[fish41213]

Bryanna -

I have gathered that you have quite an extensive knowledge in the dental field. I am getting married in 3 weeks - in the last 4 months I have had two apicoectomies after 2 failed RCT's - I developed a fistula this weekend and X'rays at my general dentist showed the infection is still there - I would really like your insight as to what I should do - If you could please contact me privaltely on this I would appreciate it!!

[fish41213]

THis is what I posted on another site - this is the whole story

This all started July 2012 when I went to my regular dentist for a check up and cleaning - He noticed a very dark circle on an X-Ray in the area below two of my bottom front teeth (#22 & #23 I believe). He immediately went in and did a RCT on one tooth. 3 months later the infection was still present and he did RCT on the other tooth (October 2012).

Both RCT's failed and I had my first apicoectomy on November 26th. I thought everything was going well until I caught a NY cold in the beginning of February (as I always do). The week I was sick - my gum started throbbing - and I developed a Fistula. I initially thought maybe the cold was related - but I went back to my oral surgeon - He took an X-Ray - saw that the infection was present and said we should go in for a 2nd Apico - I had this done on Feb 15th! I was on antibiotics for 2 weeks for the apico - then developed a cyst in my earlobe for which I was on antibiotics for another 2 weeks - The day after I finished the antibiotics I developed another fistula.

My wedding is in 3 weeks - I'm quite anxious and distraught about this. My surgeon says that is fine to stay on antibiotics through the wedding and honeymoon and re-treat the infection with a 3rd apicoectomy when I return. I've already been on antibiotics for 5 weeks straight and I would really rather not be on antibiotics throughout my wedding and honeymoon.

Are there any dangers with staying on the antibiotics and letting this ride?
Should I have an apicoectomy within the next 10 days before the wedding?
Is the gum even re-infected? Could it be healing? Any advice and insight would surely be appreciated - I'm very upset about all of this.
Also - does the fact that the fistula took 10 weeks to appear after the 1st apico and only 4 weeks after the 2nd indicate how bad the infection is???

[Bryanna]

Hi fish,

I will post my answers in caps.... it's just easier to follow that way.

<<This all started July 2012 when I went to my regular dentist for a check up and cleaning - He noticed a very dark circle on an X-Ray in the area below two of my bottom front teeth (#22 & #23 I believe). He immediately went in and did a RCT on one tooth. 3 months later the infection was still present and he did RCT on the other tooth (October 2012).>>

THE DARK CIRCLE THAT SHOWS UP ON THE X-RAYS INDICATES THAT THE INFECTION FROM THE TOOTH HAS SPREAD INTO THE JAWBONE. THIS SPREAD OF INFECTION INDICATES THAT THE TEETH HAVE BEEN INFECTED FOR QUITE SOME TIME.... PERHAPS WITHOUT OBVIOUS SYMPTOMS.

<<Both RCT's failed and I had my first apicoectomy on November 26th.>>

IT IS IMPORTANT TO KNOW THAT THE ROOT CANAL THERAPY IS A FLAWED PROCEDURE FROM THE GET GO BECAUSE IT IS NOT POSSIBLE TO REMOVE DISEASED TISSUE FROM THE TINY ACCESSORY CANALS. SO THE ROOT CANALED TEETH ARE CHRONICALLY INFECTED FROM THE REMAINING NERVE TISSUE. SECONDLY, TEETH REQUIRE BLOOD FOR NUTRITION JUST LIKE EVERY OTHER PART OF THE BODY. DURING A ROOT CANAL PROCEDURE, THE BLOOD SUPPLY IS PERMANENTLY CUT OFF RENDERING THE TOOTH NON VITAL. THE SURROUNDING BONE DETERIORATES AS IT BECOMES NECROTIC AND ISCHEMIC FROM THE LACK OF BLOOD SUPPLY IN THAT AREA. THUS THE TOOTH TURNS BLACK AND DISEASED HOLES DEVELOP IN THE BONE.

<<I thought everything was going well until I caught a NY cold in the beginning of February (as I always do). The week I was sick - my gum started throbbing - and I developed a Fistula. I initially thought maybe the cold was related - but I went back to my oral surgeon - He took an X-Ray - saw that the infection was present and said we should go in for a 2nd Apico - I had this done on Feb 15th! I was on antibiotics for 2 weeks for the apico - then developed a cyst in my earlobe for which I was on antibiotics for another 2 weeks - The day after I finished the antibiotics I developed another fistula. >>

SO AS YOU CAN SEE BY WHAT I HAVE WRITTEN, THE INFECTION CONTINUED TO BREW IN SPITE OF THE ROOT CANAL THERAPY AND THE APICOS.

