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Written by Dr. Logan Veath

Can dentistry be life or death?

I don’t know about you all, but as a dentist, I don’t really expect to deal with life and death situations, with the exception of some medical emergency like a stroke, heart attack, etc. Even though I take my profession seriously and realize that if you are careless, you could cause a medical emergency, I don’t expect to face a situation in which a patient’s life is on the line.

Two weeks ago I had a rude awakening. I saw someone almost die due to a dental infection.

I firmly believe what goes on in the mouth has a systemic effect on the entire body. These observations come from my time as a dentist and in my previous career. As an Infantryman in Iraq and Afghanistan, I noticed the majority of the indigenous population that was constantly sick or showing up for medical attention, usually had poor oral health. As a dental student, we participated in several community service projects in which we provided free dental care for people who could not afford dental care. This observation seemed to be proven correct time and time again.

As a dentist, I continue to see a direct correlation between poor oral hygiene and poor health. However, I don’t expect to run into a situation in which a patient of mine is in a life or death struggle.

The background on our patient was pretty mundane. He didn’t really come in for regular check-ups (*cough* cough* shameless plug to see your dentist at Legendary Dental every 6 months!) Most of his visits were problem focused; a cracked tooth here, a filling is out there, things like that. The very last time I saw him had been about 10 months ago.

He came into the office with some swelling in his mouth, some pain, and a little tenderness. I will save the gory details but suffice to say he had a large oozing abscess. I just wanted to help get him get cleaned up and out of pain. After completing my diagnostic testing, I was unable to pinpoint the exact tooth with the infection, because all three of his lower molars on that side of his mouth had some possible issues. I told him he needed to either have an extraction or a root canal. He understandably didn’t want his teeth pulled and I wasn’t willing to pull any of them unless I knew exactly which tooth was infected. I prescribed an antibiotic due to the present infection to help him get a start on clearing it up and told him I wanted to refer him to an endodontist (specialist who does root canals). So, our wonderful front office staff at Legendary Dental coordinated for him an appointment to see an endodontist in about a week. Pretty routine process for us when someone needs to see a specialist and we refer them to someone in our trusted network.

I wish that was the end of the story.

It should have been.

Unfortunately, he never went to that appointment.

Fast forward to present. I walk into the operatory and I see him for the first time in ten months. He had a golf ball sized lump underneath the right side of his jaw. I became very worried. We review with him his most recent appointment with us and I asked if he had seen the endodontist like we had planned. He told me he hadn’t. Naturally, I asked why? Apparently, the antibiotic worked well. The swelling went down and there was some pain relief. But the root cause of the problem was never treated since he didn’t follow through on his endodontic appointment from months ago.

Upon my exam, I could tell this infection was pretty bad. We took an x-ray of his whole jaw. The findings showed the lower right jaw didn’t look good. To verify my thoughts, I asked our new associate Dr. Roy Burkhalter, what he thought.

Dr. Roy and I both agreed my patient needed to go to the hospital immediately, start antibiotics, and go promptly to the oral surgeons due to the complexity of this case. My patient was in trouble. We called the oral surgeons and of course it’s Friday and they aren’t open past 12:00 p.m. (because all things like this happen on a Friday afternoon, weekend, or holiday, I swear!). This situation our patient found himself in was becoming very serious.

Dr. Burkhalter was still in the process of being credentialed at the hospital since it was his first week in his new job. So, Heather, our practice administrator at the time, Dr. Roy and I came up with a plan. If it was possible, we were going to have work with Myrtue Medical Center to expedite Dr. Roy’s credentialing. Then later in the afternoon, if we could, we would have the patient and Dr. Roy meet at the hospital and he would clean out the abscess.

Thank God for the medical professionals and staff in our small town! Mrs. Buman at the hospital was awesome. She saw the gravity of the situation and knew this patient needed to be seen. Our hats are off to Myrtue for their professional flexibility that was patient centric through the whole process. After some quick back and forth paperwork, they gave Dr. Roy the green light!

At about 5:00 p.m., Dr. Roy began the procedure for our patient. Due to the severity of the infection and the prolonged time it was untreated, Dr. Roy ended up extracting three teeth and a lot of his jaw bone (which was infected mush). My patient was placed in the hospital overnight and then was there for a full week after. Dr. Roy and I talked about it later that night. This patient would probably not have made it another week. After the procedure, he was diagnosed with Osteomyelitis of the jaw, which is a fancy term for an infection of the bone caused by not taking care of an abscessed tooth. My patient will be on an antibiotic IV for the next 6 weeks. On top of this, we hope and pray that he is lucky enough to keep his jaw but there is a strong possibility that he will have part of his jaw removed.

The point I am trying to make is that dental infections are serious. When we diagnose them, we need our patients to understand the seriousness of their situation. I am so grateful for Dr Roy, Heather, and Mrs. Buman working very hard to help our patient. If they had not, I am pretty sure this would have turned out much worse. If these are the things your nightmares are made of and I just created a sleepless night for you, RELAX. Here are some quick take a ways so you never end up in this type of situation.

1.  If you have pain in a tooth or your mouth, call us, we would rather you were safe than sorry. We work to get patient emergencies in the same day if they are urgent, or over the next day or two if you are able to wait and feel comfortable doing so.
2. After seeing us, please please follow through on our medical directions.
3.  If for some reason you can’t follow through on the medical directions given to you, let us know. That way we can discuss with you and follow up on our side accordingly.
4. If you have an appointment with a specialist that we help arrange, we assume you will be at that appointment. General dentists can do many things but when a specialist is the best approach, we want the very best for our patients and we use a specialist in our trusted network to provide you the best care.
5. There is a reason for those 6 month appointments! Not only do you get the satisfaction of nice, smooth, clean teeth, you also get a thorough exam to catch issues early and we can be proactive vs reactive.

I care deeply about my patients. Help me sleep better at night too by being my partner in your healthy mouth journey. 

Legendary Dental is located in the southwest Iowa city of Harlan. We serve ages 1 to 100 in Shelby County and beyond by being patient centric at every touchpoint. We are accepting new patients. Call today to schedule your appointment at (712) 340-0333 or email us at hello@harlandentist.com