Hi I have a 4 year old root canal and crown and yesterday was told I have an infection under the root canal in the bone. The fix was to clean out the root canal and get rid of the infection or take out the tooth. The tooth clean is over $2000. Ant advice on the best way to go would be great. Mark

Hi Mark,

I'm in the dental field and can clarify what it means to have an infected root canaled tooth.

The infection is actually inside of the tooth and it has spread into the jawbone. This is a common problem with root canaled teeth because the infected nerve material cannot be cleaned out of the canals completely which means there will always be some degree of infection inside of the tooth irrelevant of the number of times the tooth is root canaled. So a re treatment will not "clean out the root canal" or remove or decrease the infection in the tooth.

Sometimes a surgical treatment called an apicoectomy is suggested. This procedure is very painful, very costly, and will not remove or decrease the infection inside of the tooth.

The source of the infection is the tooth which means the infection will be present as long as the tooth is present. The only sure way to remove the infection is to remove the to remove the tooth.

I know this is not the news that you want to hear..... but I hope this information is helpful to you.

Bryanna

Hi,
I'm a new poster, and I'm impressed by the level of professional involvement in this forum.
I had all my upper teeth capped with zirconium crowns. During the grinding process, one of my front inscisers became sensitive, and the root below the gumline became very tender. Here is the interesting part: For the past 2 years, I've had the sensation at the opening to my nostril directly above this tooth that there was something 'raw' in my sinuses or nasal passage, but I've never been able to find it. I've inserted Q tips into the lower part of my nostril fully expecting to find blood or pus. Never did.

Now that I finally had that tooth root canaled, it went absolutely crazy in the space above my tooth and when I gently tap on the bottom of my nostril, that former "sinus pain' is obviously the infected root apex of the tooth. The root canal procedure did not produce any drainage or blood at all. I'm on Amoxicillin, which had been prescribed to me 3 months ago to keep it in check, but which stupidly I didnt think to take before the procedure.
Now, 3 days after the root canal, I have a swelling under my nostrils that make it look wide open, and there is no drainage anywhere that I can tell. I've been in touch with my dentist, (who is great, but is a GP,) and expressed my concern that aside from exquisite pain, I am starting to feel systemically sick, and questioned if this can become blood sepsis. He said no, but my heart is beating pretty quickly, but have no fever.

Nontheless, I have an appointmeht to go there in 2 days to have it sealed up. I told him I was converned that there was no drainage, and that it would not heal, or worse. He said he planned to 'poke' through the apex of my tooth to try to initiate drainage, which seems like maybe a decent plan, but I'm thinking that this is a bad infection, which has probably been festering in the bone which I can feel by tapping the inside lower rim of my nostril. There is also now a big swollen area inside my lip at the top of the tooth.

Any thoughts about this? I want to save the tooth, but I want the infection out, once and for all.

Hi azmanatheart,

I think your instincts about the infection are right on! From your detailed description, it sounds typical of an inflamed and/or perforated sinus from a long standing infection from that tooth.

The initial sensations in your nostril prior to the root canal were indicative of the onset of the infection. The root canal procedure does nothing to cure the infection in the tooth because it is not possible to access the microscopic canals which will always harbor infectious bacteria. The only way to cure the infection is to remove the source which is the tooth.

To perforate the apex of this tooth is the worst thing you could do because it would be like opening up a faucet of infection and giving it easy access to travel to... the sinus or further. The bump high up on your gum is a fistula which is the body's way of creating an outlet for the pressure that has built up from the infection. The pressure is what is causing the pain. The fistula is a temporary release, it does not mean the infection is leaving the tooth. To keep the fistula open, rinse 3-4 times a day with warm salt water and use your lips to make a drawing sensation as if to pull from that area. DO NOT swallow this water.

Your concerns about this infection becoming systemic are again right on! Our teeth are intricately connected to the rest of our body. Infections in our teeth can and will cause physical illness. If your dentist is not making this connection, he is misinformed big time! He may be a nice guy, but he needs to step outside of the tooth carpentry box and get some additional education on the whole body connection.

