Hi Bryanna,

Thank you for all your information regarding root canaled teeth and infections. I have some additional questions which I hope you can answer for me.

Teeth #'s 32 and 31 were both root canaled. 31 was done about 25 years ago and 32 done about 15 years ago. They both had onlays placed on top around 15 years ago. About 6 years ago, 32's onlay failed and I had a crown put on. Both teeth were, and had been discolored for years. I never had any pain or visible signs of infection except for right after the root canal on 31, 25 years ago. My face swelled up and I went to the dentist who drained it.

After I got the crown on 32, 6 years ago, I went to an orthodontist for invisalign braces. He said he saw something on the x-ray about tooth 31 that concerned him and he was going to call my dentist before moving forward. He didn't say what it was, or his concerns. When I went back he said he spoke with my dentist and she said it was nothing to be concerned about so they were moving forward.

In 2011, the onlay on tooth 31 came off and the tooth split. I tried to put the onlay back on top until I could get to the dentist but it wouldn't stay since the tooth base broke. I noticed that the onlay piece had a very bad, putrud smell. I went to the dentist and she extracted tooth 31. It wasn't an easy extraction because the tooth was split and she had to remove it in pieces. I'm not sure if she saw any signs of infection or tried to debride the area. She seemed concerned after and gave me an Rx for antibitotics. She even called me the next day, or the day after, to see how I was doing. I didn't have any issues and I went back later to get the stitches out. That was 3 years ago. There is bone loss where the tooth was, but the teeth have not shifted due to the use of a retainer.

ABout 2 years ago, at a dentists visit, she mentioned to me that I had a small "pimple" on my gum to the side of tooth 32. I asked her what it was and what we should do about it. I don't remember exactly what she said, but she never said it was the result of an active infection burrowing it's way through the gum. She said just to keep an eye on it and let her know if it bothers me. It has never bothered me or caused any pain at all. Once in a while the fistula pops and drains.

Over the past couple of months, I have been researching fistulas and that's how I found this site and have read your recommendations on fistulas. I'm concerned because I seem to get nasty sinus infections once a year and I'm wondering if this is related. Anyway, I am going to make an appointment to see an oral surgeon this week for a consultation. Below are some questions I hope you can answer. My goal is to have the tooth removed and eventually replaced with an implant, along with tooth 31.

Does the presence of a fistula necessarily mean that the infection has spread to the jaw bone, as well? Can a fistula be present if the infection is contained in the tooth and hasn't spread to the bone?

How can I be sure that the extracted tooth # 31 was properly debrided, and/or is currently free from infection? What do I ask the oral surgeon?

What is the risk of teeth shifting after I have #32 extracted? I do have my Invisalign retainer which I wear every night but since 31 and 32 will be missing, it may not fit snugly. How soon do teeth start to shift and will the retainer help prevent that, even if it does not fit snugly and 32 is extracted?

I have an impacted wisdom tooth behind 32. IS there a possiblity that the infection spread to that tooth from 32 as well? Will the oral surgeon see it on the x-ray?

Regarding implants, how safe are donor bone grafts? WHat is the sterilization process? Is there any chance, or documented cases of contamination from the donor to the recipient?

What questions should I ask the oral surgeon about implants? Are certain brands of titanium implants better than others, or preferred? Which brands are the best?

Thanks so much for your help!!