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

Hi Carleton,

If you have been reading my posts here you will see that I have written a great deal about infected teeth and how root canals and apicoectomies cannot cure the infection. You are a prime example of all that I have written here because not only have you had 2 root canals on this tooth but have gone on to develop abscesses and ultimately a fistula in spite of the root canal treatments and the over abundance of antibiotics.

You need to be aware that there is no antibiotic that will cure the infection inside of this tooth which is causing the abscesses and fistula. The bacteria is residing inside of the tiny canals and pushing it's way through the walls of the tooth and the ligament as it spreads to the bone. At this point it is not just these tiny canals that are an issue.... it is the jawbone. Imagine this bacteria festering since your original rc in 1996 or sooner!

You are wise to be concerned about the health risks associated with all of these antibiotics especially since they are serving no benefit to you in any way other than to temporarily subside your symptoms. In fact, they are doing your gut more harm than anything else and you need to be aware that they could actually cause you to have a long term gastrointestinal problem even after you stop them. So what is the point? If your dentists have not informed you of this... they should have.

Here was your questions... I will follow in bold type..

<<<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.>>

YOU ARE CORRECT, IT WILL NOT CURE THE PROBLEM.

<< 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?>>

THERE IS NO VALUE IN TAKING THE CLINDA WITH THE NOTION THAT IT WILL CURE THIS INFECTION. THAT IS UTTER NONSENSE. IT IS THE TOOTH THAT IS THE SOURCE OF THE INFECTION. THE FISTULA IS A RESULT OF THE INFECTED TOOTH.

<<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.>>

THERE IS NO EVIDENCE OR LIKELIHOOD THAT THE ANTIBIOTIC WILL CURE OR AS YOU PUT IT, KILL, THE INFECTION BECAUSE THE TOOTH IS THE SOURCE OF THE INFECTION. THE TOOTH IS OVERWHELMED WITH INFECTIOUS BACTERIA THAT CANNOT BE ERADICATED. THAT HAS BEEN PROVEN NOT ONCE BUT TWICE WITH THE ROOT CANAL TREATMENTS. THE ONLY WAY TO CURE THE INFECTION IS TO REMOVE THE SOURCE... WHICH IS THE TOOTH.

If you haven't seen this already about the systemic risks of infected teeth... I urge you to read it. There are other articles out there similar but harder to find...
http://articles.mercola.com/sites/ar...ot-canals.aspx

My hope in being here is to educate people and arm them with reliable information so they will make good decisions. I think you know what you need to do.... it's just the idea of doing it. Prioritize what you believe is in your best interest for your overall health... this will help you sort through the
process.

Please feel free to ask other questions or share your concerns.
Bryanna

Hi Carelton,

I am not a dentist or doctor but I was on Clindamycin not too long ago and was worried about the side effects like you. I took a probiotic to help reduce the risks and did not have any problems. It's good to take probiotics anytime you take antibiotics since all of them will upset the healthy flora in your intestines. So if you do decide to stay on these antibiotics I would definitely talk to your pharmacist about getting some probiotics. Just make sure you wait a minimum of 2 hours after you take your antibiotics to take the probiotics.

Aside from that I would listen to Bryanna she gave me some good advice and from what I can see helped a lot of people on these boards.

Hey Carleton2013,

You live in the same city as me.

I have the same Fistula problem with my tooth and I'm still debating if I should extract the tooth or perform a root canal. I'm just scared to extract my tooth. It's the back molar tooth.

The only difference is that you've already done root canal ready. I'm not a doctor but I read so many forums/articles saying that...if root canal procedure can't fix the Fistula problem...then the Endodontist might need to cut the root of the tooth or something. Otherwise, extract tooth as the last method.

Hi fistula_help,

Yes, if a root canal and subsequent root canal retreatment fail, then most endodontists recommend the procedure you refer to where the root of the tooth is cut - which is an apicoectomy. Bryanna has spoken about this procedure in other threads but I will say that in my opinion - it seems that by the time you're confronted with an apicoectomy as an option, it just seems better to extract the tooth. I'm looking at that eventuality myself, but am holding off for financial and other reasons at the moment.

Luckily for you, it seems that you are not at the apico stage yet. Your decision seems to be between an initial root canal versus an extraction.

Have you decided what to do next?

In regards to my Fistula tooth problem (which is probably similar to your abscess problem), 2-3 dentists referred me to a place called "Endodontic Specialists" on Bay Street to see Gary Glassman.

I think most dentists will refer you to that place for complex root canal/fistula problems.

Wow. Small world. I was referred to the exact same place and the exact same dentist. Though I suppose that's not too surprising given where we live.

I didn't take the Clindamycin. After considering Bryanna's advice and really weighing the pros/cons of that medication, I decided not to expose my system to that antibiotic for three weeks given that previous courses of the similar antibiotic Amoxicillin did not apparently remove the infection. So the medication is just sitting in a dry location on my shelf.

I believe the road I'm on is that I'm eventually going to have to extract this tooth. I also know that sooner is better than later. My dilemma is getting over the fact that I have no pain right now (pain is usually what spurs people to action in cases like this) because extraction isn't necessarily an easy procedure and I can't shake this feeling that I'd be getting rid of a tooth that isn't giving me pain right now and then have to navigate the financial costs of getting an implant or some sort of denture. The only issue is the fistula I have.

I will continue to look into options for the best way to extract the tooth and then getting some sort of affordable denture as an interim solution until I can afford one of those expensive implants (assuming I can get one given what my gum/bone situation is after extraction). I'd like to get one of the more expensive implants eventually, but probably can't spring for that financially until a few years from now. I certainly don't want to wait for years to extract this though, so I may have to get some sort of partial in the meantime.

I know that if I see another endodontist, they're just going to recommend an apicoectomy. My question is: has anyone gotten an apicoectomy and actually had the tooth hold up without issue for even 5+ years? I see the 5-year success rates of apicoectomies online, but they're all published by endodontic journals and such. I'd be very interested to know from actual people who have had the procedure if it's truly had any long-term success for them. Seems hard to find.

I did want to just say that in your case, I came across a few stories online of people extracting a back tooth (a molar for instance) and then being okay not replacing them. You should definitely do your own research but I think the general thought is that since the tooth isn't visible and not essential for eating, some people feel that they didn't need to replace it.

Hi Carleton2013,

Thanks for sharing your story. Do you have dental coverage with your full time employer? Some universities/colleges also cover about 75% of dental coverage as well if you are a student.

In my case, I have some fear extracting my molar tooth (the last tooth at the back). Thanks for letting me know about your online research. I should decide by this week and know if I will extract/or do root canal. I'm the type of person that wants to try before extracting a tooth.

Extracting the tooth means 100% is solved. I am kind of thinking about this because the molar tooth is quite weak right now. If I wiggle it, it moves whereas my other tooth doesn't move.

I was also referred to another place to extract my tooth: Metropolitan Oral and Maxillofacial Surgery Centre

Also, I don't think we should go to a basic dentist to extract tooth.