[willyhacanal]

Hi Bryanna,
I had a root canal done a few years ago which became infected in September 2013. The endo...cleaned it out with no cost. However, there is another infection at the same tooth. He said not to be concerned unless it hurts. It is only sensitive to the touch now. I am not comfortable with an infection in the same tooth which was cleaned out in September. I would like to know if the infection can just stay there indefinitely until it really bothers me. Thanks,

[Bryanna]

Hi willyhacanal,

You should know that this tooth did not become re infected... it's been that way since the first root canal therapy. At this point the infection is not restricted to just the tooth. It is also in the ligament and in the bone surrounding the tooth. The bacteria will continue to spread further into the bone and very possibly to other teeth. The longer you keep this tooth the more bone loss you will develop.

Pain is not a good indicator of the extent of a dental problem. So it is not wise to gauge the severity of the problem based on just your physical discomfort.

It is important to know that the root canal procedure cannot cure an infected tooth and make it healthy again. The procedure is done in an attempt to temporarily reduce the inflammation allowing the person to retain the tooth for an undetermined amount of time. It is not possible to remove the infected nerves from the many hundreds of microscopic canals within the tooth because they are not visible, they are not straight and there is no access to them. These canals contain infected nerve tissue and this is what keeps the tooth infected.

It is never a healthy idea to keep an infected tooth irrelevant of the level of discomfort. Oral infections can easily spread from the mouth to other areas of the body... that occurrence is called a systemic infection.

If you choose to have the tooth extracted, it is best to see an oral surgeon for the removal because the tooth is fragile and the bacteria that has spread to the bone also needs to be cleaned out. General dentists are not as experienced as oral surgeons with removing teeth in this condition.

Hope you find this information helpful.

Bryanna

Originally Posted by willyhacanal

Hi Bryanna,
I had a root canal done a few years ago which became infected in September 2013. The endo...cleaned it out with no cost. However, there is another infection at the same tooth. He said not to be concerned unless it hurts. It is only sensitive to the touch now. I am not comfortable with an infection in the same tooth which was cleaned out in September. I would like to know if the infection can just stay there indefinitely until it really bothers me. Thanks,

[willyhacanal]

Originally Posted by Bryanna

Hi willyhacanal,

You should know that this tooth did not become re infected... it's been that way since the first root canal therapy. At this point the infection is not restricted to just the tooth. It is also in the ligament and in the bone surrounding the tooth. The bacteria will continue to spread further into the bone and very possibly to other teeth. The longer you keep this tooth the more bone loss you will develop.

Pain is not a good indicator of the extent of a dental problem. So it is not wise to gauge the severity of the problem based on just your physical discomfort.

It is important to know that the root canal procedure cannot cure an infected tooth and make it healthy again. The procedure is done in an attempt to temporarily reduce the inflammation allowing the person to retain the tooth for an undetermined amount of time. It is not possible to remove the infected nerves from the many hundreds of microscopic canals within the tooth because they are not visible, they are not straight and there is no access to them. These canals contain infected nerve tissue and this is what keeps the tooth infected.

It is never a healthy idea to keep an infected tooth irrelevant of the level of discomfort. Oral infections can easily spread from the mouth to other areas of the body... that occurrence is called a systemic infection.

If you choose to have the tooth extracted, it is best to see an oral surgeon for the removal because the tooth is fragile and the bacteria that has spread to the bone also needs to be cleaned out. General dentists are not as experienced as oral surgeons with removing teeth in this condition.

Hope you find this information helpful.

Bryanna

I have an appointment with an oral surgeon on 2/27. I will talk to the oral surgeon on what you say. Thanks for the information.
I am not sure why the endodonist is wanting me to wait until there is more pain for him to look at it again. Sounds like the infection would become a big problem if I wait...

[Bryanna]

Hi willyhacanal,

All dentists are aware that root canaled teeth are not healthy. This fact is not a secret it is just information that is not often given to the typical dental patient. It is the patient who has become better informed about this either on their own or through some form of education that would be informed differently by their dentist.

The wait and see approach is often suggested by the dentist when the patient gives the impression that they are not ready to remove their tooth. The fact that the re treatment will not alter the original problem with the tooth is something that every patient should be informed of prior to the consent of the procedure.

You are correct in that waiting for more symptoms or pain to develop could result in a much bigger problem. Again, you should have been informed of that by the Endodontist.

Let us know how the appointment with the oral surgeon goes.

