Hi David,

I hope I can offer you some insight about your concerns about root canal therapy and crown lengthening surgery. Keep in mind that I am personally without waiver on my opinion about root canals. However, everyone needs to be their own advocate and make decisions that are in their own best interest. My personal opinion is based on 30 years in the dental field and thousands of patients of whom I have worked with. Biopsy reports of extracted root canal teeth <some teeth were symptomatic and others weren't> don't lie and I have never read one that indicated the tooth was in any way healthy.

MS can most definitely affect the recovery process of some dental procedures. Dentists need to be very aware of the potential risks associated with the meds that MS patients are on particularly if the patient needs oral surgery. Here is a site that goes into a bit of explanation about these things. The dental treatment planning is at the bottom of the page:
http://www.cda-adc.ca/jcda/vol-66/issue-11/600.html

Sometimes there is residual pain or discomfort in the jaw or near the site of a recent extraction. This pain should be temporary and never feel like it is spreading. I'm wondering if your MS is affecting the left side of your face either from the traumatic extraction or if the MS was already there but in remission prior to the oral surgery? Have you had an MRI recently that would have shown the oro-facial region of your head? If not, it may be wise to have one prior to undergoing any further dental work.

The root canal issue is a controversial one amongst the dental population because so many dentists work their whole career and never once order a biopsy of an infected tooth. These dentists have no clue what these reports are stating because they have never seen one. Root canals are done to "retain" a tooth that has an infection, not "cure" the infection. Some of the infectious bacteria is removed, but the rest of it is harboring in the lateral canals that cannot be seen on an xray and in the microscopic canals that are unaccessible. I often refer people to this informational site where ironically the dentist writing the lengthy article, Dr Meinig, was for many years the grand pubah of Endodontics until he did some research about them.:
http://www.rheumatic.org/teeth.htm

You are correct in that you cannot just take the wait and see attitude and do nothing. In your particular situation having MS, it may be wise to ask what all of your treatment options are for all the teeth in question. Then approach your choices by eliminating those that are questionable with regard to #1 your overall health and well being and #2 will you have to revisit or retreat these teeth sometime down the road which means that they may have become a chronic burden to your immune system.

The answers are not easy and can be life altering in more ways than you can imagine. If you choose to remove the offending teeth, then it would behoove you to seek a dentist who understands the connection about MS and dental treatment. Perhaps this site will be helpful in locating someone like that:
www.IAOMT.org

Crown lengthening surgery is generally performed for one of two reasons:

One is because there is a deep pocket of gum tissue that is trapping bacteria and infection is present. The open gum tissue is removed, eliminating the deep pocket. In these cases, a portion of the root may be exposed after the surgery site has healed which may or may not be sensitive to temperature and prone to cavities and plaque accumulation due to the softness of the root structure. If the tooth is root canaled, the temperature sensitivity will not be present but the other issues are the same. It is imperative to keep these areas very clean once they are healed.

Two is because the tooth/teeth may be broken down near the gumline which would make placing a crown on them impossible. So the gum tissue is elevated by surgically removing some of it. This will allow more acutal tooth structure to be exposed so the new crown/cap will have something to be cemented onto. But again, these areas can be sensitive <in non root canaled teeth> if there is any open margin along the gumline on the crown/cap.

Crown lengthening procedures are very different than extractions. The surgerized area will be tender for a few days but there is no bone pain like there may be with a traumatic extraction.

David, I know I have poured out more information than you probably wanted to hear! Don't let it overwhelm you, just let it give you the empowerment to ask questions and seek the best treatment for you!!

Please keep us posted on what's going on ~'.'~

Bryanna