Originally Posted by Bryanna

Hi Jamm,

Thanks for the xray.

Here's what I see on the xray..

1) A root canaled pre molar with radio graphic pathology. Did that tooth have an apicoectomy? It looks like it may have due to the blunting of the root tip..... OR the gutta percha perforated the apex. Either way, there is a cyst at the apex.

2) There is a moderate size piece of mercury lodged in the extraction site. This was likely the mercury blob that was placed at the apex of that extracted molar when the apico was done. Ideally the oral surgeon should have removed that mercury when he extracted the tooth. Really there is no excuse for leaving it there.

3) There are other small fragments of mercury scattered about which would be difficult to remove as they become embedded in the tissue.

4) There is a moderate area above the mercury blob that is suspicious. May be an infection and that may be where the sinus is involved.

5) Not sure of the health of the last molar. That tooth needs another xray taken at a bisecting angle.

6) All of these problems are likely apparent on the 3D scan.

You have a long history of dental infection in that quadrant of your mouth because root canal therapy and apicoectomies do not cure an infected tooth. The dentin tubules will remain infected with trapped nerve tissue irrelevant of how perfect either of those procedures are done.

This is not going to settle down on it's own because .....

1) There is a blob of toxic mercury stuck in the surgical site that will prevent healing.
2) There is pathology and infection with the pre molar as well as in the surgical site of the extracted molar.

The oral surgeon should have informed you of the problems with the pre molar and he should have been MUCH more thorough with the extraction and debridement of the molar. The problems you have are not going to heal in time. They require intervention.

Medicating you to kill the pain, is only a band aid at the very least.
I am really sorry your dentist has not informed you of these things. Your choices are to go back to the oral surgeon that botched up the molar extraction or see a different one and explain you want a thorough debridement of the surgical socket.

I know this is depressing news...... but I hope it is helpful to you.

Bryanna

Originally Posted by Bryanna

Hi Jamm,

I understand that you paid privately.... I often suggest that people take that route because the care is often higher quality and more individualized. I still feel that is usually the best way to go over a dental school or insurance based practitioner.

However, in the case of your first oral surgeon..... to extract a tooth without an xray is a huge NO NO as you cannot possibly know what you are getting into without that xray. That is why the surgery was so quick because he did not debride the area... because he didn't know the full extent of what was there. Secondly, ALL tooth extractions REQUIRE a thorough surgical debridement, there are no exceptions to that rule. Unfortunately, this step is not routinely done as it is suppose to be. The granuloma he referred to was a clear indication that there was more happening in that site which needed further investigation (an xray) and debridement.

What the second oral surgeon is referring to as scar tissue is most likely infection and granulation tissue. Scar tissue does not have the exact appearance as infection, which is pretty obvious on your xray. He may be making that reference to avoid further questions from you about why the first OS didn't do a more thorough debridement.

The concern about having permanent damage is two fold:

1) Without question it is never healthy to have an infection in your jawbone and especially one that has traveled to the sinus cavity. In your case you have at least 4 issues that are contributing to the bacterial problem. One is the root canaled pre molar, the second is the dirty extraction site, the third is the toxic mercury sitting in the surgical site and the fourth is the sinus perforation which is not likely to heal unless the other issues are taken care of.

2) Permanent damage can occur from long term infection (ie root canaled teeth, non debrided extraction sites and chronic sinus involvement). It can also occur from deterioration of the jaw bone due to the proliferation of infectious bacteria. All of which can make the person very ill beyond the original source of the infection.

3) At some point this quadrant of your mouth.... the rc tooth/the infected extraction site/the blob of mercury/ the sinuses.... will have to be addressed. The more deterioration that occurs, the more prolific the infection will become and the more likely it will become a systemic health concern.

Based on all of those things going on and in addition to the length of time that there has been infection in that quadrant (20 years), if the surgery is done now there is a possibility of some damage occurring with the surgical intervention, but no one can tell you if it would be temporary or permanent.
There are also no guarantees that the surgical intervention would be able to cure the infection in it's entirety because the bacteria may be hidden and not yet visible clinically or radio graphically.

The options are....

1) Wait and let it proliferate and be medicated for the pain.
2) Do not wait. Debride and remove the visible sources of the infection and the mercury giving you a better chance of a healthier, more complete recovery.

I know people think they have to just trust their dentist to always do the right or best thing. However, as much as you have no choice but to trust the skills and knowledge of the dentist, it is imperative to remain your own advocate and use your voice to make your concerns and expectations clear.

Again, I hope this info is helpful to you.
Bryanna