About 16 years ago, when I was a teenager, I had teeth 7-8-9 damaged due to a hockey accident. I had the visible tooth ground down, root canal, post and crown. The crowns were bonded together due to the trauma to tooth 7 and the stability. Although tooth 7 is not currently cracked it is a concern and always has been.

I have kept up with dental visits but moved around the US, so I have seen several dentists. There has always been a dark spot between tooth 7-8 and 8-9 when an x-ray is taken, between 7-8 the spot has always been darker. Some dentists were concerned with the dark spots wanted to retreat the root canal due to possible infection. Some dentists said they were in great shape and did not want to retreat. I never retreated due to cost and widely varying opinion.

About 2 months ago I fell in a pool area and chipped the porcelain on 7 and 8. The crowns therefore had to be removed, the dentist also noticed a fistula above tooth 7-8 at the very top of the gum (where the gum meets the upper lip). The dentist recommended canal re-treatment. I saw an endodontic and had all three root canals retreated. The original root canal on 7 was about 2 mm short of the top of the tooth and the sealing material above 9 was loose. The loose material in 9 could not be extracted was pushed up above the tooth tip.

The fistula above 7-8 still remains over three weeks since root canal retreat. Seven days ago during a revisit to the endodontic he prescribed an oral antibiotic (augmentin), I have taken the antibiotic for 7 days and the fistula remains. The endodontic has suggested apicoectomy above 7-8 to clear the infection. I currently have temp crowns on and I am awaiting a cast post build up of 7 for the permanent post.

I would love to hear your thoughts. Thanks.

Hi Marchingant,

You have managed to retain these teeth for 16 years, which is quite remarkable. On the other hand, these teeth have been infected for all of those years as you have stated by the repeated radiographic pathology. Radiolucent (dark) areas above or around a tooth on an xray always indicate oral pathology.... could be cysts, granulomas tissue, dead bone..... it's always linked to a build up of bacteria that should not be there. The fact that the teeth needed to be splinted together from the get go indicates that #7 and/or the jawbone itself near that tooth was probably fractured at the time of the original incident.

One major concern about keeping infected teeth is that the bone surrounding them also becomes infected which makes future replacement options, such as dental implants, highly risky due to the deterioration of the bone. The root canals have not eradicated the infection as you stated it has been apparent on the xrays over the last 16 years and now the "stubborn" fistula.

In case no one has explained to you what a fistula is...... This is the body's way of trying to release the pressure and pus from a long standing severe infection. An oral fistula is the result of an abundant amount of bacteria that has over time proliferated from the tooth/teeth into the jawbone and burrowed a hole through that bone, through the gum tissue. It is literally a tunnel of pus and infected, necrotic bone. The only way to attempt to eliminate the fistula is to remove the source of the infection, which is the teeth, and surgically debride that entire area removing any cysts and remnants of necrotic tissue and bone.

Your case is not unusual in that at the onset of an accident, people are scared to have their front teeth removed...totally understandable. However, the trauma caused the teeth to die, the root canals perpetuated the problem by rendering the teeth chronically infected......which means this infection has been setting up house for 16 years. So with that explanation, how much more or longer do you think your immune system can handle this infection? This is what your dentists should be talking to you about.

Although it is certainly not healthy to keep these teeth any longer, one reason why dentists have retreated them and now suggest an apico is because once you remove these teeth, your case is going to be difficult for a dentist to restore because of the deterioration in the bone from at least 7-9. The success rate to place dental implants in this site will be less than favorable, so that means you would have the choice of either a removable partial denture or a long span bridge from at least #5 through 12 or longer depending on the stability and health of your other teeth and gums. Esthetics may be an issue because once those teeth are removed, the remaining bone is going to shrink quite a bit and the gums are going to recede. It might be possible to put bone graft material inside the sockets of the removed teeth to help restore some of the bone level, but grafting can only be used if there is no residual infection and adequate bone to hold the graft.

I imagine this is not what you wanted to hear, but I'm offering you the facts that your dentists should be discussing with you, if they aren't, so you can become better informed about what your options really are at this time. To wait to remove those teeth increases the likelihood of more widespread infection that will create additional complications and limit your replacement options.

I hope your dentists are open to more discussions, like this one, before you move forward with any future dental care with regard to those three teeth.

Your feedback is most welcome on all of this and please keep us posted on your decision........

Bryanna