NeuroTalk Support Groups - Toothache, I think?

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Fsani,

I will re-ost your question and answer in bold type to try and keep these continued answers in some order ...

<<<Just a quick question do you think the endodontist would be able to better diagnose this?>>

NOT REALLY. HE MAY BE ABLE TO READ MORE INTO THE XRAYS THAN YOUR GENERAL DENTIST. BUT THE ENDODONTIST PERFORMS ROOT CANALS AND APICOECTOMIES FOR A LIVING. HE IS TRAINED TO "RETAIN" TEETH AND NOT INVESTED IN "CURING" THE PROBLEM VIA ENDODONTICS. UNLESS SOMEONE TELLS HIM THEY DO NOT WANT TO "RETAIN' INFECTED TEETH, HE WILL MOST OFTEN SIDE WITH THE REFERRING DENTIST.

<<Also my dentist does do oral surgery. But is not considered an oral surgeon. >>

UNLESS YOUR DENTIST IS TRAINED IN ORAL SURGERY IN ADDITION TO THEIR DENTAL SCHOOL... ROUTINELY PERFORMS MANY COMPLICATED TOOTH EXTRACTIONS AND SINUS COMPLICATIONS ON A DAILY BASIS..... AND IS VERY WELL VERSED IN BISPHOSPHONATE DRUGS ......... PLEASE DO NOT ALLOW HIM/HER TO REMOVE THESE TEETH. YOU ARE IN A HIGH RISK CATEGORY FOR POST OP COMPLICATIONS DUE TO THE CHRONIC INFECTION AND PROLIA MEDICATION. ORAL SURGEONS ARE EDUCATED, EXPERIENCED, KNOWLEDGEABLE OF THE MEDS AND SINUS AND EQUIPPED WITH THE INSTRUMENTS AND MEDICAMENTS THAT MAY BE NEEDED TO PERFORM YOUR EXTRACTIONS PROPERLY.

<<It's hard because I don't have insurance and I keep paying for root canals and caps and the had one pulled! But I guess there's no guarantee in life!>>

THE FINANCIAL ASPECT OF ALL OF THIS IS HEART WRENCHING. DEPENDING ON WHEN ALL OF THIS WORK WAS DONE AND DEPENDING ON IF YOUR DENTIST GAVE YOU WRITTEN TREATMENT OPTIONS OTHER THAN ROOT CANALS.... YOU MAY BE ENTITLED TO SOME REIMBURSEMENT. IF YOU WERE GIVEN WRITTEN OPTIONS AND THOSE OPTIONS WERE EXPLAINED TO YOU IN DETAIL AND YOU CHOSE TO DO ROOT CANALS, THEN YOU MAY HAVE NO LEGAL RECOURSE.

Toothache, I think?

Quote:

Originally Posted by Bryanna (Post 1062847)

Hi Fsansi6,

Okay so the blood work was really not adequate and you truly cannot rely on the results of the finger prick to tell you anything. However, since you have been taking an antibiotic... even further blood testing at this time may come up with skewed results due to the medication. Keep in mind this does not mean there is no chronic or brewing infection or that the antibiotics is killing it off.

The ct scan needs to be done in slices and needs to include dental as well as sinus. Do not assume that this is the test that will be done.... please make it known this is what you need to have done. This is very important or the results will be as irrelevant as the finger prick blood test :/

Without a doubt based on vast research and evidence the root canaled teeth are not healthy. To what degree they are infected would not be known until they are removed and it would be great if they were biopsied and cultured. That is something you <should) could request that your oral surgeon do when he removes them. The results of those tests would not only confirm the teeth are diseased but they would tell what specific antibiotic should be used post operatively. So the bacterial issue residing inside of the teeth <and most likely beyond) is the first problem that needs to be acknowledged. The second issue which would truly only be icing on the cake could very well be that these teeth are fractured. Not an unusual thing for root canaled teeth... especially those that have had a dental post put in them. Thirdly, replacement options need to be discussed with your general dentist and the oral surgeon if you should be a candidate for dental implants. As a side note..... you should give dental implants a second thought if they are offered because again you are at a high risk of complications due to hte nature of the infection and the Prolia. So in summary a plan needs to be put in place so you know what to expect dentally as well as financially.