<<My wedding is in 3 weeks - I'm quite anxious and distraught about this. My surgeon says that is fine to stay on antibiotics through the wedding and honeymoon and re-treat the infection with a 3rd apicoectomy when I return. I've already been on antibiotics for 5 weeks straight and I would really rather not be on antibiotics throughout my wedding and honeymoon.>>

CONGRATULATIONS ON YOUR UPCOMING WEDDING)
I DISAGREE WITH YOUR ORAL SURGEON IN THAT PERTAINING TO DENTAL HEALTH, IT IS NEVER A HEALTHY OR FAVORABLE IDEA TO STAY ON ANTIBIOTICS FOR LONG PERIODS OF TIME UNLESS THE SOURCE OF THE ACTIVE INFECTION, WHICH ARE BOTH OF THESE TEETH, HAS BEEN REMOVED. YOU VERY WELL COULD END UP WITH INTESTINAL AND/OR OTHER CONDITIONS THAT CAN BE PHYSICALLY DEBILITATING FOR QUITE SOME TIME OR EVEN AN INTESTINAL INFECTION CALLED CLOSTRIDIUM DIFFICILE, OFTEN REFERRED TO C-DIFF.

REGARDING A 3RD APICOECTOMY.... COMPLETELY LUDICROUS! THIS PROCEDURE IS NOT ONLY BARBARIC BUT IT DOES NOTHING TO RID THE TOOTH OF THE INFECTION IRRELEVANT OF HOW MANY TIMES IT IS DONE. IT CREATES FURTHER INFECTION, INFLAMMATION AND TRAUMA TO THE ALREADY COMPROMISED JAWBONE. IT ALSO LEAVES YOU WITH LESS BONE DENSITY THAN YOU CURRENTLY HAVE MAKING REPLACEMENT OF THESE TEETH VERY DIFFICULT. THE MORE TIMES YOU HAVE THIS DONE, THE MORE PERMANENT DAMAGE OCCURS TO THE BONE. IT IS A TOTAL WASTE OF YOUR MONEY.

<<Are there any dangers with staying on the antibiotics and letting this ride?>>

YES THERE ARE SOME REAL SERIOUS RISKS WITH BOTH OF THOSE THINGS. IN ADDITION TO WHAT I HAVE ALREADY TOLD YOU ABOUT THE RISKS OF STAYING ON THE ANTIBIOTICS YOU ALSO RUN A GREATER RISK OF DEVELOPING DRUG RESISTANCE WHICH SIMPLY MEANS THE BACTERIA CAN BECOME RESISTANT TO ANTIBIOTICS. WHEN THIS OCCURS YOU CAN DEVELOP A SERIOUS LIFE THREATENING INFECTION CALLED MRSA..METHICILLIN-RESISTANT STAPHYLOCOCCUS AUERUS.

ALLOWING THIS INFECTION TO RIDE..... FIRSTLY, THIS IS A SERIOUS INFECTION AND IT CAN TRAVEL FURTHER THAN YOUR JAWBONE. THE FISTULAS COULD CLOSE OFF AND CAUSE A TREMENDOUS SWELLING THAT COULD REQUIRE HOSPITALIZATION AND ADDITIONAL SURGICAL INTERVENTION. THE ANTIBIOTICS MAY OR MAY NOT KEEP THE INFLAMMATION DOWN ENOUGH TO KEEP THE FISTULAS OPEN SO THE BACTERIA CAN CONTINUE TO DRAIN. PERTAINING TO THAT DRAINING OF THE BACTERIA.... IT IS DRAINING INTO YOUR MOUTH AS WELL AS YOUR DIGESTIVE SYSTEM. SO IT REALLY IS NOT WISE TO RIDE THIS OUT.

<<Should I have an apicoectomy within the next 10 days before the wedding?>>

AS I STATED ABOVE, APICOECTOMIES DO NOTHING TO CURE THE INFECTION INSIDE OF THE TOOTH. THEY CAUSE ADDITIONAL INFLAMMATION, INFECTION AND TRAUMA TO THE ALREADY COMPROMISED JAWBONE.

