Bryanna,

A week ago I woke up with severe pain right around a former root canal several years ago. The dentist referred me to an Endodontist. In addition to pain meds, I was originally prescribed Penicillan and it did nothing for my pain (and calm down the infection). I'm currently about 48 hours in to Clindamycin and it has brought my pain down from a 10 to a 9.

Anyway, apparently I have an infection in a cavity below the root of my tooth. The Endodontist said my tooth is very healthy and the roots are fine (even though they have had a root canal and crown). He wants to do an Apicoectomy once the infection is brought under control in about 10 days. From what I am reading here, should I just skip the years of aggravation and get it extracted and an implant put in? The Apicoectomy procedure is expensive, painful and looks like it is bound for more problems down the road.

I'm relatively young (35) and the teeth (and I would assume bone) around the area should be healthy. Should I just have the tooth pulled? It is tooth #19, so it's pretty darn vital to chewing food.

I've already missed a week of work and I'm of the mindset to pull it and get an implant and move on. Haven't researched that yet, but it just sounds better.

Hi Slyke,

Your description:
<<<Anyway, apparently I have an infection in a cavity below the root of my tooth.>>>

What you actually have is this.... a long standing infected tooth in which the bacteria has proliferated beyond the tooth into the jawbone. The truth is this tooth is not healthy and an apicoectomy CANNOT cure it because this procedure is nothing more than a surgical root canal. The tooth will remain infected and the exact problem that you now have will recur again and again. Each occurrence destroys more bone making replacement options very risky. The procedure itself results in so much inflammation that the bone often cannot heal completely even after the tooth is removed. Apicos are very expensive, very painful and considered barbaric by many dentists.

The antibiotic you are taking will subside your symptoms... and that is all it will do. It is not bringing the infection under control, it is simply reducing the inflammation. I am sorry if your dentist mislead you to thinking anything different than that.

You are wise to consider removing this tooth now before it gets worse. The best way to go about that would be to have it removed while you are still on the antibiotic. Go to an oral surgeon not a general dentist. Discuss bone grafting and when would be the best time to do that. If there is residual infection or unhealthy necrotic bone during the extraction, then the graft should be postponed. If the surgeon can debride the area CLEAN, then its ok to graft at the same time as removal. So these are things to discuss with the surgeon before the removal.

Replacement options for #19 can be an implant (only if the bone is healthy), a permanent bridge, or a removable appliance called a partial or a smaller removable called a nesbit. Talk these options over with your dentist.

I hope this information helps. All the best to you!
Keep us posted...
Bryanna

I too have a root canal done on #19 almost 12 yrs. ago. Now I have an abcess below the root of my tooth plus a fracture in my root. It is not really painful but really annoying. Dentist prescribed an antibiotic and I would like to try a natural method before going on the antibiotic. If the infection comes back, (whatever that means, since the antibiotic is not going to get rid of it fully) the dentist will proceed with either a tooth extraction or refer me to a specialist to perform an apicoectomy. The apicoectomy seemed better because I would rather avoid losing my teeth and the thought of an implant sounds really risky especially to bones, nerves, and sinus. If I could have my tooth removed without any implant or bridge that would be great, but then I heard that it could cause the other teeth to shift. Aaah!!! I don't know what to do.

What did you decide to do? How do you feel? I am experiencing almost the same situation and would like to know more information. Thanks

Good evening,

I know this is an older post, but I am facing this decision at this point and have no idea which to choose. About 6 months ago, my gums on the lower right side were bothering me and I went to my dentist. He stated that I had an infected root canal and should get it extracted and referred me to an endodontist. After researching (and finding this site, and reading a LOT about extraction nightmares), I decided to forgo the recommendation to the endodontist and contacted an Oral Surgeon in my area. They did the huge xray-scan that includes your entire jaw/face/sinuses (I don't remember what it's called), and said that since my back molar needed to be extracted with a bone graft, I was better off removing my final two wisdom teeth as well, both of which are on the bottom. So that day, I got three teeth extracted and a bone graft (which is healing nicely). However, after doing the scan, they asked me if I knew that my other previous root canal on right top is infected. My dentist did not find that one and I had no idea (and no symptoms). They also stated that I had polyps in my sinuses and a lot of fluid (no symptoms again, though). Since the infected root canal is so close to the sinuses, they had initially suggested an Apico, which the surgeon stated he is very good at. They then presented the other option of having it extracted and bone graft. Of course, my dental benefit limit is almost reached already for the year and it's only July (I think I have $400 left?). Come January, I need to begin the implant procedure for the lower right molar that I had already extracted.
Upon my second follow-up appointment to check my bone healing about a month ago from my wisdom teeth and molar extraction, they did another panoramic x-ray and said that everything is healing well, but that infection is still a problem on the top right and I needed to make a decision. They didn't seem to really recommend one over the other, but stated that Apico is not guaranteed to work, but that I should attempt to save the tooth (but that I may need it extracted thereafter anyway).

