Hi Bryanna,

I've read your posts over the last few months and have found your advice very insightful. In the midst of a difficult decision, I wanted to ask for your thoughts on my situation.

In June 2012, I suddenly started experiencing pain above my canine tooth which had a root canal done way back in 1996. By and large, I hadn't experienced any problems in the preceding 16 years. I visited my general dentist and was given a course of Amoxicillin 500 mg. I was also told an abscess had developed and I'd likely need RC retreatment. Dreading this procedure, I simply took the medicine and when the pain subsided due to the antibiotics, I went on with my summer.

In October, the pain returned. Curiously, it wasn't quite as bad this time but realizing I probably had to do something, I relented and booked a visit with an endodontist (the one who did the original RC in '96 had predictably retired so I had to find someone new). Sure enough, he advised retreatment and also gave me another course of Amoxicillin 500 mg. I had two sessions at his office and the retreatment was completed. The pain was also gone.

About three weeks after the retreatment...the pain returned again, this time a throbbing pain that was even accompanied by a headache. I was travelling at the time so actually had to call my dentist to get him to me prescribe me another course of Amoxicillin 500 mg over the phone to a nearby pharmacy (my third time on this medication in six months). Thankfully, the pain went away.

Of course, this persistent issue took on a new form in December when I noticed a fistula above that tooth. At first I was quite concerned by its appearance but there was no pain. I found that after brushing my teeth it would go away, only to return a couple days later (usually after eating or drinking).

This is the way things have been for the last few months until my six-month checkup with the endo. Upon seeing the fistula, he has now prescribed a very aggressive course of Clindamycin 300 mg four times a day for three weeks! He says he wants to "knock out the infection for good". Since I had good experiences with Amoxicillin, I was actually quite fine with this. In fact, I was very relieved that he didn't recommend an apicoectomy. I have researched that procedure and have pretty much resolved I would rather extract the tooth than have an apico should things ever reach that point.

However, after researching Clindamycin, this drug carries a heavy risk of some unpleasant side effects such as diarrhea and some complicated potential gastrointestinal issues. Pretty scary stuff if you Google it. I really don't want to take it if I don't have to.

My question is: it seems this medicine at best may quiet the fistula for a while, but this notion of getting wholly rid of the abscess seems suspect. Simply reading these dreadful potential side effects doesn't inspire a lot of confidence, and if this tooth is destined to be extracted at some point down the road, is it really worth it to flood my system with Clindamycin for three weeks and hope to dodge those side effects for a result that (at best) will only be a temporary solution? If there was any chance this drug could truly kill this infection for good - I'd troop through it. However, I haven't come across any documentation of this drug eradicating a fistula. It seems to simply be a stronger version of Amoxicillin which, while helpful, didn't manage to stamp out this thing for good.

I'd greatly appreciate your feedback as well as your usual candid and forthright advice.

Best,
Carleton2013