[cmarie]

Firstly, I very much appreciate this forum. I have learned more here in one night than I have in many, many dentist and specialist visits over the past decade.

In a nutshell, my problems began in 2005 (20 yrs old) when I was told I had 40+ cavities and needed two RC's (the two issues I have today and will describe below). RC's were done and cavities were filled. To my horror, after finding a more educated and experienced dentist in 2007, I was told that only 90% of the decay was actually removed before the dentist filled the cavities and that all of those fillings would need to be refilled. They were all refilled and, by this time, the decay was very deep. From 2005 to today's date, on top of all of these fillings, I have had 9 abscesses, 10 RC's, 3 extractions, 6 crowns and 2 "4-tooth" bridges.

At the moment, I have two issues (long standing infections). These are the two RC's mentioned above - completed by the same dentist who only removed 90% of the decay when doing fillings.

1 - Very back top molar on the left (X-Rays attached): Fistula appeared on the gum above the tooth beside the infection about a month ago. Dentist referred me to a specialist who said that a re-treatment of any kind would have a very low success rate. I decided to extract. To further complicate the issue, there is a 4-tooth bridge anchored by this tooth which is going to have to be removed and cut in half. As seen in the X-Ray, my sinus membrane is very close to the infection.
2 - Mid molar on the bottom left: This tooth has been dead and a dark yellow color for many years. My dentist has left it for so long because he didn't want the teeth beside and above to move around and wasn't sure a bridge would work in that location. I have asked him to extract this one as well.

I am very concerned (terrified, in fact) about these two extractions for several reasons, and my questions are:
-- Because these two teeth are infected, when they are extracted, will the collection of infection not go straight into my bloodstream? I understand the infection is likely already in my bloodstream, but will extraction not cause sepsis?!
-- Is there a chance that, during extraction, there could be damage/exposure to my sinus membrane?
-- I do not want to be left with a cavitation but am assuming it's going to be difficult to convince a surgeon to do anything more than a simple extraction considering the fact that they promote RC's as "solutions" and don't even seem to understand the risks. How can I be sure that the surgeon will debride the area and remove all of the infected bone and tissue, etc.? Would the surgeon remove the periodontal ligament as well, or use a drill to remove a portion of it? It seems almost pointless to have the tooth pulled if the infection has gone much further. I want to be rid of the entire affected area.
-- This is the first time I have had to extract a RC'ed tooth. Is this extraction going to be more complicated or risky than a tooth without a RC?

My concern right now is dealing with these two teeth ASAP, but I am also now looking at the bigger picture and trying to decide what's best for my health.

-- I am considering having all of my RC'ed teeth pulled. Is it safe to keep the other teeth with deep fillings but no RC's? They will obviously become infected at some point, but if there is no pain, is it safe to say the nerves on those teeth are okay?
-- If I had all of the teeth pulled and full immediate dentures put in, would that be the end of this madness? Would it be the end of the chronic infections or would I really never be able to fully rid myself of the infection?
-- I am concerned that I have the beginnings of heart disease as a result of the chronic infections. If I remove the source, can I reverse the damage?

Thank you so very much for all of the fabulous, honest information provided here in this forum!

[cmarie]

Through further reading here, I have been able to answer the bulk of my questions below. Surgery to extract two infected RC'ed teeth is scheduled for next week. My only real concern at this point about the surgery is the risk of a sinus exposure. Can anyone interpret the XRays I have attached in terms of potential sinus involvement? Is the infection even visible on the XRay? (I can't seem to see it although I realize the images are not great).

I am now trying to look forward at a solution rather than continue to wait for abscesses and fix them as they happen, all the while knowing I have many "septic tanks" sitting in my skull. My body does not feel well at all and I cannot stand the thought of having a mess of dead teeth/ligaments/bone. I feel, though, that making the decision to pull all of my teeth is quite drastic. My teeth actually look quite good (after approx. $70,000 in restoration... if only I knew back then what I know today). Looks are deceiving, I know.

Has anyone reading here made the decision to pull them all and regretted it? Is there a threshold you should reach before making that decision? I am no longer concerned with finances or cosmetics - only my overall health, so I think the decision is obvious, but I am clearly struggling with the obvious...

