Hi! I am new and glad I found this site when trying to figure out what a fistula is. I have many questions and concerns and hope someone can help.

I had a root canal in 2006 on tooth #30. I have developed a fistula under the tooth that in hindsight could have been there about 5 months. So, after a visit to the endo, he is referring me to the oral surgeon to have it extracted. Here are my questions and any additional advice would be appreciated.

1. Should I call to be put on antibiotics prior to the appoint?

2. Once he extracts the tooth, will he know to clean out the infection or do I need to request a particular procedure?

3. If I were to get an implant would this be the time for them to start on it since they are in there? Or do I need to let this area clear up before starting anything else?

4. My two teeth on either side are perfect with no work on them. Wouldn't a bridge be grinding them down and could this be trouble in the future? It seems like a bridge would "destroy" them?

5. If I just have it pulled, is there a time limit on deciding to get an implant in the future?

6. What are the negatives to just extraction and not doing anything?

7. My wisdom tooth has not erupted on the side. Is it possible with this tooth out of the way it will come through and move my back tooth into this space? I am 44 and have not noticed any pain or movement from the wisdom tooth, so is this not a possibility at this point?

Thank you for any help! I am in no pain, but want this tooth out ASAP. I hate the thought of the infection being in there. I will never have another root canal or recommend them. I wish I would have just had an implant to begin with. Thanks again!

Also, how do you know when the infection is gone?

Thanks!

Hi slby,

I will repost your questions and reply in bold type.

<<1. Should I call to be put on antibiotics prior to the appoint?>>
YOU SHOULD CALL THE ORAL SURGEONS OFFICE PRIOR AND ASK THEM WHAT THEIR PROTOCOL WOULD BE. SOMETIMES ANTIBIOTICS ARE PRESCRIBED PRE OP AND OTHER TIMES THEY AREN'T. DEPENDS ON THE INDIVIDUAL CASE.

<<2. Once he extracts the tooth, will he know to clean out the infection or do I need to request a particular procedure?>>

ORAL SURGEONS ARE TRAINED TO ALWAYS REMOVE THE PERIODONTAL LIGAMENT AND DEBRIDE THE BONE. HOWEVER, THIS IS NOT ALWAYS DONE
I ALWAYS ENCOURAGE PATIENTS TO GENTLY BUT ASSERTIVELY TELL THE SURGEON TO PLEASE REMOVE THE ENTIRE LIGAMENT AND DEBRIDE THE BONE THOROUGHLY. AN INFORMED PATIENT TENDS TO RECEIVE THE BEST CARE.

<<3. If I were to get an implant would this be the time for them to start on it since they are in there? Or do I need to let this area clear up before starting anything else?>>

PERTAINING TO ROOT CANALED TEETH.... IT IS BEST TO REMOVE THE TOOTH AND ALLOW THE SITE TO HEAL FOR SEVERAL MONTHS BEFORE PLACING THE IMPLANT. IF THE IMPLANT IS PLACED IN UNHEALTHY BONE, IT WILL CAUSE AN INFECTION AND MOST LIKELY FAIL.

<<4. My two teeth on either side are perfect with no work on them. Wouldn't a bridge be grinding them down and could this be trouble in the future? It seems like a bridge would "destroy" them? >>

BOTH ADJACENT TEETH WOULD NEED TO BE DRILLED DOWN QUITE A BIT FOR THE BRIDGEWORK. IF THEY ARE VIRGIN TEETH... NO FILLINGS IN THEM... THEN IT MEANS DESTROYING THEIR INTEGRITY FOR NO REASON OTHER THAN TO REPLACE THIS ONE TOOTH. YES, THINGS CAN THEN GO WRONG WITH EITHER OR BOTH OF THOSE TEETH IN THE FUTURE. YOU COULD ASK YOUR DENTIST IF YOU ARE A CANDIDATE FOR AN INLAY/ONLAY BRIDGE. THIS LOOKS SIMILAR TO A REGULAR BRIDGE BUT THE ADJACENT TEETH ARE NOT CROWNED. THEY ARE ONLY CUT DOWN MINIMALLY AND PORCELAIN INLAYS/ONLAY ARE WHAT HOLDS THE FAKE TOOTH IN THE MIDDLE.

<<5. If I just have it pulled, is there a time limit on deciding to get an implant in the future?>>

FIRST OF ALL YOU SHOULD INFORM THE ORAL SURGEON IF YOU CONTEMPLATE DOING AN IMPLANT AS HE MAY DECIDE TO PUT IN SOME BONE GRAFT MATERIAL PROVIDING THE BONE IS HEALTHY ENOUGH TO NOT REJECT IT. YES, YOU DO HAVE A TIME LIMIT TO HAVE AN IMPLANT PLACED AS THE BONE (YOUR OWN AND BONE GRAFT MATERIAL) WILL START TO RECEDED OVER TIME. USUALLY IT IS RECOMMENDED TO DO THE IMPLANT WITHIN THE FIRST YEAR OF THE EXTRACTION.

<<6. What are the negatives to just extraction and not doing anything?>>

THE NEGATIVES DEPEND ON YOUR ANATOMY. TEETH NEED TEETH NEXT TO EACH OTHER AND TO CHEW AGAINST OR THEY WILL SHIFT. THE EXCEPTION TO THIS IS SECOND MOLARS DO NOT NEED TEETH BEHIND THEM ONCE THE WISDOM TEETH ARE REMOVED.

<<7. My wisdom tooth has not erupted on the side. Is it possible with this tooth out of the way it will come through and move my back tooth into this space? I am 44 and have not noticed any pain or movement from the wisdom tooth, so is this not a possibility at this point?>>

IF THE SECOND MOLAR IS BLOCKING THE WISDOM TOOTH, THEN THE WISDOM TOOTH WILL NOT COME DOWN. IT IS UNLIKELY THAT THE SECOND MOLAR WILL SHIFT FORWARD INTO THE FIRST MOLAR SPACE ALLOWING THE WISDOM TOOTH TO COME DOWN. YOU MAY BE ABLE TO DO SOMETHING WITH BRACES AS FAR AS MOVING THAT SECOND MOLAR FORWARD BUT CHANCES ARE THAT WISDOM TOOTH ISN'T GOING ANYPLACE. ALSO WISDOM TEETH CAN BE VERY SMALL OR MISSHAPEN AND WOULD NOT SERVE ANY PURPOSE IF IT CAME DOWN. IT COULD ALSO BE REALLY FAR INTO THE BONE AND FORCING IT TO MOVE WOULD NOT BE WISE.

<<Thank you for any help! I am in no pain, but want this tooth out ASAP. I hate the thought of the infection being in there. I will never have another root canal or recommend them. I wish I would have just had an implant to begin with. Thanks again!>>

I AGREE WITH YOU 100%. THIS COULD ALL HAVE BEEN AVOIDED IF YOU WERE INFORMED OF THE SHORT COMINGS OF ROOT CANALED TEETH. YOU COULD HAVE HAD THE TOOTH REMOVED AND QUITE POSSIBLY HAD AN IMMEDIATE IMPLANT PLACED. I JUST WISH DENTISTS WOULD INFORM THEIR PATIENTS OF THIS OPTION............ UGH :/

Bryanna

Thank you so much Bryanna! I am so happy to have found this site.