I read Bryanna's comments in a previous thread about a possible broken root tip during an extraction, and I was very impressed with her candor and devil's advocate approach. I would appreciate her frank opinion regarding my situation (or anyone else's who wants to play devil's advocate).

In the spring of 2012 I was exploring/invesigating/considering having a tooth implant for #8, which had been chipped severely almost 40 years ago in childhood. I had a cap over it, but the tooth had drifted upward and outward over the years. It needed something done. I was dragging my feet. I knew that an implant would be iffy because there was lots of bone loss over the years.

In May of 2012 I had a severe tooth abscess in tooth #19 that manifested itself on the buccal side of the gums. I'm not sure if it was a periodontal abscess that spread to the tooth or vice versa. I'm not even sure there's any way to tell.

I was in unbearable pain when called an oral surgeon whom I was considering using for the implant. I asked their office for the names of some dentists who collaborated with him with implants. (At that time I didn't even know that oral surgeons dealt with tooth abscesses. I assumed they specialized in higher level stuff.) His office gave me some names, and one of them saw me that day.

The general dentist said he suspected a crack and sent me to an endodontist, who almost immediately diagnosed the tooth with a severe fracture of the roots and crown. The endodontist said I'd be wasting my time with a root canal and that the tooth would have to be pulled. He didn't really explain his reasoning, but I thought that it must be legit for an endodontist to take away business from himself to give it to others. I was in a hurry to have it dealt with ASAP.

The endodontist said the oral surgeon needed to pull the tooth. I called the oral surgeon's office that same day, and they said they were busy for awhile. I can't swear to it, but I believe they advised me to go back to the general dentist because that's what I did. I can't imagine doing so on my own, after the endodontist told me I needed the oral surgeon to pull it.

The general dentist pulled the tooth unremarkably (i.e., without a flap, without sectioning). Based on my memory, it must have been a straight forceps extraction. During the extraction he broke off and left a root tip in my jaw, presumably highly infected. He didn't bother to tell me about it.

I didn't know what he had done, but I was dissatisfied with the him for his general vagueness. So when I believed I had a lingering infection a week later, I called another dentist to check it out. After the second dentist took a panorex, he sent me home, postponing a scheduled teeth-cleaning for that day until my mouth cleared up. The root tip is faintly visible in his panorex, but I didn't notice it, and this second dentist didn't tell me about it either.

Symptoms of swelling and then drainage (starting in June) persisted in the buccal side of the gums throughout the summer. I eventually discovered the root tip from a CT scan done four months after the tooth had been pulled. Another oral surgeon took it out in September 2012.

I can't understand is why I wasn't told about the broken root tip. I've seen veterinary guidelines, and dogs are supposed to be treated better than I was (i.e., the dog's veterinary dentist is supposed to inform the owner about a retained root tip).

Although I seem to be fine now, I have some lingering questions that I'd appreciate some devil's advocates to take a stab at.

1. Why would a dentist leave a highly infected root tip in my jaw without my knowledge? What are some possible reasons? Why didn't he take it out?

2. Besides the hidden root tip, what else seems wrong with this scenario? In other words, what actions or treatment issues strike you as suspicious? What do you think was going on?

Thank you for reading this. I would have posted the endodontist xray and the panorex, but I apparently can't attach images until I've had 10 posts.

Hi parminides,

Me candor?? You've got that right Hard to be the devil's advocate when you know right from wrong.... but it is not up to me to tell people what they should and shouldn't do. I'm just here to plop down the information

I will re-post your questions and answer in bold type.

<<1. Why would a dentist leave a highly infected root tip in my jaw without my knowledge? What are some possible reasons? Why didn't he take it out??>>

BECAUSE HE WAS AFRAID TO GO AFTER IT! THAT IS WHY IT IS IMPORTANT TO HAVE AN ORAL SURGEON REMOVE TEETH, ESPECIALLY IF THEY ARE INFECTED. IF THEY BREAK OFF A ROOT TIP THEY GENERALLY WILL RETRIEVE IT. THERE ARE TIMES THAT IT IS BEST TO FLAP THE ORAL TISSUE, EXPOSE THE BONE, SECTION THE TOOTH AND GENTLY ELEVATE THE TOOTH FROM THE BONE. YOUR CASE MAY HAVE BEEN ONE OF THOSE TIMES. HE KNEW HIS APPROACH TO THE EXTRACTION WAS NOT FAVORABLE WHEN HE REMOVED THE TOOTH AND SAW THE ROOT WAS BROKEN OFF. I'M SURE HIS HEART SANK. BUT EVIDENTLY NOT ENOUGH TO INFORM YOU!
SOME DENTISTS ARE NOT THAT CONCERNED ABOUT RETAINED ROOT TIPS UNTIL THE PATIENT SWELLS UP OR WORSE. IRRELEVANT OF THAT, 99% OF THE TIME IT IS NOT IDEAL TO LEAVE A ROOT TIP IN THE JAW BONE.