[Bryanna]

Hi cmarie,

I'm sorry for the delay in replying to you. You have a complicated case for many reasons. One big reason is due to the numerous root canaled teeth that you have which means you have infection throughout your mouth. Although the upper left may be symptomatic at this time, that does not necessarily mean that this is the worst area. Another concern which your dentist may not have discussed with you is how your root canaled teeth could jeopardize future dental work. Firstly, if any of those teeth are part of a multi unit bridge (similar to the upper left) the life of the bridge is going to be compromised. Secondly, when the infection has proliferated into the jaw bone and/or the sinus, all of that area becomes compromised making replacement options difficult.

I am not in the position to suggest that you get all of your teeth removed. It sounds to me like you are aware of the inevitable and need to figure out what is best for you at this time.

I will answer your questions in caps to make it easier to follow...

<<I am very concerned (terrified, in fact) about these two extractions for several reasons, and my questions are:
-- Because these two teeth are infected, when they are extracted, will the collection of infection not go straight into my bloodstream? I understand the infection is likely already in my bloodstream, but will extraction not cause sepsis?!>>

THE BACTERIA FROM YOUR ROOT CANALED TEETH HAS BEEN FILTERING THROUGH YOUR BLOOD FROM THE ONSET OF THE INFECTION. WHICH OCCURRED BEFORE OR AS A RESULT OF THE ROOT CANAL THERAPY. SEPSIS IS A VERY BROAD TERM AND BASICALLY REFERS TO A BACTERIAL INFECTION IN THE BLOODSTREAM OR BEYOND. THE COLLECTION OF INFECTION THAT YOU SPEAK OF IS ALREADY PRESENT. THE FIRST ATTEMPT TO REMOVE THE INFECTION WOULD BE TO REMOVE THE SOURCE, WHICH ARE THE TEETH.

<<-- Is there a chance that, during extraction, there could be damage/exposure to my sinus membrane?>>

YES, THERE IS A CHANCE OF PERFORATION TO THE SINUS DURING THE EXTRACTIONS. BUT THERE IS ALSO A CHANCE THAT THE BACTERIA HAS ALREADY GONE INTO THE SINUS. YOUR X-RAYS SHOW A CLOSE PROXIMITY BETWEEN YOUR SINUS AND THE ROOTS OF YOUR TEETH.

<<-- I do not want to be left with a cavitation but am assuming it's going to be difficult to convince a surgeon to do anything more than a simple extraction considering the fact that they promote RC's as "solutions" and don't even seem to understand the risks. How can I be sure that the surgeon will debride the area and remove all of the infected bone and tissue, etc.?
Would the surgeon remove the periodontal ligament as well, or use a drill to remove a portion of it? It seems almost pointless to have the tooth pulled if the infection has gone much further. I want to be rid of the entire affected area.>>

ORAL SURGEONS ARE TRAINED TO REMOVE THE PERIODONTAL LIGAMENT AND DEBRIDE THE BONE. THIS IS SUPPOSE TO BE A STANDARD PROCEDURE FOR ALL EXTRACTIONS. HOWEVER, I ENCOURAGE PATIENTS TO BE THEIR OWN EDUCATED ADVOCATE AND WITHOUT HESITATION TELL THE SURGEON TO BE SURE TO REMOVE THE LIGAMENT AND NECROTIC BONE AS MUCH AS POSSIBLE. THE LIGAMENT IS NOT DRILLED OUT, IT IS SURGICALLY SCRAPED OFF OF THE BONE. I KNOW THAT SOUNDS GROSS... IT'S ALL A PART OF DEBRIDING THE SOCKET. IT IS NOT POINTLESS TO REMOVE THE TOOTH BECAUSE THAT IS THE SOURCE OF THE INFECTION. IT IS IMPERATIVE TO THOROUGHLY DEBRIDE THE BONE.

<<- This is the first time I have had to extract a RC'ed tooth. Is this extraction going to be more complicated or risky than a tooth without a RC?>>

SOMETIMES IT CAN BE, YES. ROOT CANALED TEETH ARE MORE BRITTLE, FRAGILE, THAN NON ROOT CANALED TEETH BECAUSE THE VITALITY (BLOOD SUPPLY) WAS CUT OFF DURING THE ROOT CANAL PROCEDURE. HOWEVER, ORAL SURGEONS REMOVE ROOT CANALED TEETH EVERY DAY... THEY HAVE SPECIAL INSTRUMENTS TO DO IT PROPERLY.