Now, of course, two days ago all of a sudden my upper right gums started to bother me, and now my gums hurt and my two upper back molars are hurting me. I wouldn't say it's pain but more discomfort and like I can feel my heartbeat in them. I'm worried. I've been reading all day (ALL DAY!) and just can't decide which I should do. I am leaning toward just getting it extracted because I read so much about subsequent bone loss and infection after apico. Being that I have had all of two root canals in my life, and now I have two infected root canals, my teeth don't seem to like them very much. I'm afraid the apico will just turn on me like the two root canals did (they did each last over 10 years though).

I'm sorry I'm rambling. I have three (multi-part) questions...
1. Does my pain mean that it is possibly spreading infection? Or just making it's way toward a worse infection? Or are symptoms just starting to show?
2. Do I really want to extract this tooth? I know the infection will hide away in microscopic places because I've read your other responses, but this will mean that I will need TWO implants next year and it's just such an unexpected expense in one year... I already have to wait until January to even address my first missing molar, now I'll have TWO!
3. Also a major concern of mine... How will this extraction affect my sinuses? Could I have polyps due to the infection in the root which is so close to my sinuses? I'm so worried that this will cause me many more problems, but will the Apico make it worse or will the extraction make it worse?

Sorry this seems so disjointed. I just have so many questions after reading up on this so much today. Today is Monday night, and I wanted to call to try to schedule for Thursday morning, but I'm worried that maybe that is waiting too long.

Thanks so much for listening, and for any advice that I get back.

Shawn

Hi Shawnis,

Just a word of caution when reading the internet for dental stories about someones dental experiences..... most of the time a lay person has little knowledge about the intricacies of dentistry, therefore, their explanation of the experience in the dental chair can be a bit exaggerated. That statement is not intended to discard those who have had poor and harmful experiences as there are plenty of those. It is just to clarify that the view and interpretation of what occurs while laying in the chair can be very different than what actually occurs. Also the lay persons reasons for what had occurred can be misconstrued because of the lack of dental knowledge. I can honestly make these statements because I know what it's like to be in the dental chair as a patient and what it's like to be on the other side of the chair partaking in the care of the patient. So please don't let the stories frighten you or cloud your thinking. Read them with an open mind

I am going to re post your questions and answer you in bold type. It is just easier to follow that way.

<<1. Does my pain mean that it is possibly spreading infection? Or just making it's way toward a worse infection? Or are symptoms just starting to show?>>

YES THE PAIN AS WELL AS YOUR OTHER SYMPTOMS ARE INDICATIVE THAT THE BACTERIA HAS SPREAD. ALSO THE FACT THAT AN APICO WAS RECOMMENDED SUGGESTS PROLIFERATION OF THE INFECTION AND SO DOES THE POLYPS IN THE SINUS OVER THAT ROOT CANALED TOOTH.

<<2. Do I really want to extract this tooth? I know the infection will hide away in microscopic places because I've read your other responses, but this will mean that I will need TWO implants next year and it's just such an unexpected expense in one year... I already have to wait until January to even address my first missing molar, now I'll have TWO!>>

I KNOW THE FINANCIAL END OF THIS IS BURDENSOME AND BELIEVE ME, IT IS FOR MOST PEOPLE. BUT PERHAPS WHAT YOU SHOULD BE FOCUSING ON MORE THAN THE $$ IS THE INFECTION THAT YOU HAVE THAT HAS INVADED THE BONE AND THE SINUS. THERE IS ALREADY DETERIORATION GOING ON SURROUNDING THAT TOOTH, THE INFECTION CAN SPREAD TO THE ADJACENT TEETH AND TO BE TOTALLY TRUTHFUL WITH YOU, IT CAN EVEN CROSS THE SINUS BARRIER AND ENTER YOUR BRAIN AS THAT ORGAN IS ONLY 3-4 INCHES FROM THE TIP OF THE ROOT OF THIS TOOTH. SO YOU HAVE A SERIOUS INFECTION BREWING FROM THIS TOOTH THAT UNFORTUNATELY CANNOT BE "CURED" BY AN APICO OR RC RETREATMENT. NEITHER OF THOSE PROCEDURES CAN ALTER THE STATE OF INFECTION INSIDE OF THE HUNDREDS OF MICROSCOPIC CANALS. SO IN SIMPLE TERMS, TO KEEP THE TOOTH IS TO KEEP THE INFECTION.

