Hi Shawnis,

Just a word of caution when reading the internet for dental stories about someones dental experiences..... most of the time a lay person has little knowledge about the intricacies of dentistry, therefore, their explanation of the experience in the dental chair can be a bit exaggerated. That statement is not intended to discard those who have had poor and harmful experiences as there are plenty of those. It is just to clarify that the view and interpretation of what occurs while laying in the chair can be very different than what actually occurs. Also the lay persons reasons for what had occurred can be misconstrued because of the lack of dental knowledge. I can honestly make these statements because I know what it's like to be in the dental chair as a patient and what it's like to be on the other side of the chair partaking in the care of the patient. So please don't let the stories frighten you or cloud your thinking. Read them with an open mind

I am going to re post your questions and answer you in bold type. It is just easier to follow that way.

<<1. Does my pain mean that it is possibly spreading infection? Or just making it's way toward a worse infection? Or are symptoms just starting to show?>>

YES THE PAIN AS WELL AS YOUR OTHER SYMPTOMS ARE INDICATIVE THAT THE BACTERIA HAS SPREAD. ALSO THE FACT THAT AN APICO WAS RECOMMENDED SUGGESTS PROLIFERATION OF THE INFECTION AND SO DOES THE POLYPS IN THE SINUS OVER THAT ROOT CANALED TOOTH.

<<2. Do I really want to extract this tooth? I know the infection will hide away in microscopic places because I've read your other responses, but this will mean that I will need TWO implants next year and it's just such an unexpected expense in one year... I already have to wait until January to even address my first missing molar, now I'll have TWO!>>

I KNOW THE FINANCIAL END OF THIS IS BURDENSOME AND BELIEVE ME, IT IS FOR MOST PEOPLE. BUT PERHAPS WHAT YOU SHOULD BE FOCUSING ON MORE THAN THE $$ IS THE INFECTION THAT YOU HAVE THAT HAS INVADED THE BONE AND THE SINUS. THERE IS ALREADY DETERIORATION GOING ON SURROUNDING THAT TOOTH, THE INFECTION CAN SPREAD TO THE ADJACENT TEETH AND TO BE TOTALLY TRUTHFUL WITH YOU, IT CAN EVEN CROSS THE SINUS BARRIER AND ENTER YOUR BRAIN AS THAT ORGAN IS ONLY 3-4 INCHES FROM THE TIP OF THE ROOT OF THIS TOOTH. SO YOU HAVE A SERIOUS INFECTION BREWING FROM THIS TOOTH THAT UNFORTUNATELY CANNOT BE "CURED" BY AN APICO OR RC RETREATMENT. NEITHER OF THOSE PROCEDURES CAN ALTER THE STATE OF INFECTION INSIDE OF THE HUNDREDS OF MICROSCOPIC CANALS. SO IN SIMPLE TERMS, TO KEEP THE TOOTH IS TO KEEP THE INFECTION.

<<3. Also a major concern of mine... How will this extraction affect my sinuses?>>

YOU WILL MOST LIKELY HAVE A SINUS PERFORATION. THE SEVERITY OF THAT CANNOT BE DETERMINED UNTIL THE TOOTH IS REMOVED. A PRE OP 3D CAT SCAN CAN BE A VERY INFORMATIVE AND DIAGNOSTIC TOOL IN SHOWING MORE OF THE SINUS PROBLEM THAN ANY 2 DIMENSIONAL XRAYS LIKE THE PANOREX OR PERIAPICAL. THE ORAL SURGEON SHOULD BE PREPARED AHEAD OF TIME TO DEAL WITH THE SINUS PERFORATION AND HOPEFULLY CAN TAKE CARE OF THAT AT THE TIME OF THE EXTRACTION. HOWEVER, THE POLYPS NEED TO BE ADDRESSED IN CONJUNCTION WITH THE EXTRACTION AS THAT MAY BE THE BEST TIME TO REMOVE THEM TOO.

<< Could I have polyps due to the infection in the root which is so close to my sinuses?>>

YES, ABSOLUTELY. THE INFECTION IS BREWING INSIDE OF THE TOOTH IN THOSE MICROSCOPIC CANALS CALLED DENTIN TUBULES. IT HAS BEEN AN ONGOING INFECTION SINCE OR PRIOR TO HAVING THE RC DONE. IT'S JUST REMAINED ASYMPTOMATIC UNTIL NOW. IT'S IMPORTANT TO KNOW THAT THE ENTIRE TOOTH IS INFECTED, NOT JUST AT THE ROOT. THE INFECTION SHOWS ITSELF ON A 2 DIMENSIONAL XRAY AT THE ROOT TIP BECAUSE THE XRAY BEAM IS SELF LIMITING TO THE AREAS THAT ARE BEING CAUGHT IN THAT ANGLE OF THE FILM. IF THE FILM HAD BEEN TURNED OR BI SECTED TO CAPTURE A DIFFERENT ANGLE OF THE TOOTH, WHICH IS WHAT A 3D SCAN AUTOMATICALLY DOES, THEN DIFFERENT AREAS OF INFECTION WOULD BE CAUGHT BY THE RADIATION.

<< I'm so worried that this will cause me many more problems, but will the Apico make it worse or will the extraction make it worse?>>

THE APICO WILL NOT CURE THE INFECTION AS THAT PROCEDURE DOES NOT ACCESS THE MICROSCOPIC CANALS. THE APICO ALSO CAUSES PERMANENT BONE LOSS AT THE ROOT TIP OF THE TOOTH WHERE THE SURGEON MAKES HIS OPENING TO ACCESS THE BONE. THAT HOLE IN THE BONE IS OFTEN PLUGGED WITH MERCURY OR SOME OTHER TOXIC SUBSTANCE. SO YOU WILL CONTINUE TO HAVE A BREWING INFECTION, SINUS PERFORATION AND POLYPS, AND BONE DETERIORATION. UNFORTUNATELY, THE ONLY DENTAL PROCEDURE TO ATTEMPT TO CURE THE INFECTION, IS TO REMOVE THE SOURCE OF THE INFECTION WHICH IS THE TOOTH. IT IS IMPERATIVE THAT THE ORAL SURGEON REMOVE THE TOOTH AND ALL DISEASED TISSUE AND BONE IN THEIR ENTIRETY WHEN HE EXTRACTS THE TOOTH. ANY RESIDUAL INFECTED TISSUE OR BONE CAN RESULT IN FURTHER INFECTION. IT IS IMPERATIVE TO DISCUSS IN DETAIL WITH THE ORAL SURGEON WHAT HE PLANS ON DOING WITH THE SINUS POLYPS AND IF YOU SHOULD CONSULT AN EAR NOSE AND THROAT DOCTOR TO EITHER DISCUSS THAT SURGERY WITH THE OS OR HAVE THE ENT PARTAKE IN THE POLYP REMOVAL AT THE TIME THE TOOTH IS EXTRACTED. YOU WANT TO UNDERGO SURGERY THE LEAST AMOUNT OF TIMES POSSIBLE.

I know none of this is pleasant to read and it is scary and expensive. It is best to discuss all of this in detail with the oral surgeon, ask about having the 3D scan done ... even consult an ENT on your own. The whole ordeal can be a lot easier and with less post op complications if you have all of your ducks in a row.

I hope this information was helpful to you. Let us know how things go.
Bryanna