Bryanna,

I have two issues. One is a sinus lump on my first upper molar. I had a root canal on this tooth 5 years ago. I'm going to see an endontist next week and then discuss my options with my dentist. I lost the first lower molar below this tooth 3 and a half years ago and have left the gap. These are the first serious dental problems I've had and I'm trying to decide the best way forward for my dental health. Any ideas.

Thank you

Kat

Hi Kat,

I'm not sure what you mean by a "sinus lump"...? If you are referring to a "pimple like" lump on the bony gum area above the molar, then that is called a fistula. Could that be what you have?

A fistula is a path of infection that originates from the inside of the tooth, proliferates into the jawbone and burrows a hole through the bone showing itself as a bump or pimple above the infected tooth.

All root canaled teeth harbor necrotic, infectious bacteria. Therefore, it is common for root canaled teeth to end up with this type of proliferated infection. Retreating the tooth with another root canal or a surgery called an apicoectomy will not eliminate the necrotic bacteria inside the microscopic canals (called dentin tubules) that line the interior portion of the entire tooth. The only way to eliminate the infection is to remove the source which is the tooth.

Your treatment options are going to be... retreat with another root canal, apicoectomy or removal. Replacement options may be a dental implant; a bridge if you have healthy teeth on both sides of this tooth to anchor a bridge onto; or a removable partial denture is you are missing other teeth in your upper arch that have not yet been replaced.

You are wise to review your treatment options with your dentists prior to having any treatment done. If you are seeking complete removal of the infection and a long term solution... then removal of the tooth is the ideal option.

Kat, please keep us posted on how you're doing or if you have any other questions.

Bryanna

Thank you Bryanna. I appreciate the clarity of your reply.

When I review the best way forward with my dentist, is it worth asking whether an implant is still an option for the molar I lost just over three years ago. This is in the lower jaw, directly below the upper molar I'm currently having a problem with.

Also can implants for upper first molars be more difficult to obtain success with?

My other teeth, particularly the front ones are nice and I want to try and not cause any trauma elsewhere.

Thank you

Kat

Hi Kat,

You're welcome! Thanks for sharing your dental story with us!

Yes, it is definitely worth discussing the replacement of your lower molar. An implant may be a good option there if the adjacent teeth have not "tilted" in towards the open space AND if the bone level and diameter of the space are adequate to place an implant.

Please keep us posted .....

Bryanna