Bryanna

Originally Posted by willyhacanal

I have an appointment with an oral surgeon on 2/27. I will talk to the oral surgeon on what you say. Thanks for the information.
I am not sure why the endodonist is wanting me to wait until there is more pain for him to look at it again. Sounds like the infection would become a big problem if I wait...

[willyhacanal]

Originally Posted by Bryanna

Hi willyhacanal,

All dentists are aware that root canaled teeth are not healthy. This fact is not a secret it is just information that is not often given to the typical dental patient. It is the patient who has become better informed about this either on their own or through some form of education that would be informed differently by their dentist.

The wait and see approach is often suggested by the dentist when the patient gives the impression that they are not ready to remove their tooth. The fact that the re treatment will not alter the original problem with the tooth is something that every patient should be informed of prior to the consent of the procedure.

You are correct in that waiting for more symptoms or pain to develop could result in a much bigger problem. Again, you should have been informed of that by the Endodontist.

Let us know how the appointment with the oral surgeon goes.

Bryanna

Hi Bryanna,

The oral surgeon is suggesting to be conservative. Before doing an extraction, to let the endodonist do a procedure which I am not sure of the spelling. Begins with A. As I understand it, because the mark or infection is at only one root that it would be possibly better to try before the extraction procedure. Some kind of cutting at the root and cleaning it! And to keep the tooth...However, the oral surgeon would do an extraction and an implant if that is what I want. Or possibly just the extraction! From previous posts I seem to think you would favor an extraction and possibly the implant...appreciate your thoughts...willy

[Bryanna]

Hi willyhacanal,

First let me clarify that it is irrelevant as to whether the infection shows radio-graphically at one root or both roots. The tooth itself is infected and the infection is not limited to one area. The darkened area on the x-rays simply means that the bacteria from inside that portion of the tooth has now perforated that root tip and spread into the jaw bone. It is does not mean that the other root is healthy. Your surgeon is well aware of this.

The procedure you are referring to is called an Apicoectomy. This is nothing more than a surgical root canal. It does not alter the infection status of the tooth as it cannot accomplish anything more than the conventional root canal did. To be honest... an apicoectomy is a barbaric procedure in which the dentist makes a deep large incision, flaps the tissue up off of the bone, drills a window into the bone, uses sharp files and scalers to access that window and scrapes out the dead infected tissue and bone. The window hole is then plugged up with a mercury filling material and the gum tissue is sutured closed. Not only does this procedure cause inflammation and abundant bacteria.... but the mercury filling becomes embedded in the bone and surrounding tissue and it is usually not something that can be removed. This poses a problem when the tooth is removed because it compromises the health and integrity of the bone which will elevate the risk of failure if a dental implant is placed.

Another barbaric dental procedure that is prescribed in cases like yours is called a Root Amputation. This basically has not long term value as the remainder of the tooth will continue to be infected. Again compromising the health and integrity of the jaw bone.

If your goal is to remove the source of the infection then your only option would be to remove the tooth in it's entirety.

I hope this information is helpful to you. If you want to read more thoroughly about root canals.... google Dr Mercola or Dr George Meinig root canal cover up.

Bryanna

Originally Posted by willyhacanal

Hi Bryanna,

The oral surgeon is suggesting to be conservative. Before doing an extraction, to let the endodonist do a procedure which I am not sure of the spelling. Begins with A. As I understand it, because the mark or infection is at only one root that it would be possibly better to try before the extraction procedure. Some kind of cutting at the root and cleaning it! And to keep the tooth...However, the oral surgeon would do an extraction and an implant if that is what I want. Or possibly just the extraction! From previous posts I seem to think you would favor an extraction and possibly the implant...appreciate your thoughts...willy

[willyhacanal]

Originally Posted by Bryanna

Hi willyhacanal,

First let me clarify that it is irrelevant as to whether the infection shows radio-graphically at one root or both roots. The tooth itself is infected and the infection is not limited to one area. The darkened area on the x-rays simply means that the bacteria from inside that portion of the tooth has now perforated that root tip and spread into the jaw bone. It is does not mean that the other root is healthy. Your surgeon is well aware of this.

