Hi everyone. We're writing to get advice for our mom, who is almost 80 and has had three failed root canals in the past 12 months. We've read every post here, so we understand the pro's and con's of root canals. But they've been done (highly recommended endodontist), and our mother developed a jaw bone infection a few months after the first root canal -- that isn't going away.

Our mom took Fosamax for under a year then was switched to Actonel for six years. (She stopped it six months ago, as per her GP's instructions.) We understand the current controversy over these meds, but don't know if the infection is related to the medicine. Our general dentist & the endo don't think so.

At this point, it's time to find a new dentist/doctor. My mother is getting depressed, the infection has been hanging around for at least eight months, and we're concerned about her. Does anyone know what kind of dentist/doctor my mother should see? An oral surgeon? All suggestions are very much appreciated.

Thanks all!! -- Dana

Hi Dana,

The connection between Bisphosphonate drugs and bone infection is simply that the drug inhibits the formation of new bone. This means that when there is an infection in the jawbone, in spite of antibiotics and dental treatment to eradicate the infection, the drug prevents the growth of new bone. So the infection becomes extremely difficult to treat. There is no controversy about these facts. The controversy stems from the lack of written evidence from the dental and medical profession with regard to the "number" of their patients who encounter this problem. In dentistry, we are so use to seeing jawbone infections that the medical background of the patient is often overlooked as being a part of the problem. Thus the lack of connecting all the dots....... drug = infection.

All root canal teeth remain infected as it is impossible to remove all of the infected nerve material from the inside of the tooth. As long as these teeth are present, she will have proliferating infection. To remove those teeth will rid the source of infection but because of the decreased ability to regrow new healthy bone, she may continue to have chronic pain/infection where those infected teeth were.

This is a very tough situation especially given your mom's age. She should consult an oral surgeon to talk to you about the removal of those teeth and what it would entail to take care of the lingering infection.

Wish I could give you better news.... I feel bad that the endodontist chose to root canal her teeth as he knew he was not "curing" any of her problems. I see this all the time.... I cannot tell you how bad this makes me feel.

Please take your mom's symptoms seriously... she needs to get this taken care of as soon as possible.

Please keep in touch to let us know how she's doing.

Bryanna

Bryanna, thanks for the quick reply. I posted too quickly yesterday and should have clarified that the same tooth has had 1 root canal, followed by 2 retreatments. So 1 tooth (part of a bridge) is involved. In retreating the tooth, the endo said he was "cleaning the canals" and "getting medication where it needed to go." (I know.... makes you furious...)

We've talked to other dentists and doctors, most of whom said they knew of no one taking a bisphosphonate drug who developed a jawbone infection. But most knew about thigh fractures.

I'll keep looking for an oral surgeon who knows about the effects of bisphosphonates.

Thanks again!

P.S.: Without getting too specific, medical background initially was ignored. My mother filled out forms listing her ONE medication. Dentist saw that medication listed after infection appeared....

Hi Dana,

The endodontist was misleading your mom 100%. He can retreat the tooth 1000 times and would still not remove all of the infected nerve. Along with that, each retreatment causes more internal tooth damage, more trauma to the bone (and the patient!!), more inflammation, more likelihood of fracturing that tooth and what about the systemic affect from all of this infection? Those are the issues he should have told your mom and you and then allowed her to make the decision as to whether or not she wanted it retreated. I doubt he told her any of those things.... right?

The fact that this tooth is part of a bridge becomes one of the primary reasons why they push the root canal therapy in that they don't want to deal with the consequences of not being able to replace that tooth.... especially due to her age. They also are either totally ignorant to the literature in their monthly journals or at best (silently) concerned about the connection between her Bisphosphonate use and removal of that tooth. Those drugs prohibit the formation of new bone growth so it is risky to remove that tooth because that surgical sight may not heal. With that said, the chronic infection exacerbates the likelihood of the bone not healing. So they misinform the patient by telling them the root canal(s) are going to make everything just fine.... and now she's been through hell and probably feels badly that she trusted their word.

The primary concern here is her systemic and mental health...and retaining this infected tooth can be a huge source of problems for her. I often recommend people to search for a dentist who belongs to an organization called the IAOMT. Their website... www.iaomt.org

This is a worldwide organization of physicians, dentists and other practitioners who were traditionally taught their profession but have chosen to continue their education outside of the conventional arena. They combine traditional with wholistic methods by using safer, less toxic dental materials, follow safe/sterile protocols when doing procedures and basically follow an Integrative approach so as to consider the patient as a whole person and not just the one issue at the moment.

