Hi dbpei,

I will re post your questions and answer them in bold

<<<I had a dental implant of tooth #15 in 2008 that never felt right to me. The tooth had a failed root canal followed by a difficult extraction. When I would bend down, it was as though I could feel the metal in my bone and I would feel sinus pressure. My gum above that tooth has been dark gray ever since the implant. (Could this be necrotic bone beneath the gum tissue?) >>>

YOUR DESCRIPTION INDICATES A PROBLEM IN THE AREA OF THE IMPLANT. THE ACTUAL IMPLANT ITSELF MAY APPEAR TO LOOK OKAY (NOT TO BE CONFUSED WITH "HEALTHY") BUT THERE IS SOMETHING BREWING BECAUSE YOU SHOULD NEVER HAVE SINUS PRESSURE FROM THE IMPLANT. CHANCES ARE THE BONE WAS INADEQUATE AND NOT HEALTHY WHEN THE IMPLANT WAS PLACED AND THERE MAY HAVE BEEN A SINUS EXPOSURE AS WELL. THE DISCOLORATION OF THE GUM INDICATES THAT THE BUCCAL BONE (THE BONE THAT FACES THE CHEEK SIDE) IS EITHER EXTREMELY THIN OR NON EXISTENT DUE TO THE BACTERIA THAT SPREAD FROM THE INFECTED ROOT CANALED TOOTH CAUSING THE BONE TO DETERIORATE. DURING THE DIFFICULT EXTRACTION, WHATEVER BONE WAS PRESENT IN THIS AREA WAS MOST LIKELY REMOVED BECAUSE IT JUST CRUMBLED FROM DISEASE.

UNFORTUNATELY, MANY DENTISTS WILL PLACE IMPLANTS IN DISEASED BONE AND TAKE A LET'S SEE WHAT HAPPENS ATTITUDE. USUALLY PATIENTS ARE NOT INFORMED OF ANY OF THIS AND WHEN PROBLEMS ARISE THEY ARE EVENTUALLY TOLD THAT THE BODY REJECTED THE IMPLANT OR THE IMPLANT FAILED. I CANNOT SAY FOR CERTAIN THIS IS YOUR CASE.... BUT IT DOES OCCUR VERY FREQUENTLY.

<<<1. If tooth #15 is infected, is it likely that the jaw bone above the implant on #14 could be infected as well?>>>

IT IS VERY LIKELY THAT THE BONE "SURROUNDING" 14 AND 15 IS NECROTIC AND DISEASED RATHER THAN JUST ABOVE EITHER TOOTH. IT IS NEVER WISE TO PLACE AN IMPLANT IN UNHEALTHY BONE AND/OR NEXT TO A ROOT CANALED TOOTH. AGAIN, THIS IS DONE FREQUENTLY AND THE END RESULT IS NOT FAVORABLE DUE TO THE DISEASED BONE FROM THE INFECTED TEETH.

<<<2. Is there any way that the oral surgeon can determine if the adjacent bone is infected when he is extracting the tooth and cleaning out the necrotic bone tissue?>>>

FIRST OF ALL, THE RADIOGRAPHS COULD BE USEFUL IN SHOWING SOME OF THE ISSUES WITH THE IMPLANT. SECONDLY, IN THIS CASE HE MAY FLAP THE TISSUE OVER BOTH TEETH TO GIVE HIM A VISUAL OF THE BONE AND ENABLE HIM TO ADEQUATELY REMOVE THE DISEASED BONE.

<<<3. If it looks like the jaw bone is infected above the dental implant, should the oral surgeon try to remove the implant while he is extracting the tooth next to it?>>>

YES, HE SHOULD REMOVE THE IMPLANT IF THE BONE IS DISEASED. IT MAKES NO SENSE TO RETAIN AN IMPLANT IN INFECTED BONE.

<<<I am concerned that this infection has spread throughout my jaw and even into my skull. I feel strange sensations in my face and the side of my head as well as my mastoid bones. I am hoping this can all be taken care of with the extraction and antibiotics, but I am so afraid of the damage already done.>>>>

NOT TO FRIGHTEN YOU BUT TO INFORM YOU THAT ...... THE INFECTION CAN SPREAD TO VARIOUS AREAS OF YOUR JAW BONE AND BEYOND. IT IS NEVER OKAY TO RETAIN AN INFECTED TOOTH OR AN IMPLANT IN INFECTED BONE. IT IS IMPERATIVE FOR YOU TO EXPLAIN IN DETAIL TO THE OS ALL OF YOUR PHYSICAL SYMPTOMS. IT IS ALSO IMPERATIVE FOR YOU TO SHOW SINCERE CONCERN ABOUT YOUR "SYSTEMIC HEALTH" REGARDING THIS DENTAL PROBLEM. IT IS UP TO YOU TO INFORM THE OS THAT YOU ARE WILLING TO REMOVE THE IMPLANT IF IT IS NOT SITTING IN HEALTHY BONE. OTHERWISE, HE MAY JUST LEAVE IT THERE... AS STUPID AS THAT SOUNDS :/

<<<I want the oral surgeon to take a culture or biopsy of the bacteria so we know what type of bacteria we are fighting. Is there anything else you would recommend for me to communicate with my oral surgeon tomorrow before he does the surgery? I am going to have conscious sedation for this as I don't think I could tolerate the anxiety!>>>

HE CAN SEND THE ROOT CANALED TOOTH ALONG WITH SOME FRAGMENTS OF BONE TO BE CULTURED AND BIOPSIED. HE MAY TELL YOU THIS IS NOT NECESSARY OR ROUTINELY DONE...... HOWEVER, IT CAN AND SHOULD BE DONE ROUTINELY TO DETERMINE WHAT SPECIES OF BACTERIA YOU ARE DEALING WITH SO THE PROPER ANTIBIOTIC CAN BE PRESCRIBED. YOU MAY HAVE TO STAND REALLY FIRM WITH THIS AND HE MAY BECOME ANNOYED... BUT WHO CARES??!! IT'S YOUR BODY AND IT'S HIS OBLIGATION TO PERFORM THE PROCEDURE PROPERLY AND THOROUGHLY WHICH INCLUDES KNOWING WHAT YOU'RE DEALING WITH. IT WOULD BE WISE TO CALL THE OS OFFICE AHEAD OF TIME, LIKE TODAY, TO INFORM THEM THAT YOU WANT THE PATHOLOGY DONE SO THEY CAN HAVE IT SET UP AHEAD OF TIME.

I wish this did not have to be so difficult. It is bad enough that you have not been properly informed regarding root canals.... and that you have been living with the discomfort of the implant... and that you have this serious infection going on.... geez, you shouldn't have to now deal with telling the OS what to do! I can tell you this.... the informed patient gets different and more thorough dental care.... without a doubt. I always tell patients to be their own advocate and let the dentist be annoyed at your questions or your insistence to be thorough..... he'll get over it

You will be okay... just follow your instinct with this and be assertive with your concerns. Believe me.... when dentists are surgical patients themselves ... they are scared sh**tless and they have plenty to say about everything!

Try to calm your nerves... do some slow, deep breathing to help calm down. It is also best if you have a food menu planned ahead of time. You will be on soft foods for several days. So make the menu as healthy as possible

Keep us posted!
Bryanna