Here is the link to my post about what a root canal is to help give you a better idea of what is going on..
http://neurotalk.psychcentral.com/thread163589.html

Here is a tooth and organ chart depicting the real whole body connection. This information has been around for many centuries originating with chinese medicine.
http://www.naturalworldhealing.com/D...organchart.htm

Please use your instincts about this tooth, they are correct, it is in the bone, it has been festering for awhile and is moving upward. There is no cure for this infection other than to remove the tooth. Root canal therapy does not cure an infection.... it simply "retains" an infected tooth. To keep the tooth means to keep the infection. I know this is very difficult to hear and deal with. Please, do not just go along with the old standard of care routine... become better informed instead.

Please let us know how you are doing.

Bryanna

Dear Bryanna,
Thank you for the education. However, after reading the links you provided, it seems like there is no good course of action to take in my situation. If I leave the root canaled tooth in place, the infection continues: if I have it extracted, I release even more bacteria and will most likely develop a cavatation. Unless I missed something, it seems I'm damned no matter what I do?!
Seriously, this is enough to make a person panic. I need to make a judicious, informed decision. After reading your post, I was ready to have the tooth extracted to be rid of this infection, despite the fact that I lose a front tooth that has a brand new crown, and I wll probably need an expensive implant down the road. But after reading the link in your post, I dont see a route to getting better.
Can you please set me straight on this? I'm very grateful to you for taking the time to educate a stranger, but I seem to be missing something. There must be a correct action I can take, but my time is running short, since I have a very painful condition that needs attention.
I do feel sick, and cant taste the Eugenol in my mouth from the cotton filled hole made by the dentist, left open to allow drainage that isnt happening! The lump in my gum, or fistula, has not opened from what I can tell, and your advice to use warm soaks to try to 'bring it to a head' seems wise, although I'm tempted to take a sterile diabetes needle and try to draw it out. My lower nostril is now numb, and I'm getting worried. I dont know what to do.
Thank you for your time and patience in answering my questions.
Regards,
JEff

Bryanna is spot on. I removed several teeth rather than additonal treatment that in the long run does not work. Saving an infected tooth, puts your whole immune system on guard, and is not the best option in my opinion. I have immune problems to begin with, and sure didn't want additional problems. I wound up with a simple device called a besnit. You may want to look into this. For me, it was a wonderful solution to an awful problem I wish you all the best. ginnie

Hi Jeff,

You are welcome!
Are you a diabetic?? If so, that is a huge reason to NOT hang onto an infected tooth. And if your dentist is aware of your diabetes, he should know better than to have root canaled your tooth in the first place. Especially since you have a history of dental pain in that area of your mouth and sinuses prior to the root canal... both indicative of a long term infection.

Also, it is OLD school dentistry to leave a tooth open after having a partial root canal. That cotton pellet is doing nothing to prevent bacteria from getting up inside of that tooth.... adding insult to injury. The reason he did that was because he knows that tooth has a severe infection and if he closed it up, you would have developed a huge swelling and horrible pain from the pressure of the bacteria inside of that tooth. The fact that you developed a fistula after the root canal procedure was started and left opened to supposedly drain ...... again indicates a complicated infection. Let me clarify... this tooth is not draining, thus the fistual. Also, it is OLD school dentistry to leave an infected tooth open to drain into a person's mouth, especially a diabetic.

Forgive my assertiveness Jeff, I don't think I need to educate you on the risks of diabetes and infection, but perhaps you need to educate your dentist. Many dentists are tooth carpenters, not wise doctors.... unfortunately.

Let me clarify the difference between keeping an infected tooth and having a cavitation...... there is no difference. The cavitation is CAUSED by the proliferation of infection FROM the tooth. There is no "cure" for that infection in that tooth. The longer the tooth is present, the deeper the bone infection = cavitation.

DO NOT use anything to open that fistula. The bacteria is not just contained in that lump, it is in the jawbone and the tooth. It will open on it's own from the warm salt water if the pressure builds up enough. If that happens do not swallow the stuff that comes out ... spit it out and rinse with the salt water. The bump will continually fill up because the infection is coming from the tooth.

You are right about the complications of this situation and yes, it is disheartening that you have had all of this dentistry and are now faced with this decision. You should also know that if you are diabetic, you may not be a candidate for a dental implant mainly because of the health risk of placing an implant in an area of bone that has an infection is elevated in a diabetic.

