Vowel Lady,

It is very disturbing to know what really goes on. Even for me and I work in the profession. In an ideal world all people, irrelevant of their profession, would have the best of intentions and money would not be their motivating factor. However, there is no industry in the world that I can think of that is not driven by money.

The education that dentists receive goes into anatomy, biology, etc but it mainly delves into the carpentry of dentistry. Dentists are not educated to become physicians. They are educated to be doctors of dental science or doctors of dental medicine. Therefore many stay focused on the "carpentry" aspect of what they do much more so than the biological or pathological aspect. This does not mean they are not knowledgeable about the risks or toxicities of dead or infected teeth. It just means those topics are not their top priority. For that reason, they will continue to sell rc procedures under the notion that they are "saving" the teeth. The term "saving" simply means to "retain" not "cure" and they know that.

The other side of this is the lack of knowledge that the average person has regarding what a root canal procedure is and what it isn't. I blame the dental profession for withholding the truth but at the same time, when a person presents with a severely broken, deeply decayed or infected tooth and they want to "save" their tooth... the only options a dentist has to offer is root canal or extraction. I personally believe every patient has the right to be informed of the health risks associated with keeping dead infected teeth and the risks associated with extracting their tooth as well as replacement options. If someone is in an emergency situation and their pain is preventing them from making a clear decision, most of the time a pulpotomy can be done and antibiotics can be prescribed giving the patient a day or so to think about what they believe is in their best interest. Then time should be spent on educating the patient about the risks of both procedures.

Because dentists are basically taught to be tooth carpenters, many of them do not give a second thought to the rc issue and for that reason they do not feel they are doing any harm.

I never want to upset anyone and there is no denying that it can be disturbing. But there is no easy way to deliver this information and I try to give the facts in ways that most people would understand. I urge people to educate themselves on the basic anatomy of a tooth and the obvious connection to the blood vessels and beyons will become obvious. This information allows people to be able to communicate with their dentists much more effectively.

I hope I was able to explain myself clearly. I know you are in a difficult situation and I wish I had a remedy to your problem. Please let me know what you think of the information offered in that book. I hope you find it helpful!

Bryanna

Bryanna -

You are providing an incredible service here, so thank you! I have a similar situation which I wanted to run by you, although I think I know what you are going to say. Here is my somewhat unusual(?) story.

9 months ago, I had a fistula form above tooth 2 which has three roots. The tooth already had a root canal. My dentist diagnosed an infection and we tried a conservative treatment of cleaning it out along with antibiotics but a few weeks later, the fistula returned. My dentist then performed exploratory gum surgery and discovered a hole in one of the roots that he said was causing the infection. He amputated most of the root leaving just a little nub for stability. This solution worked well and the tooth was pain free after healing. He believed that my body was reacting to a foreign body and that this would be the most conservative treatment.

Fast forward 9 months when I developed pain in the gum above the tooth. Upon examination, my dentist says I have another infection as evidenced by a hole in the gum (pictured) which is emitting puss when prodded. He says another fistula would have already formed except the puss is draining. I've attached a picture of the hole and an X-Ray of same where you can see the amputated root. Based on the puss, he has concluded that the original procedure failed and that my body is still treating the tooth as a foreign object. He also said there is a 6mm pocket around the gum.

He has offered two options:

1) We can repeat the original gum surgery and remove the rest of the root.
2) We can extract the tooth and replace it with an implant.

He is strongly recommending the extraction, so my question to you is whether that is reasonable.

Based on everything you've written, I'm betting yes, but I wanted to post the info anyway. Picture follows.

Thank you again.
MS7356

PS A secondary question would be - what caused the infection in the first place. Why don't all root canaled teeth develop infection if bacteria is prevalent in the tooth structure?

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Hi MS7356,

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

First let me clarify that your case in not unusual. In fact it is typically seen in dental offices all the time.