<<2. Besides the hidden root tip, what else seems wrong with this scenario? In other words, what actions or treatment issues strike you as suspicious? What do you think was going on?>>

I THINK I ANSWERED THIS IN MY ABOVE STATEMENT.
REGARDING THE FACT THAT NEITHER HIM NOR THE SECOND DENTIST INFORMED YOU ABOUT IT...... EITHER THEY ARE NOT TOO GOOD AT READING XRAYS AND/OR THEY CHOSE TO IGNORE IT FIGURING YOU WOULD EVENTUALLY END UP ELSEWHERE. NEITHER OF THOSE EXCUSES IS ACCEPTABLE IN MY OPINION.

I am glad that you had it removed and that the area seems to be doing well!!

What are you doing about tooth #8?

Bryanna

Thank you for your quick reply.

As for #8, I'll probably get a denture! One reason is the pre-existing bone loss makes it a very questionable candidate for an implant. I don't want to spend all that money if there's very little chance of success.

I wish that I could have attached the xray from the endodontist and the panorex from the second dentist. I would love to see what you think. But I'm brand new to this forum, and I apparently must have 10 posts before I can attach files or put links in my message. (Only 8 more to go after this one!)

You might not want to spend much time on my case since it seems resolved. I can understand that. You seem to be on the forum to help people. When I said I was fine, it's not quite so simple. I meant that all the infection seems to be out of the bone. But I'm still draining slightly from the buccal gums, almost a year and a half after the extraction.

For many months I would have bet a lot of money that I had osteomyelitis. Not anymore. I had my teeth cleaned in August, and an xray showed that the root channels had completetly filled in. That image convinced me that this remant drainage must be confined to the gums. So that's the long version of "I seem to be fine now."

I think I have a small, chronic, periodontal abscess. The place that cleaned my teeth in August didn't get the full history, because I've found that no one wants to jump into someone else's medical error, followed by unending complications.

The dentist I saw in August said that this kind of thing could take years to resolve or might never go away. He didn't call it a periodontal abscess or anything. He said he could do a gingival curettage or an open flap debridement that might help.

I was reluctant to go through with either procedure since he might have recommended something completely different if he'd known about the root tip. All he knew was that the tooth had been pulled almost a year and a half ago, and I still have drainage.

You don't know the full history either, but you know about the root tip that lurked in my jaw for four months. Something else that might be pertinent is that I've been on antibiotics five different times since the tooth was pulled. Three times before the root tip was removed and two times afterward (the last course was in January).

Do you think a gingival curettage and/or an open flap debridement would be the best thing to try to finally knock out the lingering drainage? If not, what would you recommend?

Parminindes,

I think you definitely have something going on there. Whether it is bone and/or tissue related... that is hard to tell. It is a good sign that the bone appears to have filled in since the removal of the tooth. However, dental xrays are only 2 dimensional so if the film were angled differently the area may or may not take on the same radio-graphic appearance.

I would not opt for an open flap procedure there as that could compromise the integrity of the oral tissue and cause severe gum line recession. What you might look into is a laser procedure called LANAP. This requires no cutting of the tissue with a scalpel so there is no trauma to the oral tissue. The laser is used in the sulcus between the tooth and the gum. It is so precise as it kills the bad bacteria and restores the health of the good tissue.

Do you have periodontal disease? Have you consulted with a periodontist about this area or others? Have you had any form of periodontal treatment?
You mentioned getting a denture to replace tooth #8. Are you missing other teeth in your maxillary arch that you are hoping to replace with this denture?

I would like to see those xrays so keep posting )

Bryanna

I'm surprised and concerned that you think it might be bone related. I thought that the bone filling back in would be the opposite of what an infection would do (eat away bone). What's wrong with that line of thinking?

I do have periodontal disease. I have avoided seeking treatment because if what's leaking out of the side of the extraction site is some antibiotic-resistant infection, I don't want to introduce it into all those deep cracks. That may not be a valid reason, but that's why I've put off treating the periodontal disease. I want to take care of this leaky jaw problem first.

