Hi Mr Outsider,
I am in the dental field and can offer you some information here.
Your initial tooth problem may have had 2 issues going on. One was it had a deep cavity which was close to the nerve and after the cavity was excavated and the tooth was filled the symptoms lingered. This indicates that the nerve was irritated and the tooth was on a slow path to a problem sometime down the road. The second issue with this tooth could be that it is fractured. When a tooth has deep decay and a large filling (I am going to assume it was an amalgam/mercury/metal filling) is placed in the tooth, the filling expands and contracts with hot and cold temperatures which results in movement of the filling material causing microscopic openings in the filling. At the same time, the pressure on the outer walls of the tooth from chewing on this large filling often result in a fracture in one or more of those walls which could also be microscopic. This would account for all of the symptoms that you have described and they could wax and wane from time to time until the nerve tissue from all of this ongoing irritation becomes so irritated and inflamed that bacteria that has been getting into these cracks decides to set up house inside the tooth.
Let's fast forward to the bump on your gum below this tooth....
This is most likely a fistula that has formed and is the result of the bacteria spreading from the inside of the tooth to the jawbone. It can be hard or soft and it is usually pus filled. It is not self contained and no your body is not isolating the infection. The formation of the fistula is the body's way of trying to find a way to drain the bacteria because it is building up inside of the tooth. Fistulas are usually sore but they may not produce a whole lot of pain until or unless a large swelling occurs.
A fistula can occur in many places in the body. But when it is related to an infected tooth it indicates that the infection has burrowed a hole through the tooth and formed a tunnel through the bone trying to find a way to release or drain the pressure and infection. This tunnel of infection results in deterioration of the bone and the longer the source of infection is present, which is the tooth, the further the bone deterioration will occur. Keeping the tooth, irrelevant of what is done to it, will not favorably alter the status of the infection.
The root canal procedure irrelevant of how well or how poorly it is done cannot sterilize or make a tooth healthy again because there is no access to the hundreds of tiny canals that will continue to contain infected nerve tissue. It is also important to be informed about the chemicals used to disinfect and kill off nerve tissue. These chemicals are very toxic and can cause systemic health problems as they cannot be rinsed free from the tooth so they will travel with the bacteria as it moves from the tooth into the bone and beyond.
Root canal therapy is most often presented to a patient as a "cure all" when a tooth becomes infected. The terms often associated with this are "save or keep" the tooth. In dentistry those terms when used in the context of a root canal or an apicoectomy (surgical root canal) simply mean "to retain" an unhealthy tooth for an uncertain amount of time.
I get the impression that you are concerned about the systemic risks associated with "retaining" this tooth and have been doing some research on that. Most of what you will find on the internet is either from lay people who mean well but are not truly knowledgeable about the subject and from other sources that promote root canal therapy as a cure all. The information that I offer here is not easily available in free literature to the public. It is found in dental and medical journals or publications purchased by those in the industry. However, you can find some information on some holistic dental or medical sites where practitioners are talking openly about it, as I do here.
I hope this was helpful to you..
Bryanna
Quote:
Originally Posted by Mr_Outsider
Try and be brief as possible here whilst including as many details as I feel might be relevant. I'm a bit of a worrier with health issues so any studied advice would be welcome.
This goes back to about 17 years ago, when I had a deep filling in a lower molar. The dentist at the time said that as the filling went so close to the nerve that it might become irritated and require a root canal. She said it might be 3 months, might be a year. In actuality the tooth remained sensitive to pressure and hot and cold for a couple of years but never caused significant discomfort and then settled down. Around 3 years ago the same tooth started to cause mild pain so I visited a dentist who said the nerve was still vital and simply refilled it.
About 3 weeks ago I developed pain in the same tooth again, this time more severe and throbbing than previously. I visited a different dentist who said I needed a root canal, which was booked for nearly a month after this initial appointment. He prescribed me antibiotics which he said it was up to me if I wanted to take or not, which seemed a little weird to me, but since reading a lot on the internet since, it seems that the prescription of antibiotics for tooth infections is indeed sort of optional, though it should be at the discretionary advice of the dentist not the patient surely!
Anyway, I didn't want to take precautionary antibiotics and in any case the pain was still manageable with standard doses of pain killers, and even sometimes without. However I didn't really feel happy about maxing out daily on ibuprofen / paracetamol for a month nor just allowing an active infection to progress that long and the dentist had mentioned an 'open and med' procedure that could be undertaken to alleviate pain etc. I called again and went on the standby appointment list and got one to have this done. The dentist opened the tooth, cleaned out some of the infection, injected the nerve to finally kill it (though he said he could only find two canals and would need to check later for a third), and also some medication to help with the infection.
As far as the pain went, this was as instantly effective as I had hoped. The pain subsided greatly and I was generally happy, although the temporary filling tasted intensely of medicinal clove oil for 3 days solid, which was almost as bad (it also seems to have worn down and left 'jagged edges' of tooth quite rapidly).
The dentist sent me on my way and said I still had the prescription for metronidazole 'should I need it', otherwise, see you in 3 weeks for the root canal. Since then the pain has mostly gone, though the tooth is still tender to touch and pressure, possibly increasingly so as the days go by but still not at a level which I need to take antibiotics.
My main concern now is that I've noticed the formation of a bony lump underneath the tooth at the base of the gum which I'm fairly sure wasn't there before the open and med, and either way the dentist hasn't mentioned to me or pointed to on the x-ray etc. It isn't itself painful, except for very mildly if I apply pressure with my finger. Internet searching seems to suggest this is a granuloma, but would it be normal for this to form so quickly? Does it mean that the infection is spreading dangerously or that my body is effectively isolating it (as one article I read seemed to suggest). And will it likely be solved by the root canal procedure (as also seemed to be suggested).
|