Hi Jeff,

You are welcome!
Are you a diabetic?? If so, that is a huge reason to NOT hang onto an infected tooth. And if your dentist is aware of your diabetes, he should know better than to have root canaled your tooth in the first place. Especially since you have a history of dental pain in that area of your mouth and sinuses prior to the root canal... both indicative of a long term infection.

Also, it is OLD school dentistry to leave a tooth open after having a partial root canal. That cotton pellet is doing nothing to prevent bacteria from getting up inside of that tooth.... adding insult to injury. The reason he did that was because he knows that tooth has a severe infection and if he closed it up, you would have developed a huge swelling and horrible pain from the pressure of the bacteria inside of that tooth. The fact that you developed a fistula after the root canal procedure was started and left opened to supposedly drain ...... again indicates a complicated infection. Let me clarify... this tooth is not draining, thus the fistual. Also, it is OLD school dentistry to leave an infected tooth open to drain into a person's mouth, especially a diabetic.

Forgive my assertiveness Jeff, I don't think I need to educate you on the risks of diabetes and infection, but perhaps you need to educate your dentist. Many dentists are tooth carpenters, not wise doctors.... unfortunately.

Let me clarify the difference between keeping an infected tooth and having a cavitation...... there is no difference. The cavitation is CAUSED by the proliferation of infection FROM the tooth. There is no "cure" for that infection in that tooth. The longer the tooth is present, the deeper the bone infection = cavitation.

DO NOT use anything to open that fistula. The bacteria is not just contained in that lump, it is in the jawbone and the tooth. It will open on it's own from the warm salt water if the pressure builds up enough. If that happens do not swallow the stuff that comes out ... spit it out and rinse with the salt water. The bump will continually fill up because the infection is coming from the tooth.

You are right about the complications of this situation and yes, it is disheartening that you have had all of this dentistry and are now faced with this decision. You should also know that if you are diabetic, you may not be a candidate for a dental implant mainly because of the health risk of placing an implant in an area of bone that has an infection is elevated in a diabetic.

To be honest... your dentist should have informed you about the health of this tooth prior to doing your crown work. Your original symptoms indicated an infection.... irrelevant of whether it showed up on an xray or not. I have a hunch that it did show up and was not diagnosed until you developed further symptoms. At the onset of your symptoms, especially since you were going to have all of this crown work, you should have been given the option of extraction at that time. You could have had a 3 unit bridge made there to replace this tooth instead of single crowns. It would have esthetically tied in beautifully with the other crowns. So if that had been done, the concern over doing an implant would have not been an issue. NOW, the situation is more complicated because of the extent of the infection. Am I explaining myself okay? Does this all make sense to you?

Your options are.....

Complete the root canal procedure = infection
Re treat with an additional root canal procedure = infection
Apicoectomy (a surgical root canal) = infection
Extraction of the tooth, debridement of the bacteria from the bone and possible entry into the sinus cavity depending on how extensive the infection has traveled.

Replacement option...

1) Take off the crowns on the adjacent teeth and make a three unit bridge. He should not charge you anything extra for doing this.

2) Consult an oral surgeon for a CT scan to see if you are a candidate for a dental implant.

I am sure that you are feeling quite panicked at this point. PLEASE stay calm so you can think clearly. The information that I have given you is meant to empower you with the knowledge that your dentist neglected or minimally provided to you. Lack of information is unfortunately a common situation in many dental offices... that is why I became a patient advocate in dental offices many years ago and why I'm here to help educate you on the issues that would otherwise be overlooked. You have the right to be properly informed.

It is hard to come across subtle on the internet about such important issues such as this. If you were sitting with me, I would be gently touching your hand and reassuring you that this can be remedied in a healthy manner. But it needs to be addressed asap.

Please keep in touch here.......
Bryanna