<<Is the gum even re-infected? Could it be healing?>>

IT IS NOT HEALING. THE FISTULA IS NOT A GUM INFECTION. THE FISTULA OCCURS WHEN THE PRESSURE FROM THE INFECTION BUILDS UP SO MUCH THAT THE BACTERIA LITERALLY BURROWS A HOLE THROUGH THE BONE LIKE A TUNNEL AND BREAKS THROUGH THE BONE, THROUGH THE GUM AS A MEANS OF LETTING OFF THE PRESSURE. IF THE FISTULA CLOSES, A HUGE SWELLING WILL OCCUR.

<< Any advice and insight would surely be appreciated - I'm very upset about all of this.>>

I'M SURE YOU ARE VERY UPSET AND THAT MY INFORMATION HAS ALARMED YOU. YOU HAVE THE RIGHT TO BE HONESTLY INFORMED AND IF YOUR SURGEON HAS NOT TOLD YOU ANY OF THIS, THEN YOU HAVE NOT BEEN PROPERLY INFORMED. IT WOULD HAVE BEEN A HELL OF A LOT BETTER IF HE HAD TOLD YOU ALL OF THIS PRIOR TO THE FIRST ROOT CANAL AND OFFERED YOU THE OPTION OF REMOVING THESE TEETH BECAUSE IF YOU HAD DECIDED TO DO THAT AT THAT TIME, YOU WOULD HAVE NOT BEEN IN SUCH A TIME CRUNCH AS YOU ARE RIGHT NOW.

<<Also - does the fact that the fistula took 10 weeks to appear after the 1st apico and only 4 weeks after the 2nd indicate how bad the infection is???>>

IT ACTUALLY MAY BE A GOOD INDICATION, YES. KEEP IN MIND THAT THE ENTIRE AREA OF BONE AROUND THOSE TWO TEETH IS INFECTED, INFLAMED, ANGRY, SICK AND YOUR BODY IS TRYING TO FIND A RELEASE FROM THE PRESSURE OF ALL OF THAT. AT THIS POINT AFTER BEING ON THE ANTIBIOTICS FOR SO LONG, YOU MAY BE RESISTANT TO THE ANTIBIOTIC AS NEW BACTERIAS DEVELOP. INFECTION IS A COMPLICATED MATTER. DIFFERENT STRAINS OF BACTERIA WILL CONTINUE TO DEVELOP THE LONGER THE INFECTION IS PRESENT AS THE IMMUNE SYSTEM CONTINUALLY TRIES TO DEAL WITH IT.

I know the last thing you want to deal with is this dental problem as you have more than enough on your mind with the wedding. However, if you were my daughter, I would be very concerned about your health and I would urge you to seriously consider removing these teeth asap. You could first contact your general dentist and go in for a consult about having a dental appliance made called a nesbit or partial denture which could be fabricated within a weeks time. It is a small appliance with teeth on it and is basically worn for esthetics and to hold the space open until you get a permanent replacement. The other replacement option may be to have a temporary bridge made soon after the teeth are removed. This bridge is made of an acrylic material, it would involve cutting down and capping the adjacent teeth to these two teeth, resembles normal looking teeth and is cemented in. It is worn during the surgical healing phase and then a permanent bridge is made later on. Both of these options need to be discussed with your general dentist or a prosthodontist (a dentist who specializes in the replacement of teeth).

If you were to act on this idea now, you could have the teeth out asap... have a couple of weeks to heal and then wear the bridge or appliance the day of your wedding and afterwards.

I wish I had better news for you.... but the truth is, you really have a serious infection that needs to be dealt with sooner than later. Please reconsider throwing your money away on procedures that are not going to positively affect the outcome of your situation. You are also entitled to reimbursement of the apico(s) because they did not work... period.

Please let us know how you're doing.
Bryanna

[threeputt]

I would like to add what Bryanna stated from experience of my own.

Yesterday I went to an Oral surgeon to have an infected tooth extracted. Before the doctor pulled the tooth he told me that the crown was solid and he thought by doing an apicoectomy he could save the tooth and if it did not work he would pull it for free.

I had already researched this subject good by reading here and other places and I was prepared for what I wanted. I told him lets get this infected tooth out of my mouth now ASAP. It has already been there way to long. He said A- OK and he did the job.

When he finished he told me Tom, you made the right decision, that the apicoectomy would have not worked in my case because the infection was where he could not have got to any of it . Why he wanted to chance it to begin with is beyond me unless he made lots more money doing the apicoectomy. I believe that to be the case.