<<My concern right now is dealing with these two teeth ASAP, but I am also now looking at the bigger picture and trying to decide what's best for my health.>>

WHAT IS BEST FOR YOUR OVERALL HEALTH IS TO ELIMINATE THE INFECTION IN YOUR MOUTH. IF YOU CANNOT FATHOM THE IDEA OF REMOVING ALL 10 OF YOUR ROOT CANALED TEETH AT THIS TIME, THEN IT WOULD BE HELPFUL IF YOU HAD A TREATMENT PLAN WITH YOUR DENTIST THAT TOOK YOU THROUGH PHASES TO REMOVE THEM SO THAT YOU ARE NOT CONTINUOUSLY THROWING AWAY YOUR MONEY ON DENTISTRY THAT IS NOT GOING TO LAST. A PLAN OF PHASES WOULD ENABLE YOU TO DO THE EXTRACTIONS IN STAGES WHEREAS YOU COULD WEAR PARTIAL DENTURES DURING THE REMOVAL PHASE. PARTIAL DENTURES MAY BE FITTED TO ACCOMMODATE EACH REMOVAL AS TEETH CAN BE ADDED TO THESE APPLIANCES DEPENDING ON WHERE THE TEETH ARE IN YOUR MOUTH.

<<-- I am considering having all of my RC'ed teeth pulled. Is it safe to keep the other teeth with deep fillings but no RC's? They will obviously become infected at some point, but if there is no pain, is it safe to say the nerves on those teeth are okay?>>

IT IS IMPOSSIBLE FOR ANYONE TO TELL YOU IF THOSE NON ROOT CANALED TEETH ARE HEALTHY WITHOUT X-RAYS AND A CLINICAL EXAM. DEEP FILLINGS DO NOT NECESSARILY MEAN THE TEETH NEED TO BE REMOVED. AGAIN PARTIAL DENTURES MAY BE AN OPTION DURING THE REMOVAL PHASE WHICH MAY ALLOW YOU TO KEEP THE TEETH THAT ARE HEALTHY.

<<-- If I had all of the teeth pulled and full immediate dentures put in, would that be the end of this madness? Would it be the end of the chronic infections or would I really never be able to fully rid myself of the infection?>>

FULL DENTURES MAY NOT BE NECESSARY AT THIS TIME. YOUR OTHER TEETH MAY BE HEALTHY ENOUGH TO KEEP FOR MANY YEARS YET. THE TEETH THAT ARE ROOT CANALED ARE WITHOUT A DOUBT HARBORNG BACTERIA. THE FURTHER THIS BACTERIA GROWS THE MORE DIFFICULT IT IS TO ERADICATE.

<<-- I am concerned that I have the beginnings of heart disease as a result of the chronic infections. If I remove the source, can I reverse the damage?>>

HOPEFULLY YES! ORAL BACTERIA HAS BEEN LINKED TO CORONARY ARTERY DISEASE .... DIABETES....SOME FORMS OF KIDNEY DISEASE.... SINUS INFECTIONS... EVEN CANCER OF THE BRAIN CALLED GLIOBLASTOMA MULTIFORME.

I know you are terrified of what you are living with and also afraid of the thought of losing your teeth. The remedy is not 100% clear due to the various areas of bacteria. But you are aware of the current risks connecting your oral health with your systemic health and that perhaps should be what steers you to your conclusions.

I wish I could give you better news.... I am so sorry you are dealing with all of this. I think you will be able to make choices based on what you believe to be in your best interest in spite of the fear.. I really do.

Bryanna

[Bryanna]

Cmarie,

I will answer your last question and then repost your last statement...

<<Has anyone reading here made the decision to pull them all and regretted it? Is there a threshold you should reach before making that decision? >>

IN 30+ YEARS IN DENTISTRY I HAVE NEVER HAD A PATIENT REGRET THE REMOVAL OF THEIR INFECTED TEETH. YES, THEY HAD TO ADAPT TO PARTIALS OR DENTURES. YES, IT WAS DIFFICULT AT THE BEGINNING. BUT WHEN THEY REALIZED THEY TRADED THEIR TEETH FOR THEIR HEALTH... THE JOURNEY WAS WORTH IT.

I THINK THIS SAYS IT ALL...
I am no longer concerned with finances or cosmetics - only my overall health, so I think the decision is obvious, but I am clearly struggling with the obvious...

AND IT IS UNDERSTANDABLE TO STRUGGLE WITH THIS DECISION. BUT ONLY YOU CAN MAKE IT AND FOR THE REASONS THAT YOU FEEL ARE MOST IMPORTANT TO YOU.

Bryanna