The procedure you are referring to is called an Apicoectomy. This is nothing more than a surgical root canal. It does not alter the infection status of the tooth as it cannot accomplish anything more than the conventional root canal did. To be honest... an apicoectomy is a barbaric procedure in which the dentist makes a deep large incision, flaps the tissue up off of the bone, drills a window into the bone, uses sharp files and scalers to access that window and scrapes out the dead infected tissue and bone. The window hole is then plugged up with a mercury filling material and the gum tissue is sutured closed. Not only does this procedure cause inflammation and abundant bacteria.... but the mercury filling becomes embedded in the bone and surrounding tissue and it is usually not something that can be removed. This poses a problem when the tooth is removed because it compromises the health and integrity of the bone which will elevate the risk of failure if a dental implant is placed.

Another barbaric dental procedure that is prescribed in cases like yours is called a Root Amputation. This basically has not long term value as the remainder of the tooth will continue to be infected. Again compromising the health and integrity of the jaw bone.

If your goal is to remove the source of the infection then your only option would be to remove the tooth in it's entirety.

I hope this information is helpful to you. If you want to read more thoroughly about root canals.... google Dr Mercola or Dr George Meinig root canal cover up.

Bryanna

I have looked at Dr. Mercola's website interview. I appreciate your information concerning an Apicoectomy and root amputation. I am not sure why both the endodonist and oral surgeon want to be conservative. One reason for the oral surgeon is that I am on coumidin (warfarin).
It is frustrating to not get straight answers from the endodonist. Your posts and Dr. Mercola's interview helped to see why...the oral surgeon did say that the probability is high that an extraction and implant would be most effective. He did mention that the Apicoectomy would only be about 70% or so effective. I would like to have another consult with a dentist in town who was recommended. That is, before going with the extraction and implant with the oral surgeon. Your information and knowledge are greatly appreciated. I understand a lot more now about root canals! Thanks...

[Bryanna]

Hi willyhacanal,

Thank you for the support and kind words. I really appreciate it.

Many dentists, including dental specialists, intentionally give the impression that they are taking the "conservative" approach when they recommend endodontic treatment and/or surgical procedures like apicos and root amps. Let me explain what that really means in layman's terms. It means to "procrastinate" on the inevitable extraction of the tooth. This results in financial gain for the dentists ..... financial loss and systemic health risks for the patient.

Regarding the Coumadin.... I assume you have some type of heart disease, and/or blood clotting disorder? Those health conditions put you in a high risk category for systemic complications with regards to any chronic infection.
Therefore, retaining this infected tooth is a greater risk to you than removing it. Surgeons routinely remove teeth on patients on blood thinners... they know the risks associated with the surgery and take the necessary measures to limit any complications. I get the sense that you are giving these dentists the impression that you are not ready to let go of this tooth. Could that be correct?

The percentages that they are giving you are a bit misleading regarding the impression that they are leaving on you. In other words.... the 70% effective statement about the apico is not really a positive outcome. It is simply another way of saying.... the tooth will remain infected and inevitably need to be removed. He should add to that statement the systemic consequences that can occur in retaining this tooth. As you have learned here and on dr Mercola's site, it is irrelevant if 30% or 90% of the tooth is infected...... the bacteria that resides inside of the tooth is shared by the tooth in its entirety.

I'm sure you will make the best decision for yourself after you have gathered all of the information. Keep us posted on how you're doing.

Bryanna

Originally Posted by willyhacanal

I have looked at Dr. Mercola's website interview. I appreciate your information concerning an Apicoectomy and root amputation. I am not sure why both the endodonist and oral surgeon want to be conservative. One reason for the oral surgeon is that I am on coumidin (warfarin).
It is frustrating to not get straight answers from the endodonist. Your posts and Dr. Mercola's interview helped to see why...the oral surgeon did say that the probability is high that an extraction and implant would be most effective. He did mention that the Apicoectomy would only be about 70% or so effective. I would like to have another consult with a dentist in town who was recommended. That is, before going with the extraction and implant with the oral surgeon. Your information and knowledge are greatly appreciated. I understand a lot more now about root canals! Thanks...

[willyhacanal]

Originally Posted by Bryanna

Hi willyhacanal,

Thank you for the support and kind words. I really appreciate it.

Many dentists, including dental specialists, intentionally give the impression that they are taking the "conservative" approach when they recommend endodontic treatment and/or surgical procedures like apicos and root amps. Let me explain what that really means in layman's terms. It means to "procrastinate" on the inevitable extraction of the tooth. This results in financial gain for the dentists ..... financial loss and systemic health risks for the patient.