I would say to anyone reading this is to avoid an apicoectomy and root canal. Get those infected teeth out now. You are only delaying what's to come later like I did before I knew more about all these things.

I would delay the wedding if that's what you need to do. Get those teeth out now where you can begin to start healing. Bryanna knows her stuff and she tells it like it is. I just wish more Dentist and assistants would warn about these unless snuff jobs. Tom

[fish41213]

Well an update is certainly in order.....and thank you for your replies!!!

I ended up waiting until after the wedding & honeymoon to deal with dental saga!! We had the best time of our lives and luckily there were no issues while we were away...Once we returned, I opted to see a 2nd oral surgeon who performed the 3rd (AND FINAL) apicoectomy in an attempt to save my two teeth (#25 & #26)

Within a week it was clear that the apico failed - and I had the two teeth removed 1 week ago. I am going back to the surgeon in 2 days to have the stitches removed. She extracted the teeth, bone grafted, and I am wearing a temporary flipper until I am ready for implants...

This whole process has certainly taken its emotional and mental toll but I am finally seeing light at the end of the tunnel...The extraction site seems to be healing well with the exception of the occasional bit of blood after a salt water rinse/brushing...

I am confident/hopeful that the extraction has/will completely expel the infection that was in the area. Looking forward, if I am ever faced with this again - I would opt for the teeth to be removed immediately. I could have easily had these teeth removed and carrier on with a flipper for my wedding and honeymoon but what's done is done... fingers crossed this drama is over =)

[Bryanna]

Hi fish,

Congratulations!!!!!!!! Glad to hear your wedding was wonderful and dentally uneventful!

I am sorry that you decided to do the apicos.... but I did warn you :/
It is a very painful and invasive procedure with no positive benefit regarding the health of the teeth or the jaw bone. Most dentists do not even recommend them anymore. Generally when someone insists on keeping their teeth in spite of the infection, oral surgeons will perform the procedure. However they need to explain the consequences of retaining the teeth.

Glad to hear that the flipper is working out okay!
What are thinking about doing as far as replacing those teeth?
Did the surgeon think you had adequate healthy bone for implants?
Or are you going to just wear the flipper?
Or are you going to have 4 unit bridge made?

Thanks for checking back in with us. I am not glad that you have been through so much...... but I am glad that you shared with us your experience of having the apicos and your ultimate decision on never doing that procedure again.

Bryanna

Originally Posted by fish41213

Well an update is certainly in order.....and thank you for your replies!!!

I ended up waiting until after the wedding & honeymoon to deal with dental saga!! We had the best time of our lives and luckily there were no issues while we were away...Once we returned, I opted to see a 2nd oral surgeon who performed the 3rd (AND FINAL) apicoectomy in an attempt to save my two teeth (#25 & #26)

Within a week it was clear that the apico failed - and I had the two teeth removed 1 week ago. I am going back to the surgeon in 2 days to have the stitches removed. She extracted the teeth, bone grafted, and I am wearing a temporary flipper until I am ready for implants...

This whole process has certainly taken its emotional and mental toll but I am finally seeing light at the end of the tunnel...The extraction site seems to be healing well with the exception of the occasional bit of blood after a salt water rinse/brushing...

I am confident/hopeful that the extraction has/will completely expel the infection that was in the area. Looking forward, if I am ever faced with this again - I would opt for the teeth to be removed immediately. I could have easily had these teeth removed and carrier on with a flipper for my wedding and honeymoon but what's done is done... fingers crossed this drama is over =)

[fish41213]

Thanks for your kind wishes!!!

So- I went back to the surgeon on Friday (8 days after extraction) had the stitches removed and she said the surgical site looks great (NO sign of infection). That was so encouraging and rewarding to hear - after 6 months of built up hopes and let downs.

She said to come back in 3 months for a "scan" and if all looks well I can have implants a month later so by October I should have implants. The flipper is annoying at times but manageable.

I kept asking if the infection was definitely gone and she said there is always a possibility the bone graft can become infected - I am trying to not even go there mentally but just for my own knowledge - will I know if the bonegraft becomes infected??? How long from now would that become evident??

[Bryanna]

Hi fish,

Glad to hear the surgical site looks good!!

