Dear Bryanna and all,
Thank you! Thank you!
My story is not so different from other I have read about. I have had minor health issues for years, fatigue, lung issues and 3 summer colds in the last 5 weeks. I know now why, after a x-ray last week that my #3 tooth that had a RC many years ago has a infection in the bone above the tooth and where apex meets the bone. My very nice Dentist told me to have another root canal job and gave me there card. That night we started to figure out what to do. Found on a group site about Dr. Orlando in S.A ( he is the best) and his very informative web site. From there I found this site, thank G-D and read a lot about what Dr. Bryanna has to say about my situation. She helped me and I am very grateful to her and all of you. I am planning to meet with 2 oral surgeons ASAP.

So this is where I am holding and these are my questions.
For having my tooth extracted and the periodontal ligament scraped out.
What questions should I ask the potential surgeon and what answers do I want to hear or do not want to hear? What equipment in this day and age should they have, example a laser??? Plus any other advice you all have.
Thank you for all your time in advance.
Sincerely,
Ori

Hi Ori!

You are so funny
First let me clarify that I am not a doctor or a dentist. I am however in the dental field for 35 years. So yes, I have lots of knowledge that I will honestly and openly offer you... but I'm not a doctor

Okay so you are correlating your infected tooth #3 with your colds and other physical maladies. You are wise to consider that as possible and you may be right!

Here are your questions... I will answer them in bold type.

<<<For having my tooth extracted and the periodontal ligament scraped out. What questions should I ask the potential surgeon>>>>

YOU WANT TO TELL THE SURGEON YOU HAVE BECOME INFORMED ABOUT TOOTH EXTRACTIONS AND YOU HAVE SOME SPECIFIC REQUESTS. YOU WANT TO HAVE THE TOOTH REMOVED AS GENTLY AS POSSIBLE TO AVOID TRAUMA TO THE BONE AND SINUS IF POSSIBLE, AND YOU WANT THE PERIODONTAL LIGAMENT AND ALL NECROTIC TISSUE AND BONE REMOVED. ASK HIM IF HE DOES THIS ROUTINELY AND/OR WILL OBLIGE YOUR REQUESTS. THE REASONS FOR THE ABOVE REQUESTS ARE SIMPLY.....

YOU WANT THE TOOTH REMOVED GENTLY TO AVOID FRACTURE OF THE BONY RIDGE OR UNNECESSARY TRAUMA TO THE ADJACENT TEETH. IF THE INFECTION IS DEEP AND/OR SEVERE, THE RIDGE MAY BE COMPROMISED AND YOU WANT HIM TO REMOVE WHAT IS COMPROMISED, DON'T LEAVE IT THERE. THE LIGAMENT, NECROTIC TISSUE (CYSTS) AND BONE NEEDS TO BE REMOVED BECAUSE THEY ARE ALL INFECTED AND IF LEFT IN THERE IT WILL PREVENT THE BONE FROM HEALING PROPERLY. MAKE SURE YOU LET HIM KNOW THAT YOU WANT TO BE INFORMED OF ALL OF HIS FINDINGS AFTER THE EXTRACTION INCLUDING ANY ISSUES WITH THE SINUS.

<<<and what answers do I want to hear or do not want to hear? >>>>

IDEALLY YOU WANT HIM TO BE OPEN TO YOUR KNOWLEDGE AND REQUESTS AND NOT BE INTIMIDATED OR ANNOYED BY THEM. IDEALLY YOU WANT HIM TO SAY... I ALWAYS REMOVE THE LIGAMENT AND DEBRIDE THE BONE THOROUGHLY. A RED FLAG SHOULD GO UP IF YOU FEEL HE IS OFFENDED BY YOUR KNOWLEDGE AND/OR IF YOU FEEL THAT HE IS SMUG AND WILL DO WHAT HE WANTS IRRELEVANT OF WHAT YOU WANT.

<<<What equipment in this day and age should they have, example a laser???>>>

MOST "MODERNIZED" ORAL SURGEONS HAVE LASERS AND THE PROPER EQUIPMENT AND INSTRUMENTS. IT IS IMPORTANT TO GO TO AN OFFICE THAT IS NOT ANTIQUATED BECAUSE UNFORTUNATELY THESE DENTISTS OFTEN STILL PRACTICE OLD SCHOOL DENTISTRY. THE OFFICE MUST BE CLEAN IN THE WAITING ROOM, THE TREATMENT ROOMS AND YES, THE BATHROOM AS THIS USUALLY INDICATES THAT CLEANLINESS AND STERILE PRACTICES ARE IMPORTANT TO THE DENTIST.

<<<Plus any other advice you all have.>>>

YES, DO NOT BE AFRAID TO EXPRESS YOUR REQUESTS. JUST BE GENTLY ASSERTIVE IN YOUR APPROACH

Keep us posted Ori!!

Bryanna

Dear Bryanna,

Thank you for all your info and your time.
I feel much better about my first meeting with one of the oral surgeon which should be in 13 hours from now with the info you provided , Thanxs again.

I have some more questions.