Regarding the Coumadin.... I assume you have some type of heart disease, and/or blood clotting disorder? Those health conditions put you in a high risk category for systemic complications with regards to any chronic infection.
Therefore, retaining this infected tooth is a greater risk to you than removing it. Surgeons routinely remove teeth on patients on blood thinners... they know the risks associated with the surgery and take the necessary measures to limit any complications. I get the sense that you are giving these dentists the impression that you are not ready to let go of this tooth. Could that be correct?

The percentages that they are giving you are a bit misleading regarding the impression that they are leaving on you. In other words.... the 70% effective statement about the apico is not really a positive outcome. It is simply another way of saying.... the tooth will remain infected and inevitably need to be removed. He should add to that statement the systemic consequences that can occur in retaining this tooth. As you have learned here and on dr Mercola's site, it is irrelevant if 30% or 90% of the tooth is infected...... the bacteria that resides inside of the tooth is shared by the tooth in its entirety.

I'm sure you will make the best decision for yourself after you have gathered all of the information. Keep us posted on how you're doing.

Bryanna

Hi Bryanna,

The Coumadin is for AFib condition. The oral surgeon wants my INR to be 2.5 or so. I take 2.5 mg. once a day and my level is around 3 currently....I'll need to adjust this with the cardiologist.
The oral surgeon wants me to speak to the endodonist before deciding...i will talk with the endo on Wednesday. Keeping in mind what you wrote.
The oral surgeon's office quoted me a cost for the extraction plus implant plus "Graft-socket graft" to be $2200...i'm in Upstate NY. They wrote down that they will either do the extraction & immediate implant or extraction & graft....then I need they say to get a crown....I don't know that cost! Would you know if these costs are sounding reasonable?
Some people just have the tooth extracted without anything else, I am wondering what you think about that too? Thanks, willy

[Bryanna]

Hi Willy,

Yes, it is best to consult with your cardiologist to try and get the INR down prior to extracting that tooth.

The cost of $2200 for extraction of the tooth, placement of the graft and an immediate implant is actually a bit low. Sometimes they give a break on the fee when doing an immediate implant. HOWEVER...... please don't make your decision based on what will be less expensive. Depending on the health and integrity of the bone due to the chronic infection, the immediate implant may or may not be a wise option at the time of the extraction. Any residual infectious bacteria residing in that site after the extraction could prevent the bone graft from integrating with the jaw bone which could result in additional infection and would compromise the longevity of the dental implant.

Bone grafts as well as dental implants ideally should be placed in healthy bone only. If there is any question as to the health of the bone, it is best to just remove the tooth and go back in at another time to place the graft and the implant. Sometimes this requires one or two additional surgeries depending on the individual case. When the dentist or surgeon tries to rush this process.... the outcome is often unfavorable.

It is important that you make a personal decision which way you want to pursue this tooth issue because I really get the impression that although your surgeon is sure about the inevitable of this tooth, he's unsure you are ready to remove it at this time. Dentists will "procrastinate" on treatment if the patient is not in imminent danger (that is purely subjective) until the patient is ready to move forward with it. In doing this, they are simply covering their own behind so that if complications should arise at any time ... they can say well we advised you of so and so and you choose to have such and such at that time.

Yes, all dental implants require a restoration on top of them. The implant is similar to a root of a tooth as it lies in the jaw bone underneath the gum. A small piece of the implant is above the gum and several small parts attach that portion of the implant with a crown. When all is said and done, the crowned implant should resemble one of your own teeth.

I cannot find where you said which tooth this is.....?
Some teeth do not need to be replaced while others really should be. It depends on which tooth it is... how it fits into your existing bite... and how many other teeth you are missing.

Bryanna

Originally Posted by willyhacanal

Hi Bryanna,

The Coumadin is for AFib condition. The oral surgeon wants my INR to be 2.5 or so. I take 2.5 mg. once a day and my level is around 3 currently....I'll need to adjust this with the cardiologist.
The oral surgeon wants me to speak to the endodonist before deciding...i will talk with the endo on Wednesday. Keeping in mind what you wrote.
The oral surgeon's office quoted me a cost for the extraction plus implant plus "Graft-socket graft" to be $2200...i'm in Upstate NY. They wrote down that they will either do the extraction & immediate implant or extraction & graft....then I need they say to get a crown....I don't know that cost! Would you know if these costs are sounding reasonable?
Some people just have the tooth extracted without anything else, I am wondering what you think about that too? Thanks, willy