dwnjef,

I am saying that to retain an infected tooth and this includes root canaled because all root canaled teeth are chronically infected, means to retain a brewing infection. You had a chronic infection in tooth #14 for over 5 years as the original infection did not occur suddenly before you had the original root canal. The longer the source of the infection, your tooth, was retained in your mouth the more widespread the infection would become.

There are many problems associated with retaining infected teeth. Some of these problems include the spread of infection to other teeth, other areas of the mouth, the sinus, the brain and other organs of the body. When a bacterial infection has spread beyond it's original area and enters the bloodstream it is referred to as a systemic infection. It can be difficult to eradicate these types of infections because there is no telling where it has settled as not all infections produce symptoms at the onset.

There is no sure way to know how far the bacteria from tooth #14 has spread. Not all infection can be seen visually or radio-graphically or have symptoms until it is severe. This is why is it never wise to retain an infected tooth as there is no procedure that can sterilize a tooth, remove all of the necrotic nerve tissue from the microscopic canals, or make a tooth healthy again. Root canals and apicoectomies are performed to retain an infected tooth for an undetermined amount of time. They are not intended to cure an infected tooth nor do they prevent the spread of infection. It is a shame that many dentists do not inform their patients about this prior to their patient giving consent to these procedures. ALL dentists are aware of the information that I am giving you here.

The infection in tooth #13 did not occur after the removal of #14. The infection in #13 has been brewing for who knows how long. It was either missed on previous x-rays, or you were not informed about it until #14 was removed, or the infection did not show itself visually or radio-graphically until it was severe.

If you remove #13 you are removing "a source" of the infection as you've already become aware that the original infection has spread to this tooth. There is no way at this point in time to know for certain if the bacteria has not spread beyond #13 unless it can be visually or radio-graphically seen. However you do know that not to remove it means you are retaining the infection that will continue to spread.

The issues with removing #13 at this time have to do with how that surgery will affect the newly placed dental implant. As there is always a risk of infection with any surgery and removing this tooth may disturb the healing of the bone in the site of the implant. At the same time, retaining infected #13 may also risk failure of the implant. This is why you have to consult with an oral surgeon.

I am so sorry you are going through this. Your situation is complicated but it is not unusual. Unfortunately it happens frequently because the patient was not fully informed of these risks prior to performing these rc procedures. If you had been informed prior, you may have decided to remove #14 instead of root canaling it, had the implant placed in healthy bone and never had to deal with situation. I am really sorry to be the one to tell you this at this late stage of everything.