Bryanna, I sincerely appreciate your generous advice and time!

I had a root canal on #3 tooth a month ago, and the tooth and gums are now in reasonably OK shape. My endodontist referred me to an oral surgeon, because after he suggested an apico, I expressed concern about the infection that imaging showed above the tooth. Yesterday, the OS said he saw no external or otherwise obvious indication of infection. The 3D imaging was sent from the endo to the OS, so he could see the area above the tooth where infection was present. The OS wanted to see me in 30 days, to image and make an assessment, (eventual extraction with possible implant).

He stated that it was possible for the infection above the tooth to "regress'.

Assuming this is possible, can I help myself with peroxide (Colgate Peroxl) or povidone iodine (Betadine mouthwash)?
I thoroughly understand that the tooth will remain infected no matter what, and needs to come out sometime soon.

Thanks.

Hi space22,

Thank you for the kind words

Based on your description, tooth #3 is really not okay. The gum may look okay but the tooth is very unhealthy.

Firstly, irrelevant of your symptoms or xray findings, the tooth is root canaled which indisputably renders the tooth non vital as the blood vessel that was feeding this tooth vitality has been severed. Secondly the hundreds and hundreds of microscopic canals that are not accessible either with a conventional root canal or a surgical root canal called an apicoectomy will harbor trapped infectious bacteria. So the tooth is infected.

Conventional dentists, both general and specialists, have varying opinions about treating or not treating the lesion (cystic infection) that often presents itself at the apex (tip) of the root canaled tooth.

This lesion, which is often a pus filled infectious cyst or pus filled hole in the bone, is caused by the proliferation of infection from the inside of the tooth to the outside of the tooth. This area of infection is fed by the blood vessels inside of the jaw bone. The infection is progressive and has the potential to spread beyond the apex of the tooth. The area of jaw bone that is infected can become deteriorated beyond repair leaving what is referred to as NICO or Neuralgia Inducing Cavitational Osteonecrosis. It's also worth mentioning that the apico surgery procedure can also lead to NICO.

Sometimes the lesion changes in size or shape, smaller or larger. Sometimes the pus will attempt to drain from the lesion out through the gum tissue or go another direction up into the sinus cavity. Even when the lesion appears to be "healed" the recurrence of it is highly likely because the tooth is still infected for the reasons that I stated above. I will attach a diagram of the anatomy of a tooth to show you the magnitude of the microscopic canals.

Unfortunately there is nothing "you" can do topically to treat the infection inside of tooth #3 or the infection that resides at the apex. The bacteria is trapped inside the microscopic canals inside of the tooth and the lesion is embedded in your jaw bone.

You can take certain supplements and eat nutritiously to help your immune system deal with this infection. But there is no amount of either that would favorably alter the status of the infected tooth.

Also worth mentioning..... dental implants are meant to be placed in healthy, non infected bone. They require a healthy blood flow that encourages your own bone to grow around the implant and adequate height, width and thickness of bone to hold the implant during the integration process. Root canaled teeth cause unfavorable changes in the surrounding jaw bone due to the proliferation of infectious bacteria and bone necrosis. Apicos also cause unfavorable changes in the bone. The longer an infected tooth is present in the bone, the more deterioration occurs. Therefore, it is always risky to replace an extracted root canaled tooth with a dental implant. So all the more reason to not hang on to that infected tooth for too long.

Some oral surgeons will suggest to place an immediate implant. This is fine is the tooth were healthy and say fractured or deeply decayed. However, it is not usually wise to do an immediate implant when replacing a root canaled tooth due to the proliferation of infection. It is usually wise to remove the rc tooth, wait 3-6 months and then place the implant. This way you can avoid additional post op complications as the site is being monitored during the interim between the extraction and the implant placement.

I hope this information was helpful to you. Let us know if you have further questions.

Bryanna

Thanks again, Bryanna. Your detailed explanations help tremendously!

space22,

You are welcome.
I forgot to attach the diagram of a tooth to show you the dentin tubules. So I am attaching it here. Please take a look.

Bryanna

Attached Thumbnails