With regard to the Bisphosphonate use and jawbone infection....every dentist who is not blind is seeing it, they are either ignorantly or deliberately not connecting the two together. If that wasn't bad enough, they rarely will acknowledge that they never even took her medication into consideration. I can tell you from my perspective... dentists are talking amongst themselves about these drugs and are relying on the medical profession to tell them what to do. Stupid huh??

Ugh.... you must be mentally anguished over this. Please look into the IAOMT and see if you can come up with someone within a reasonable distance. That is where I would look if this were about my own mother.

Please keep me informed on how things are going...
Bryanna



QUOTE=DC02;808721]Bryanna, thanks for the quick reply. I posted too quickly yesterday and should have clarified that the same tooth has had 1 root canal, followed by 2 retreatments. So 1 tooth (part of a bridge) is involved. In retreating the tooth, the endo said he was "cleaning the canals" and "getting medication where it needed to go." (I know.... makes you furious...)

We've talked to other dentists and doctors, most of whom said they knew of no one taking a bisphosphonate drug who developed a jawbone infection. But most knew about thigh fractures.

I'll keep looking for an oral surgeon who knows about the effects of bisphosphonates.

Thanks again!

P.S.: Without getting too specific, medical background initially was ignored. My mother filled out forms listing her ONE medication. Dentist saw that medication listed after infection appeared....[/QUOTE]

Hi Bryanna,

Thanks again for your replies -- and for all the wisdom you so generously share here. No, the dentist explained next to nothing, certainly not what you explained. Actually, he spent more time explaining the dangers of Clindamycin than about the root canal procedure and possible complications.

We're looking at the IAOMT list now, plus we have the name of an oral surgeon recommended by my mom's internist. The internist called this morning because he said recent blood work indicates my mom has a severe vitamin D deficiency that requires a prescription for a few months.

In your opinion, do we call a few people for consultations? That seems reasonable because of the circumstances. Yet we realize there's a need for urgency. Also, will an oral surgeon want the endo's x-rays?

Thanks again.
Dana

Hi Dana,

You should get all of the xrays of her entire mouth that have been taken within the last 3 years and keep them in your possession as you may be taking her to more than one dentist. It is imperative to make sure ALL of her xrays pertaining to that tooth including before the first root canal all the way through to the most recent one taken. These xrays will tell the story better than anyone can tell it.

I would call several oral surgeon offices if necessary and ask one question... Does Dr___ treat patients who have a tooth infection that may be complicated by the use of an oral bisphosphonate drug? If the answer is vague or definite denial.... move on to the next oral surgeon. If the answer is, we recognize that drug can contribute to jawbone healing... bingo, go there!

Not to get off subject, but I'd be remiss if I didn't share my information about vitamin d deficiency and supplementation just in case you are not aware. Vitamin D deficiencies are very common in older people as well as a huge portion of the population in the US. The written prescription for vitamin d is usually Vitamin D2 (ergocalciferol) which is not easily metabolized by the body, especially in older people who are lacking digestive acids and enzymes, making D2 more of a toxicity than anything else. In my personal and professional experience, one of the best absorbed vitamin D supplements on the market today is made by Biotics Research, it's called Bio-D Mulsion Forte...it is an emulsified liquid form of vitamin D3 (cholecalciferol) and each drop = 2000 international units. Here is the information....http://en-us.www.mozilla.com/en-US/firefox/central/

When there is a vitamin d deficiency, the supplementation is usually a high dosage to start off with because lower doses will not be stored due to the deficiency. The idea is to build up the serum level to an optimal range and then lower the dosage to a maintenance dose in the attempt to keep the serum level at an optimal level at all times. This supplement, bio d mulsion forte will elevate her vitamin d levels fairly quickly if she is taken mega doses of it, so she should have a serum test 3 months after the start of her supplementation called 25-hydroxy vitamin D, another name for the same test is 25 OH Vitamin D, to see what her levels are at that time so her supplementation can be adjusted accordingly. This is the most accurate serum test for vitamin d according to the vitamin d council. Some physicians are still ordering the wrong test that's why I'm offering you this information... google vitamin d council for more info.

Your mom is so blessed to have you looking out for her well being. I know you will be better informed as you take this journey with her and hopefully you will not have too much trouble finding an oral surgeon who can properly help her.