What about a bone graft? Does he make the call doing the extraction, ect???
I think we should talk about this in advance with them and prices? Is this something I should do anyway???

Do I want him to do a swipe for a culture once he is inside???

Sincerely,

Y.Ori

Hi Y. Ori,

You are very welcome!!

Your questions....

<<<What about a bone graft? Does he make the call doing the extraction, ect??? >>>

DISCUSS BONE GRAFTING WITH HIM PRIOR TO THE EXTRACTION. ASK WHAT TYPE OF GRAFT MATERIAL HE USES... CADAVER, PIG, CALCIUM BASED... ETC.
GRAFTING IS DONE TO ENCOURAGE YOUR OWN BONE TO GROW INTO THE VOID FROM THE EXTRACTION. WITHOUT IT, EVERY EXTRACTION SITE LOSES ABOUT 50-60+% OF THE BONE LEVEL BY THE TIME THE SITE HAS HEALED. HOWEVER.... BONE GRAFTING SHOULD ONLY BE DONE IF THE EXISTING BONE IS HEALTHY. IT SHOULD NOT BE PLACED IN NECROTIC BONE. THUS ANOTHER REASON WHY IT IS IMPERATIVE TO REMOVE THE LIGAMENT AND ALL NECROTIC TISSUE (CYSTS) AND BONE AFTER THE TOOTH IS REMOVED. SO IN A SENSE, YES, THE OS DOES MAKE THAT CALL AT THE TIME OF THE EXTRACTION. JUST MAKE IT CLEAR THAT YOU DO NOT WANT GRAFTING PLACED IN UNHEALTHY BONE.

<<< I think we should talk about this in advance with them and prices? Is this something I should do anyway??? >>

YES, MOST DEFINITELY!

<<< Do I want him to do a swipe for a culture once he is inside???>>>

IT WOULD BE IDEAL IF HE TOOK A BIOPSY SPECIMEN OF THE TOOTH (THIS WILL SHOW THE BACTERIA SPECIES THAT WAS LIVING INSIDE OF THE TOOTH AND OTHER THINGS)... A SPECIMEN OF THE TISSUE THAT HE SCRAPES OUT OF THE SOCKET.... AND A SPECIMEN OF THE BONE THAT HE SCRAPES FROM THE SOCKET AS BOTH OF THESE THING WILL ALSO SHOW THE SPECIES OF BACTERIA, ETC.

Gosh you are so on top of this stuff! How did you learn about all of this?? Do you have a background in biology or.....???

Bryanna

Dear Bryanna,
You asked me about my background... I have a good teacher, YOU!!! Almost everything that I have learned up to now is from you, thanxs!!! I read a lot of your answers and advice to people that where or are in a similar situation as myself.

I hope you are here for me because I still need your help.

This is where I am holding. I went and saw two oral surgeons. 0ne was a #8 on a scale of 1 to 10 and the other ??? The 8 is a maybe. he said that I have inflammation and it is not an active infection??? I told him I really want to extract the tooth. He feels that that is way too evasive and think that the best thing for me to do is apicoectomy. He said for him extraction and cleaning out the socket is much easier for him to do and his price for that is 1/3 the price of an apico if I do not need a bone Graft and double the appt. time. He says his concentration for the apico is really intense. He goes in through the gum and cleans it out and cut the top of the apex and seals it. He said if he go in and he feels it needs to be pulled he will do it on the spot. His opinion is, less evasive is the key. Bridges or implants also have pros and cons. At the end of the day he says it is my call. he e-mailed me what types of bone grafting material he uses and his price, collagen based bone filling augmentation material and or collagen of spongious bone granulate and 10% porcine collagen fibres. What are your thoughts on these materials and also his price for the grafting at the time of either procedures if it is needed is a little less then double the cost of the extraction, it seem a little high, what are your thoughts???
I am going to attach a x-ray from around 2 weeks ago. Maybe you could tell me your thoughts???
Sincerely Yours,
Ori

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Hi Ori,,

Thanks for posting the xrays.

Inflammation yes...but both of these molars are infected.
Tooth #2, the last molar, is decayed/diseased inside of the tooth where the post has perforated the furcation. Tooth #3, the first molar, two out of the three roots have areas of pathology at the apex... the center root has a large post and appears to be decayed/diseased at the furcation.

Apicos will not alter or cure the infection in either of these teeth. An apico is not really a less invasive procedure than an extraction when you think about how it causes additional inflammation and infection in that already compromised area of bone. Making the extractions and replacement of these teeth more complicated. Bone grafting may or may not be advisable at the time of extractions if the bone cannot be cleaned up completely. The surgeon would have to determine that at that time.

Regarding the bone graft material... depends on whether you want to use a synthetic graft or one that was derived from an animal or cadaver.

Regarding replacement of these teeth... you are not a candidate for a permanent bridge because you would have no anchor tooth in the back. Implants are risky when replacing root canaled teeth.. so it would depend on the health and thickness of the bone after the site healed. You may be a candidate for a removable partial denture... are you missing any teeth on the upper left side?

Bryanna