take a tooth a while to settle after it's been pounded for so long. I felt really rough when my bite was too high on several teeth. Even had a dentist telling me it was all in my mind because there was nothing on x ray. It took more than just adjusting the teeth that hurt. Not all those that hurt were cracked, some were just too high, others were too low and were making pressure imbalanced.

But I have had several cracked teeth due to bad dental work. The best cases were fixed by a filling, the worst case by an onlay. But the pain is gone since treatment with no root canals needed so no infections were present in my case. Just bad dentistry. There's a lot of it around. I was waking at night too. In fact a hard guard caused me more problems than it solved. Is your's hard?

 

[EmBee]

CBCT depends upon quality of machine and some operator skill. But I wouldn't suggest it for you until you've exhausted other more likely possibilities.

ok. Thank you.

 

[EmBee]

EmBee in my case the dentist could see the cracks when treating the teeth. They tend to go on symptoms. Usually hot food really affects a cracked tooth.

How long ago did you have the bite adjusted? It can take a tooth a while to settle after it's been pounded for so long. I felt really rough when my bite was too high on several teeth. Even had a dentist telling me it was all in my mind because there was nothing on x ray. It took more than just adjusting the teeth that hurt. Not all those that hurt were cracked, some were just too high, others were too low and were making pressure imbalanced.

But I have had several cracked teeth due to bad dental work. The best cases were fixed by a filling, the worst case by an onlay. But the pain is gone since treatment with no root canals needed so no infections were present in my case. Just bad dentistry. There's a lot of it around. I was waking at night too. In fact a hard guard caused me more problems than it solved. Is your's hard?

Wow... really? That's all very interesting. Thanks so much for sharing! I got the bite adjusted late Dec, then again 1.5wks ago. I do feel I still need just a little more adjustment but I didn't think something so little could be causing me so much pain. I will hopefully get it adjusted again this week and see how it goes. That's very encouraging to hear that you were also waking at night even though you didn't have infections. Yes, my mouth guard is hard. Can't wait to get to the bottom of all this. It's so distracting My worst fear is having one or more hidden infections spreading into my body and making me sick. Thanks again so much for sharing, I really appreciate it!

 

[Busybee]

EmBee it's very promising that adjusting the tooth helped.

Worth trying more conservative options such as adjusting the tooth first before taking more drastic and irreversible treatment options. Hard guards can have slight deformities that can also press on a tooth when you're grinding at night. Ask the dentist for a semi soft guard to see if that changes the way the tooth feels, or ask for the hard guard to be adjusted for that tooth. A tiny deformity becomes enormous when in the mouth night after night.

Hard guards are overrated for heavy grinders unless they are perfectly made for all potential positions of the mouth, and they never are because nobody has the technology or skill to determine every variable of a specific individual.

It's worth looking at those and other minor aspects before writing the tooth off.

 

[EmBee]

EmBee it's very promising that adjusting the tooth helped.

Worth trying more conservative options such as adjusting the tooth first before taking more drastic and irreversible treatment options. Hard guards can have slight deformities that can also press on a tooth when you're grinding at night. Ask the dentist for a semi soft guard to see if that changes the way the tooth feels, or ask for the hard guard to be adjusted for that tooth. A tiny deformity becomes enormous when in the mouth night after night.

Hard guards are overrated for heavy grinders unless they are perfectly made for all potential positions of the mouth, and they never are because nobody has the technology or skill to determine every variable of a specific individual.

It's worth looking at those and other minor aspects before writing the tooth off.

Thank you very much I appreciate it.