<<3. Also a major concern of mine... How will this extraction affect my sinuses?>>

YOU WILL MOST LIKELY HAVE A SINUS PERFORATION. THE SEVERITY OF THAT CANNOT BE DETERMINED UNTIL THE TOOTH IS REMOVED. A PRE OP 3D CAT SCAN CAN BE A VERY INFORMATIVE AND DIAGNOSTIC TOOL IN SHOWING MORE OF THE SINUS PROBLEM THAN ANY 2 DIMENSIONAL XRAYS LIKE THE PANOREX OR PERIAPICAL. THE ORAL SURGEON SHOULD BE PREPARED AHEAD OF TIME TO DEAL WITH THE SINUS PERFORATION AND HOPEFULLY CAN TAKE CARE OF THAT AT THE TIME OF THE EXTRACTION. HOWEVER, THE POLYPS NEED TO BE ADDRESSED IN CONJUNCTION WITH THE EXTRACTION AS THAT MAY BE THE BEST TIME TO REMOVE THEM TOO.

<< Could I have polyps due to the infection in the root which is so close to my sinuses?>>

YES, ABSOLUTELY. THE INFECTION IS BREWING INSIDE OF THE TOOTH IN THOSE MICROSCOPIC CANALS CALLED DENTIN TUBULES. IT HAS BEEN AN ONGOING INFECTION SINCE OR PRIOR TO HAVING THE RC DONE. IT'S JUST REMAINED ASYMPTOMATIC UNTIL NOW. IT'S IMPORTANT TO KNOW THAT THE ENTIRE TOOTH IS INFECTED, NOT JUST AT THE ROOT. THE INFECTION SHOWS ITSELF ON A 2 DIMENSIONAL XRAY AT THE ROOT TIP BECAUSE THE XRAY BEAM IS SELF LIMITING TO THE AREAS THAT ARE BEING CAUGHT IN THAT ANGLE OF THE FILM. IF THE FILM HAD BEEN TURNED OR BI SECTED TO CAPTURE A DIFFERENT ANGLE OF THE TOOTH, WHICH IS WHAT A 3D SCAN AUTOMATICALLY DOES, THEN DIFFERENT AREAS OF INFECTION WOULD BE CAUGHT BY THE RADIATION.

<< I'm so worried that this will cause me many more problems, but will the Apico make it worse or will the extraction make it worse?>>

THE APICO WILL NOT CURE THE INFECTION AS THAT PROCEDURE DOES NOT ACCESS THE MICROSCOPIC CANALS. THE APICO ALSO CAUSES PERMANENT BONE LOSS AT THE ROOT TIP OF THE TOOTH WHERE THE SURGEON MAKES HIS OPENING TO ACCESS THE BONE. THAT HOLE IN THE BONE IS OFTEN PLUGGED WITH MERCURY OR SOME OTHER TOXIC SUBSTANCE. SO YOU WILL CONTINUE TO HAVE A BREWING INFECTION, SINUS PERFORATION AND POLYPS, AND BONE DETERIORATION. UNFORTUNATELY, THE ONLY DENTAL PROCEDURE TO ATTEMPT TO CURE THE INFECTION, IS TO REMOVE THE SOURCE OF THE INFECTION WHICH IS THE TOOTH. IT IS IMPERATIVE THAT THE ORAL SURGEON REMOVE THE TOOTH AND ALL DISEASED TISSUE AND BONE IN THEIR ENTIRETY WHEN HE EXTRACTS THE TOOTH. ANY RESIDUAL INFECTED TISSUE OR BONE CAN RESULT IN FURTHER INFECTION. IT IS IMPERATIVE TO DISCUSS IN DETAIL WITH THE ORAL SURGEON WHAT HE PLANS ON DOING WITH THE SINUS POLYPS AND IF YOU SHOULD CONSULT AN EAR NOSE AND THROAT DOCTOR TO EITHER DISCUSS THAT SURGERY WITH THE OS OR HAVE THE ENT PARTAKE IN THE POLYP REMOVAL AT THE TIME THE TOOTH IS EXTRACTED. YOU WANT TO UNDERGO SURGERY THE LEAST AMOUNT OF TIMES POSSIBLE.

I know none of this is pleasant to read and it is scary and expensive. It is best to discuss all of this in detail with the oral surgeon, ask about having the 3D scan done ... even consult an ENT on your own. The whole ordeal can be a lot easier and with less post op complications if you have all of your ducks in a row.

I hope this information was helpful to you. Let us know how things go.
Bryanna