When the graft becomes infected the tell tale signs can be a fever, fatigue, and swelling in the area of the surgery. Sometimes there are no symptoms or they are vague at best... but radio-graphically the infection can usually be seen irrelevant of your symptoms.

I know she said to wait 3 months but given the severity of your situation it may be best to wait a month or two longer. This gives your bone more time to integrate with the graft. You definitely do not want to place the implants too early because they will fail and/or you will experience bone loss rather than bone growth. Just something to consider...........

Thanks for checking back with us!

Bryanna

Originally Posted by fish41213

Thanks for your kind wishes!!!

So- I went back to the surgeon on Friday (8 days after extraction) had the stitches removed and she said the surgical site looks great (NO sign of infection). That was so encouraging and rewarding to hear - after 6 months of built up hopes and let downs.

She said to come back in 3 months for a "scan" and if all looks well I can have implants a month later so by October I should have implants. The flipper is annoying at times but manageable.

I kept asking if the infection was definitely gone and she said there is always a possibility the bone graft can become infected - I am trying to not even go there mentally but just for my own knowledge - will I know if the bonegraft becomes infected??? How long from now would that become evident??

[fish41213]

Thanks for your reply---

I'm beginning to become concerned --- The surgeon warned me that chips of the bone graft may come to the surface of the extraction site - Well - I woke up yesterday morning and felt 2 chips --and shortly thereafter I was spitting out blood coming from the extraction site- It hasn't happened since but I've also noticed a smell coming from the extraction site along with clear fluid.

Before I had the extraction the surgeon left the fistula open to drain and not only has the hole not closed - but if I put my finger in front of it I can also smell the bad odor ---

I called the surgeons office this morning and they said that the bleeding and smell are normal but I'd like your thoughts on this--

I am 18 days post extraction
I am 10 days post my last dose on clinda

Given the circumstances I am hyper sensitive to this healing properly and naturally it's constantly in the back of my mind that it could become re-infected, etc. Let me know what you think.....

[Bryanna]

Hi fish,

It is unusual for small piece of the graft to work their way out as the site heals closed. The blood that you were spitting out... were you forcing the spit as in pursing your lips and drawing up saliva? If so, then you were creating a suction and that could be what caused the bleeding. So don't do that anymore. If you weren't doing that and it bled on it's own that may be okay so long as that bleeding does not continue or become more than just a smidgen of blood.

It is hard for me to speculate as I cannot see what the area looks like. But I can tell you that this area of your mouth has been through a WAR! I would expect this to take at least several weeks to heal closed from the perspective of the gum. The bone is going to take months to heal. The fistula is an opening into the bone and it is going to take a long time to heal. It is also a reservoir for bacteria so you need to continue rinsing with warm salt water 3 times a day until it closes over.

Most oral extraction sites have a bad odor for many reasons without there being any infection present. It can take several weeks for this to be completely gone. It is imperative to make sure that you are brushing and flossing all of your teeth thoroughly every day to keep the plaque down. Make sure you clean the flipper really well when you take it out... brush it with your toothbrush and use some non abrasive toothpaste or a little bit of salt and water. Rinse it really well before you put it back in. If you are sleeping with the flipper... try not to as that can contribute to the odor. Do not use any mouthwash or dip the flipper in mouthwash....because the ingredients in mouthwash is too irritating and drying to the gum tissue... all of which contributes to bad odor.

If you feel that the fistula is not improving or you see anything that resembles pus coming from it, then see the OS to evaluate it.

I know this can be all too consuming. You have been through A LOT and so has your poor mouth! You both need some time to ... heal

Bryanna


QUOTE=fish41213;988992]Thanks for your reply---

I'm beginning to become concerned --- The surgeon warned me that chips of the bone graft may come to the surface of the extraction site - Well - I woke up yesterday morning and felt 2 chips --and shortly thereafter I was spitting out blood coming from the extraction site- It hasn't happened since but I've also noticed a smell coming from the extraction site along with clear fluid.

Before I had the extraction the surgeon left the fistula open to drain and not only has the hole not closed - but if I put my finger in front of it I can also smell the bad odor ---

I called the surgeons office this morning and they said that the bleeding and smell are normal but I'd like your thoughts on this--

I am 18 days post extraction
I am 10 days post my last dose on clinda

Given the circumstances I am hyper sensitive to this healing properly and naturally it's constantly in the back of my mind that it could become re-infected, etc. Let me know what you think.....[/QUOTE]