To be honest... your dentist should have informed you about the health of this tooth prior to doing your crown work. Your original symptoms indicated an infection.... irrelevant of whether it showed up on an xray or not. I have a hunch that it did show up and was not diagnosed until you developed further symptoms. At the onset of your symptoms, especially since you were going to have all of this crown work, you should have been given the option of extraction at that time. You could have had a 3 unit bridge made there to replace this tooth instead of single crowns. It would have esthetically tied in beautifully with the other crowns. So if that had been done, the concern over doing an implant would have not been an issue. NOW, the situation is more complicated because of the extent of the infection. Am I explaining myself okay? Does this all make sense to you?

Your options are.....

Complete the root canal procedure = infection
Re treat with an additional root canal procedure = infection
Apicoectomy (a surgical root canal) = infection
Extraction of the tooth, debridement of the bacteria from the bone and possible entry into the sinus cavity depending on how extensive the infection has traveled.

Replacement option...

1) Take off the crowns on the adjacent teeth and make a three unit bridge. He should not charge you anything extra for doing this.

2) Consult an oral surgeon for a CT scan to see if you are a candidate for a dental implant.

I am sure that you are feeling quite panicked at this point. PLEASE stay calm so you can think clearly. The information that I have given you is meant to empower you with the knowledge that your dentist neglected or minimally provided to you. Lack of information is unfortunately a common situation in many dental offices... that is why I became a patient advocate in dental offices many years ago and why I'm here to help educate you on the issues that would otherwise be overlooked. You have the right to be properly informed.

It is hard to come across subtle on the internet about such important issues such as this. If you were sitting with me, I would be gently touching your hand and reassuring you that this can be remedied in a healthy manner. But it needs to be addressed asap.

Please keep in touch here.......
Bryanna

Hi ginnie,

Thanks so much for all of your kind words.... you are an amazing woman!!

The appliance that you had made is called a nesbit Just wanted to clarify your spelling so that someone reading that would know what to ask for.
Unfortunately, I don't think Jeff is a candidate for a nesbit as a permanent solution. But if he is a candidate for an implant, then he could wear a nesbit as a temporary solution while the implant integrated in the bone.

Ginnie... when is your foot surgery scheduled for??

Bryanna



T

Nesbit, I have to laugh at myself. do you know I do that all the time?. I get close but not quite.
I can't have surgery. I have mostly neruological problems extensively on the foot, going up my leg. he did mention RSD. I already knew I had PN. He things even though the structure of the foot is bad, a three incision surgery would only make the RSD Worse. The Neuro problems would not be corrected at all. So, a bit of a sad situation. I am OK. I will continue to get help for pain, and deal with it as best I can. I think this doctor a orthopedic surgeon did have my best interests at heart, and I believed him.

Keep up your posts and keep telling the truth! Education, knowledge is so important these days. Nobody can make an informed choice without that knowledge. It sounds like an old school dentist was involved, and didn't give the patient enough information from the beginning. I hope this good soul, gets the right treatment, and can move on with another better solution than what has already occured. I would rather have no teeth than deal with the pain and worry of those kinds of situations. I am so glad you are here Bryanna. Have a good night Bryanna. ginnie

ginnie,

I laugh at myself all of the time too .... it sure beats cryin'!!

It is wise for your physician to acknowledge the risks of surgery if he suspects that you have RSD. There is no way to know how much worse, if at all, the RSD would be or how that would affect the PN. I'm sure you are relieved to not be having surgery, but I know you were counting on this to help correct the structural issues.

I'm glad you are okay with this decision. I hope you are able to manage the pain okay..... like I said... you are one special woman!

I so agree with your statement....that no one can make an informed decision without the knowledge. I just wish more doctors/dentists believed in that too.

You are so helpful to so many here, ginnie. Your kindness always comes through loud and clear

Wishing you a good night also!
Bryanna




oot, going up my leg. he did mention RSD. I already knew I had PN. He things even though the structure of the foot is bad, a three incision surgery would only make the RSD Worse. The Neuro problems would not be corrected at all. So, a bit of a sad situation. I am OK. I will continue to get help for pain, and deal with it as best I can. I think this doctor a orthopedic surgeon did have my best interests at heart, and I believed him.

Keep up your posts and keep telling the truth! Education, knowledge is so important these days. Nobody can make an informed choice without that knowledge. It sounds like an old school dentist was involved, and didn't give the patient enough information from the beginning. I hope this good soul, gets the right treatment, and can move on with another better solution than what has already occured. I would rather have no teeth than deal with the pain and worry of those kinds of situations. I am so glad you are here Bryanna. Have a good night Bryanna. ginnie[/QUOTE]