Keep me posted!!
Bryanna





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Hi Bryanna,

Thanks once again. The vitamin information makes perfect sense. (You were correct about the doctor's prescription, too.)

I guess I knew all along that my mother was heading down the wrong path. I asked the endo for x-rays a few months ago and he said they're digital and can be sent to any other healthcare provider in seconds. In effect, he blew me off. But I'll get them, plus older ones from the referring dentist.

I decided today to stay with my mom for the next few months because this is a lot for anyone to handle. We'll start calling for x-rays and consults in the morning. At this point, I could shoot that endo, but I know it's best to be positive and move forward.

I'll definitely report back. Thanks again -- you're a lifeline!

Dana

Hi Dana,

The endo is correct in that digital xrays can be emailed to another dental office in seconds.... however, not all dental offices have digital compatibility which means if they don't, then they will be copying the xray from their email onto regular copy paper. This type of copy is usually not very diagnostic and defeats the purpose of obtaining the xrays. Usually, offices that have digital xray equipment also have a special printer and photo paper so the printed version of the xrays are clearer than if they were printed out on a regular printer w/reg copy paper. I would not wait to ask the endo to make "legible" copies of all her xrays... tell them the xrays are going to be used to tell the radiographic history of this tooth. When you find a dentist for her to see, ask that office if they have digital and can receive xrays ... if they do, get their email address and call the endo office again and have them email them to the new dentist. I would do the same with the general dentist that she saw as well. The reason for doing it this way is to have a hard copy of her xrays in your possession just in case she has a dental emergency while you are seeking a new dentist for her.

Let me know how things are going....
Bryanna

Hi Bryanna,

Here's where we are. We had two consults with oral surgeons who treat patients taking bisphosphonates. Both spent substantial time explaining what the drugs can do to the jawbone and outcomes they've seen with their patients. And both oral surgeons, who work in neighboring states and don't know each other or the endodontist, said an apico should clear the infection.

I had many questions and both were patient; both said I can't link my mother's infection to bisphosphonate use because many people develop infections after oral procedures. They said extraction would prevent a much more serious problem for my mother, because healing might not occur.

I have a feeling they want to buy time...

We're taking a break, and I'll update when we continue.

Thanks,
Dana

Hi Dana,

First let me say that this is not an easy fix irrelevant of what treatment option is chosen because with her medication history and age, every option is a gamble on what the outcome might be. I think you would agree that the main concerns are her health and dealing with this infection before it proliferates. Putting a bandade on this situation really concerns me when thinking of what this infection could become in the long run. An apico is a surgical bandade and nothing more than that. It will not remove the source of the problem, which is the tooth.

I could be wrong but I have a feeling that the dentists are getting the impression that your mom does not want to lose this tooth. Could that be?? If so, then that is part of the reason why they offer the option of an apico. The other part is once the tooth is removed, what will she have to chew on? Is she a candidate for a removable partial denture.... has anyone spoke to her about that?

<<They said extraction would prevent a much more serious problem for my mother, because healing might not occur.>>
(IN CAPS JUST TO DIFFERENTIATE MINE FROM YOURS)
I'M NOT SURE WHAT THIS STATEMENT MEANS OTHER THAN THEY BOTH ARE CONCERNED AND ACKNOWLEDGE THAT HEALING FROM SURGERY MAY BE AN ISSUE..... DUE TO (IN PART) THE BISPHOSPHONATE DRUG? REMOVING THE TOOTH NOW IS SAFER THAN REMOVING IT LATER WHEN THE INFECTION HAS PROLIFERATED AND THE BONE HAS BECOME NECROTIC. THERE IS A VALID CONCERN ABOUT HEALING.... BUT IT APPLIES TO ANY ORAL SURGERY, EXTRACTION OR APICO.

I can offer you what my personal decision would be if this were my 84 yr old mother. I would not hesitate to remove the infected tooth simply because it's the only way to eliminate the source of the infection. Then deal with the outcome as it presents itself. Better to deal with it now than later when the problem has become worse. I would not want to risk her health by keeping this tooth only to be extracted anyway. That is what makes sense to me.

You and your mom have to do what you feel is in her best interest. I know this has been very stressful and you are trying so hard to make the best choices for her. I feel the answer will come to you sooner than you think and it will be the right choice.

Keep me posted... and keep your chin up =)

Bryanna