I have seen one periodontist and some oral surgeons. The sad truth is that no one wants to inherit my jaw. I know it's a major breach of ethics to leave a root tip in a patient's jaw without telling him. I've never seen a single source that says it's acceptable to leave an infected root tip in a patient. Also, the root tip was near the surface (maybe because he tried to get it out?), another reason *never* to leave it in.

No one wants to take over that mess. The leakage is at such a low level that they don't see it. Nor is there a well-defined fistula (at least that they admit to seeing). So doctors and dentists generally just say that they don't see what I'm talking about.

This dentist last August was an exception, but I didn't tell him about the root tip! I told him about others doubting my symptoms. He said that he never doubts a patient when they say they're draining.

I'm not missing any other teeth in the maxillary arch. I know I could get a bridge, and maybe I will. But the idea of messing up two more teeth isn't very appealing to me. I know it would be a lot less trouble for me in the long run.

Only 7 more posts to go!

Parminides,

I gathered that you had untreated periodontal disease. The problem lies in the bacteria that causes this disease. It is highly infectious and aggressive. It is rarely, if ever just contained to one area of the mouth.

You wrote:
<<I do have periodontal disease. I have avoided seeking treatment because if what's leaking out of the side of the extraction site is some antibiotic-resistant infection, I don't want to introduce it into all those deep cracks. That may not be a valid reason, but that's why I've put off treating the periodontal disease. I want to take care of this leaky jaw problem first.>>

My answer: The ongoing problem that you have with that particular area is not going to heal due to the overall bacteria in your mouth from the perio disease. That is why I suggested that you look into the LANAP laser therapy as it can beneficial with not just that area but your entire mouth.

The root tip was probably near the surface because it had worked it's way up from where it originally was. That can happen... not all that unusual.

Before you have #8 removed... please seek a consultation from a periodontist who uses the LANAP laser. Have an overall examination and treatment plan. I have no doubt that #8 needs to be removed but your replacement options may be different than you assume. If you have other teeth in your maxillary arch that are very ill from periodontal disease, you may not want to hold onto them. So a removable partial denture could be made to replace those teeth as well as #8.

Bryanna

Thanks again for all your attention. I really appreciate it. I'll keep this one shorter so I can get to 10 posts sooner!

In you last message you didn't address my argument that the bone isn't infected or else I would have undergone more bone loss instead of bone gain (filling in the root channels). I know it would be much better if you could see the xrays, but what do you think of my argument in principle?

I had a flare up in September 2012 and various infections seemed to florish together (probably by weakening my immune system). I wanted all infection sources removed, so #8 was pulled at that time (it was known to be infected).

The first panorex that showed the root tip at the top was taken a week after the extraction. It doesn't seem possible that it could work it's way from the bottom to the top in only a week. Can that happen?

I don't think my periodontal disease is as advanced as you make it sound. My teeth are not loose.

Parminides,

As I said, dental x-rays are 2 dimensional and depending on the angle of the film the area of #19 may show differently at a different angle. I hope that it has healed but because you have a chronic infection there, it cannot be assumed that the bone is healthy because it appears to have filled in on one x-ray.

Even if the bone has healed well from the extraction, if there is a perio infection ... the bone will deteriorate from that bacteria which may or may not show up on a dental x-ray until the bone loss is severe.

<<The first panorex that showed the root tip at the top was taken a week after the extraction. It doesn't seem possible that it could work it's way from the bottom to the top in only a week. Can that happen?>>>

Maybe it wasn't a root tip. Maybe it was a piece of splintered bone. They both resemble each other.

I have no idea how advanced your periodontal disease is. You mentioned that you have had it but never had it treated. So I assume you have had it for awhile. This disease does not get better on it's own. In the early stage it can be remedied with daily diligent oral hygiene care at home. Oil pulling with coconut oil can also be very helpful. But once the bacteria has advanced it is difficult for the patient to remove it.

Some people with perio disease do not have loose teeth while others do. Some people have gum tissue recession while others have deep pockets.

Bryanna

Thank you for giving some more detail about how a single xray can't prove there's no infection.

It was definitely a root tip. I saw it after it was removed. It had a curved shaft that came to a smooth, rounded point, just like the root appeared in the xray before the tooth was pulled. No one familiar with my case has suggested that it wasn't a root tip.

The reason I think my periodontal disease is not that advanced is that none of the doctors have made it sound very dire. What is "oil pulling with coconut oil"?

parminides, I see you continuously referencing the 10 post rules for links, but that does not apply to photo attachments. You are allowed to use our attachment feature for a photograph....you will see "manage attachments" in the section below the box where you type your post.
Just to be sure to remove all personally identifying info from your xrays etc before you attach them to your post