[Janet N]

I recently had a root-canal retreated and this past week my gum has started swelling again. I've rinsed with peroxide mixture w/ warm salt water and it seems to help. I've read several of Bryanna's Posts regarding root canals/fistulas and am dumbfounded! I erroneously thought once a root canal was done, the tooth couldn't be infected again - so I thought I had a botched root canal. Now I understand that is not the case apparently, thanks to Bryanna. I'm not quite sure how to direct this post to Bryanna, but hope she will see it & reply

Here are a few concerns/questions: (1) should I go back to endodontist, dentist or see a a periodontist? (2) I'm leaning towards extraction and and implant but the tooth is #13 and I noticed my sinus' are bothering me. Thinking maybe I should back-up my immune system with pro-biotics until I get whatever procedure I end up having? (3) It seems like the extraction/implant is the way to go, right? (4) I live in SF any idea what I should expect to pay for extraction/implant (I know it varies from one office to the next, but ball-park)? (5) it seems this can be a pretty serious condition - how quickly should I seek attention?

Cost is not my main concern, making the right decision and having good information to do so is most important to me. I appreciate your response.

Thank you!

[Bryanna]

Hi Janet,

The swelling could be an indication that the infection had spread from the tooth into the bone. The rinsing will temporarily subside some of the inflammation but it is not going to cure the problem. Besides that, the peroxide will eventually start to irritate the gum tissue, so that's not good to use for more than a couple of days.

Here's your questions...

(1) should I go back to endodontist, dentist or see a a periodontist?

<<THE ENDODONTIST MAY SUGGEST A PROCEDURE CALLED AN APICOECTOMY. THIS IS A SURGICAL ROOT CANAL THAT TRULY SERVES NO POSITIVE PURPOSE AND IT'S VERY COSTLY AND PAINFUL. A PERIODONTIST MAY SUGGEST A FLAP SURGERY TO DEBRIDE THE INFECTION AROUND THE TOOTH. THIS PROCEDURE CAUSES GUM RECESSION AND THE TOOTH WOULD STILL REMAIN INFECTED. HE MAY ALSO SUGGEST A LASER PROCEDURE CALLED LANAP. THIS PROCEDURE IS VERY INSTRUMENTAL IN THE TREATMENT OF PERIODONTAL DISEASE. IT COULD TEMPORARILY DECREASE THE BACTERIA IN THIS AREA, BUT BECAUSE THE TOOTH WILL REMAIN INFECTED, YOU WILL BE ADDRESSING THIS PROBLEM AGAIN.

(2) I'm leaning towards extraction and and implant but the tooth is #13 and I noticed my sinus' are bothering me. Thinking maybe I should back-up my immune system with pro-biotics until I get whatever procedure I end up having?

YOUR SINUSES MAY BE INFECTED OR INFLAMED FROM THE TOOTH. IT IS ALWAYS A GREAT IDEA TO TAKE PROBIOTICS.....DAILY... FOR OPTIMUM HEALTH.


(3) It seems like the extraction/implant is the way to go, right?

EXTRACTING THE TOOTH ELIMINATES THE SOURCE OF THE INFECTION. IT'S IMPORTANT TO KNOW THAT AN IMPLANT SHOULD ONLY BE PLACED IN HEALTHY BONE. THE LONGER THE INFECTION IS PRESENT, THE MORE THE BONE DETERIORATES.

(4) I live in SF any idea what I should expect to pay for extraction/implant (I know it varies from one office to the next, but ball-park)?

THE COST DOES VARY PER GEOGRAPHICAL AREA. THE GENERAL COST OF AN EXTRACTION IS $250 TO $500 DEPENDING ON THE DIFFICULTY AND THE EXTENT OF SURGICAL DEBRIDEMENT THAT IS INVOLVED. BONE GRAFTING IS AN ADDITIONAL FEW HUNDRED DOLLARS, THE IMPLANT $1800 TO $3000, AND THE IMPLANT CROWN $2000 TO $3500.

(5) it seems this can be a pretty serious condition - how quickly should I seek attention?

THE SOONER THE SOURCE OF THE INFECTION IS REMOVED, THE BETTER. THE BACTERIA IS VERY INVASIVE AND IT CAN BECOME DIFFICULT TO ERADICATE COMPLETELY WHICH CAN COMPLICATE THE REPLACEMENT OF THIS TOOTH. THE INFECTION CAN ALSO INVADE THE SINUS WHICH CAN END UP BEING A CHRONIC PROBLEM.

I'm glad are now aware of the risks of root canal therapy. I'm sorry you were not previously informed. Whatever you choose to do, please keep us posted on how you're doing.

Bryanna

Originally Posted by Janet N

I recently had a root-canal retreated and this past week my gum has started swelling again. I've rinsed with peroxide mixture w/ warm salt water and it seems to help. I've read several of Bryanna's Posts regarding root canals/fistulas and am dumbfounded! I erroneously thought once a root canal was done, the tooth couldn't be infected again - so I thought I had a botched root canal. Now I understand that is not the case apparently, thanks to Bryanna. I'm not quite sure how to direct this post to Bryanna, but hope she will see it & reply

Here are a few concerns/questions: (1) should I go back to endodontist, dentist or see a a periodontist? (2) I'm leaning towards extraction and and implant but the tooth is #13 and I noticed my sinus' are bothering me. Thinking maybe I should back-up my immune system with pro-biotics until I get whatever procedure I end up having? (3) It seems like the extraction/implant is the way to go, right? (4) I live in SF any idea what I should expect to pay for extraction/implant (I know it varies from one office to the next, but ball-park)? (5) it seems this can be a pretty serious condition - how quickly should I seek attention?

Cost is not my main concern, making the right decision and having good information to do so is most important to me. I appreciate your response.

Thank you!

[Janet N]

Bryanna:

Thank you for your response! I have a consultation with a Periodontist in the morning. A friend who recently had an implant referred an oral surgeon (who happens to be on my list of network physicians). Not sure the difference - does one have better credentials than the other? Do you prefer the use of on over another? I picked up my xrays from my Endodontist who is really super nice and she said extraction is probably indicated at this point as their may be a small crack in the tooth. Just for another opinion - since I'm not sure what I'm looking at - I've attached a copy of the xrays - BTW Endo says its #14 not #13? Although if I start from back right and count - I count it as #13... (?)

Thanks again, you're awesome!!
Janet

[Bryanna]

Hi Janet,

A periodontist is a dentist who specializes in the surgical and non surgical treatment of the gums and is most concerned about the health of the surrounding bone and the systemic risks associated with dental infection. An oral surgeon is a dentist who specializes in all phases of oral surgery. They are both surgeons but their individual skill is what sets them apart from one another. Both are capable of removing teeth and placing implants.

Tooth #13 is the second premolar on the upper left side and #14 is the first molar on the upper left side. So you can probably tell which number it is by the size of the tooth... the premolar is smaller than the molar.

You indicated that you attached some xrays... they didn't come through. Could you try again? I'd be glad to look at them......

Bryanna

Originally Posted by Janet N

Bryanna:

Thank you for your response! I have a consultation with a Periodontist in the morning. A friend who recently had an implant referred an oral surgeon who happens to be on my list of network physicians). Not sure the difference - does one have better credentials than the other? Do you prefer the use of on over another? I picked up my xrays from my Endodontist who is really super nice and she said extraction is probably indicated at this point as their may be a small crack in the tooth. Just for another opinion - since I'm not sure what I'm looking at - I've attached a copy of the xrays - BTW Endo says its #14 not #13? Although if I start from back right and count - I count it as #13... (?)

Thanks again, you're awesome!!
Janet