Hi N2LE,
I understand that you wanted to keep your tooth... but your dentists should have informed you of the risks of retaining this tooth in spite of your insistence on keeping it. They should have informed you that re treatment with a second root canal procedure would not cure the infection. That information "may" have prompted you to remove the tooth sooner and you wouldn't be dealing with any of this other stuff.
I don't recall stating that the bone graft had failed.??
You wrote:
<<The 3rd round I was put on after the tooth was pulled. So it seems the infected tissue wasn't quite removed properly during the debridement?>>
ME: The third round of antibiotics was given to you because there is no way to know for certain that all of the infected material and necrotic bone was removed during the extraction. The dentist can only remove what he can see and feel with the instruments. With that in mind, because the infection was long term and extensive, the periodontist is concerned that the graft could become infected so he's prescribed the antibiotic "just in case" there is residual bacteria. I cannot tell you whether you really need this medication or not.... only he can.
<<<My concern with taking this next course of amoxicillin is that the 2nd course of amoxicillin couldn't fully deal with the infection,>>>
THE SECOND ROUND OF ANTIBIOTICS WAS TAKEN WHILE YOU STILL HAD THE INFECTED TOOTH IN YOUR MOUTH. SO NO MEDICATION WAS GOING TO CURE THE INFECTION.
<<<then the course of clindamycin couldn't either (and this was once the tooth was gone), so why should I believe this third course of amoxicillin will? >>>
I ANSWERED THIS ABOVE. ALSO, THE DENTIST MAY BE THINKING THAT IF HE CHANGES THE ANTIBIOTIC FROM CLINDA TO AMOX THAT YOUR GUT MAY NOT REACT TOO SEVERELY. ALSO AMOX IS FREQUENTLY GIVEN MORE SO THAN CLINATO PATIENTS WHO HAVE EXTRACTIONS AND BONE GRAFTS.
<<<Am I wrong in assuming antibiotics only act to control the infection which will invariably come back (this is why we pull the tooth in the first place)?>>>
YES, YOU ARE MISTAKEN.
1) ANTIBIOTICS CAN KILL THE BACTERIA THAT CAUSES INFECTION. SO LONG AS THEY CAN REACH THE INFECTION.
2) THEY ALSO NEED TO BE THE PROPER ANTIBIOTIC TO BE ABLE TO KILL THE PARTICULAR BACTERIA THAT IS CAUSING THE INFECTION. BROAD SPECTRUM DRUGS LIKE CLINDA AND AMOX ARE GENERALLY USED IN DENTISTRY BECAUSE THERE ARE SEVERAL SPECIES OF BACTERIA THAT CONTRIBUTE TO AN ORAL INFECTION.
3) ONCE THE SOURCE OF THE INFECTION HAS BEEN REMOVED, THEN THE ANTIBIOTICS CAN CLEAN UP THE RESIDUAL BACTERIA THAT IS MICROSCOPIC.
<<<If antibiotics were capable of eradicating the infection I wouldn't have had to remove the tooth in the first place.>>>
AS I'VE WRITTEN ... THE ANTIBIOTICS CANNOT GET INSIDE THE DENTIN TUBULES (MICROSCOPIC CANALS) INSIDE OF THE TOOTH. SO THE TOOTH REMAINS INFECTED IRRELEVANT OF HOW MANY ANTIBIOTICS YOU TAKE. SO THE INFECTION JUST CONTINUES TO PROLIFERATE THROUGH THE TOOTH INTO THE JAW BONE. AS LONG AS THE TOOTH IS PRESENT, THE INFECTION WILL BE PRESENT.
<<<The graft area itself feels okay, it is above this region where the original infection was (closer to my nose) that the tenderness persists.>>>
YOU HAD STATED THAT YOU HAD A "BIG RED BOIL" ABOVE THE TOOTH. THIS IS CALLED A FISTULA AND YES THE BACTERIA DOES DRAINS THROUGH THIS FISTULA. WHEN THE INFECTION SPREADS INTO THE BONE IT TRIES TO FIND A WAY TO RELEASE THE PRESSURE FROM THE INFLAMMATION. SO THE BACTERIA BURROWS A HOLE THROUGH THE BONE UNTIL IT REACHES THE GUM TISSUE AND THAT IS WHERE IT FORMS A PIMPLE (FISTULA) ON THE OUTSIDE OF THE GUM. THE TENDERNESS YOU FEEL COULD MEAN THAT THERE IS INFECTION STILL IN THAT AREA. IT COULD ALSO BE CAUSED BY THE TRAUMA TO THE BONE FROM THE INFECTION AND ALSO FROM THE SURGERY.
<<<If I take this next course of antibitics and the infection doesn't subside what would be the next possible course of treatment?>>>
THE DENTIST WOULD PROBABLY REMOVE THE BONE GRAFT AND RESURGERIZE THAT AREA TO OBTAIN A GOOD BLOOD VOLUME. THEN THE SITE WOULD BE CLOSED UP... MORE ANTIBIOTICS WOULD BE GIVEN....IT WOULD BE MONITORED.... AND SOMETIME IN THE NEAR FUTURE IF THERE WERE NO FURTHER COMPLICATIONS, YOUR SYMPTOMS WENT AWAY AND RADIOGRAPHS SHOWED A HEALTHY SITE HE MAY ATTEMPT TO PUT IN A NEW BONE GRAFT.
<<< What should I be asking my dentist? What exactly is a fistula? I don't have any drainage, so not sure what is going on?>>>
YOU SHOULD LET HIM KNOW THAT YOU ARE NOT TAKING THE ANTIBIOTICS AND THE REASON WHY. AS I'VE WRITTEN, HE KNOWS WHAT WAS PRESENT WHEN HE DID THE EXTRACTION AND HAS HIS REASONS FOR PRESCRIBING THE ANTIBIOTIC. I CANNOT TELL YOU IF HE DID THAT JUST FOR A PRECAUTION OR BECAUSE HE FELT IT WAS NECESSARY. I EXPLAINED THE FISTULA ABOVE. IF THE FISTULA IS STILL PRESENT OR EVEN THROUGH THE SURGICAL WOUND YOU MAY BE HAVING DRAINAGE AND NOT KNOW IT.
Sorry this is in small and big letters... hard to differentiate between your post and mine. Hope I did that okay ...
Bryanna