Hi AKDENTAL,

I am in the dental field and can offer you some information here.

I don't know where you have been looking for information about root canals or what you have read but the information that I provide here is not nonsense at all. Every dentist is well aware that the root canal procedure cannot cure an infected tooth or ever make that tooth healthy again. They also know there are systemic risks associated with keeping chronically infected teeth. They all learn this early on in their education but lose sight of it as they focus more on the "carpentry" aspect of their education as that is where most of the emphasis ends up.

I am sorry that your son has experienced this trauma and only at the age of 15. I don't know if any of the dentists have informed you of the risks of keeping these teeth but they certainly should have before you consented to having the root canals done.

It is important to know that these teeth will be a chronic source of infection, they will continue to abscess and the bacteria will become more widespread. The sinus issues that he has, even if they are on and off, are a common and often overlooked symptom indicating that the inflammation and bacteria is making it's way into the sinus. The longer this goes on, the more widespread the problem will become. Irrelevant of how many times these teeth are root canaled the necrotic infected nerve tissue cannot be removed from the tiny canals. So the teeth will remain infected. ALL dentists are aware of this.

If you have not been informed you should know that what usually happens in cases like your sons.... he will get recurrent fistula's (abscesses) that break through the gum tissue above the teeth. He will be told he needs another root canal procedure done as the originals failed. He will continue to have further bone loss. His crowns will eventually not fit properly and he may get decay underneath them. Then he will be told he needs a surgical root canal which is called an apicoectomy. This surgery is very painful and it does nothing to alter the chronic infection inside of those tiny canals that are causing this brewing infection and it results in more bone loss. The bacteria from these teeth can easily spread to the adjacent teeth. Again, all dentists are very aware of these facts.

Keep in mind that dentists are tooth carpenters. They have been taught to "keep" teeth, not "cure" them. They offer rc and apico procedures in an attempt to help a patient "keep" their non-vital and infected teeth for an undetermined amount of time. Obviously there are many problems with that train of thought as it is never healthy, or medically acceptable, to "keep" any non vital body part anyplace in the body.

The only way to attempt to cure the infection and preserve the bone for replacement of those teeth is to have those teeth extracted to attempt to eradicate the infection that is already gone into the jaw bone. Extracting them will help preserve the healthy bone that he still has by decreasing the overall loss of bone in the future. The more bone loss he has the more difficult it will be to replace those teeth in the future as the bone and cartilage in the upper front area of the mouth cannot be replaced well enough to support dental implants.

It sounds extreme to remove those teeth at his age. However, in doing so you remove the source of the chronic problem and give him a better chance of saving the health and integrity of the jaw bone so that dental implants can have a chance at having an indefinite life span. Removing the teeth also stop or severely decrease the systemic health consequences that typically occur with chronically infected teeth.

The controversy with the post and crown issues between the 2 dentists....
The endodontist knows these teeth are not healthy. To prep these teeth for posts and crowns adds further trauma and bacteria to these fragile teeth. To put a post into these teeth will likely cause them to fracture and/or perforate the apex (the root of each tooth) causing further trauma and bacteria at the site of the already inflamed tissue and bone. He knows these teeth have a limited life span before more problems occur and knows the money spent on them is not worth it.

The general dentist is only thinking about the "carpentry" portion of the tooth and he knows that the teeth are fragile and wants to make them more stable with a post and crown. However, he is not giving consideration to the trauma or inflammation or injury that the preparation of the post and crown will cause both teeth. He also knows that placing large composite fillings on these teeth is not going to hold up for very long either ... but he will then blame the recurrent symptoms on the fact that you did not crown these teeth. So most likely he will try to convince you to do the post and crown before the next round of symptoms occur as then he can blame them on the endodontist or just say... the rc procedure failed, do it all again.

This is a terrible situation to be in. I feel so badly for you and your son. I have seen many hundreds of patients over the years who have been in the same situation and if they had only been properly informed in the beginning, it would have saved a whole lot of stress, anxiety and money for the parent while saving stress, pain and bone loss for the patient.

I would suggest that before you do anything else... consult with an oral surgeon about the health of these teeth and the health of his jaw bone. Explain to him that you are concerned about the long term risks of retaining these teeth... how will these teeth affect the health of his jaw bone... would the bone loss make it more difficult to replace these teeth with implants in the future.... express concerns about your son's systemic health as he is already showing signs of sinus problems. These are issues that parents and patients need to bring up at the consultation with their dentists and their oral surgeons. Once this issues are put on the table by the parent or the patient... a wise dentist will provide a more straight forward picture of the situation. If you wait for the dentist to discuss these things... it will not happen. Remember, they are tooth "carpenters" and they are taught to "keep" teeth irrelevant of the systemic risks.

Please feel free to come back with more questions and please keep us updated on everything.

Bryanna