If your teeth problem has progressed to your sinuses and/or beyond then that needs to be confirmed as best as it can be. However, the extent of the bacteria may not be adequately visible until the oral surgeon removes the teeth and literally gets into those other areas. These issues are a very common occurrence and most often seen in cases regarding infected and/or root canaled teeth. If the sinuses are involved depending on the extent of the involvement the surgeon may or may not deal with that at that time. That is something you need to discuss with him ahead of time. In some extensive cases and ENT will also be present during the surgery and may need to perform additional treatment at that time. Keep in mind that no one is yet sure of the extent of your infection .... hopefully it has not yet spread too far. This is why I urge you to be aware that the teeth are a problem.

You are at an elevated risk for slow healing and post op complications due to the Prolia. Irrelevant of what your general dentist tells you about osteonecrosis, you are in the high risk category and no one can tell you how your jaw is going to heal after any oral surgery procedure. Your overall health, any medications that you take and your nutrition play a huge role in how you will heal.

It is best at this time to not get side tracked on things like referred pain .... TN pain .... post op complications ..... the maybes or what ifs. Focus on the origin of the problem which is the root canaled teeth. This will help you sort through the pages of this journey and keep you feeling more positive about the outcome.

You may have a healthy mouth aside from this quadrant. Or your dentistry may be very esthetic and gives the appearance of a healthy mouth. I'm hoping it's both of those things!!!

Do you think it could be something really simple? Still waiting for authorization from my insurance company for cat scan. It's horrible that it takes so long. But my dentist will not do any work until she sees results of cat scan. She also is an educator and teaches dentistry at a ny hospital. All volunteer work. I don't doubt her opinion but it's to long for me to wait. I worry if it's an infection it's doing damage. But I'm still on the antibiotic. Today and yesterday the pain was intense. I don't get why sone days it feels better and others days it's horrible. She did say I don't have a lot of bone and bone grafting might be something I need in the future. But it all depends on this darn cat scan. Thanks for taking to to listen to my problem.

Toothache, I think?

Quote:

Originally Posted by Bryanna (Post 1062847)

I can't find my old posts so I'm not sure if I mentioned this, I've been clenching my teeth and night causing me to bite my tongue and give me canker sores! Ever since I got the 2 prolia shots this past year I've been getting canker sores every month. Do you think having 2 shots could cause that much damage already? Thanks Fran

Hi Fran,

I can only go by what you have shared with me as you have not posted any radio-graphs. However, I have personally seen this dental problem countless times in my career so I am fairly certain of my suspicions of what is happening.

I do not believe that your case would be considered simple and here is why. You had 3 unhealthy teeth that had been brewing for ? years. In spite of one of them being removed the problem continues to be severe. This is indicative of the fact that all 3 of those teeth have been unhealthy for the entire time. Unfortunately the bacteria from infected teeth will proliferate beyond the tooth.... again this is typical and what I think has occured in your case. The fact that your dentist is telling you that there is not much bone in that area .... definitely indicates long term infection. That fact along with the Prolia complicates the removal of the teeth and the regrowth of new bone.

Regarding the placement of bone graft after the extractions..... this should only be done if the debrided area is found to be free of disease and is healthy enough to receive the graft. If the graft is placed in diseased bone not only will the graft fail but the likelihood of infection is significant. This is another reason why you need to consult with an oral surgeon ...... not your general dentist.

I know you want to trust your dentist, everyone does. I know her teaching in a hospital is impressive to you. However, she teaches "tooth carpentry" not oral surgery. There is a huge difference in those two occupations.

Regarding the cat scan.... are you certain that it is a dental cat scan with emphasis on dental and sinus?? Do you plan on having her remove those teeth?

I cannot urge you enough to consult with an oral surgeon prior to the cat scan. They are more familiar than a general dentist with this area of dentistry. Your insurance may also be more likely to pay for the scan if it is prescribed by an oral surgeon.

The reason you have varying degrees of pain is due to the fact that the antibiotic is somewhat reducing the inflammation... but it is not curing the infection. So when the inflammation builds up... you have pain.... when it subsides the pain is less. Chances are the bacteria is attempting to drain either through a deep pocket in between one or more of those teeth and/or into the sinus which temporarily lessens the pain.

Fran, please consult with an oral surgeon. I just sent you a personal message, please check it out.

Your previous threads on this are on the page prior to this one. Go to the top of this post where it says page 1 of 2.