<<<9 months ago, I had a fistula form above tooth 2 which has three roots. The tooth already had a root canal. My dentist diagnosed an infection and we tried a conservative treatment of cleaning it out along with antibiotics but a few weeks later, the fistula returned.>>

CONTRARY TO WHAT YOU MAY HAVE BEEN TOLD, THE ROOT CANAL DID NOT CURE THE ORIGINAL INFECTION IN THE TOOTH. THE TOOTH HAS BEEN CHRONICALLY INFECTED THE WHOLE TIME. THE BACTERIA WAS PROLIFERATING FROM THE TINY CANALS INSIDE OF THE TOOTH, TO THE REST OF THE TOOTH, TO THE LIGAMENT AND INTO THE BONE. THERE IS NO CONSERVATIVE OR OTHER DENTAL TREATMENT THAT CAN ALTER THIS INFECTION.

<< My dentist then performed exploratory gum surgery and discovered a hole in one of the roots that he said was causing the infection. He amputated most of the root leaving just a little nub for stability.>>

EXPLORATORY GUM SURGERY...... NOT EXACTLY. THE PROBLEM IN THE GUM TISSUE WAS SECONDARY AND AS A RESULT OF THE INFECTION INSIDE OF THE TOOTH. THE ROOT THAT HE AMPUTATED WAS BADLY DETERIORATED FROM THE INFECTION. THIS DOES NOT MEAN THE OTHER ROOTS WERE HEALTHY, THEY WERE JUST INTACT MORE SO THAN THIS ONE AT THAT TIME. THERE IS NOTHING STABLE ABOUT THIS TOOTH.

<< This solution worked well and the tooth was pain free after healing. He believed that my body was reacting to a foreign body and that this would be the most conservative treatment. >>

THE ROOT AMP TEMPORARILY REDUCED THE INFLAMMATION IN THAT AREA. BUT BECAUSE THE TOOTH IS SO INFECTED, THE PROBLEM IS STILL PRESENT AND THE BACTERIA IS STILL SPREADING. YOUR BODY WAS REACTING TO THE INFECTION...... AND WILL CONTINUE TO REACT TO IT. THAT FOREIGN BODY STUFF HE TOLD YOU.......... BS.

<<Fast forward 9 months when I developed pain in the gum above the tooth. Upon examination, my dentist says I have another infection as evidenced by a hole in the gum (pictured) which is emitting puss when prodded. He says another fistula would have already formed except the puss is draining.>>

AS I SAID THE INFECTION IS STILL BREWING. IT IS NOT ANOTHER INFECTION, IT IS THE SAME ONE AND ALL EVIDENCE SHOWS IT'S SEVERE.

<< I've attached a picture of the hole and an X-Ray of same where you can see the amputated root. Based on the puss, he has concluded that the original procedure failed and that my body is still treating the tooth as a foreign object. He also said there is a 6mm pocket around the gum. >>

AGAIN THIS FOREIGN STUFF...... THE TOOTH HAS BEEN CHRONICALLY INFECTED SINCE THE ONSET OF THE INITIAL INFECTION PRIOR TO THE ROOT CANAL PROCEDURE. SINCE ROOT CANALS CANNOT CURE AN INFECTED TOOTH, THE RC PROCEDURE DID NOT "FAIL". THE PROCEDURE IT IS FLAWED TO BEGIN WITH AS THE ANATOMY OF TOOTH DOES NOT ALLOW ACCESS TO THE HUNDREDS OF TINY CANALS THAT HARBOR INFECTED NERVE TISSUE. YOUR TOOTH IS NOT A FOREIGN OBJECT AND YOUR BODY IS REACTING TO THE INFECTION.

<<He has offered two options: 1) We can repeat the original gum surgery and remove the rest of the root. >>

NO YOU REALLY CAN'T. YOU NEED ROOT STRUCTURE TO ANCHOR A TOOTH IN THE BONE. THE TOOTH DOES NOT JUST SIT ON THE GUM IT NEEDS ROOTS. REPEATING ANY PROCEDURE WILL NOT CURE THE INFECTION INSIDE OF THIS TOOTH NOR WILL IT CURE THE INFECTION IN THE JAW BONE.

<<2) We can extract the tooth and replace it with an implant. >>
THE ONLY WAY TO ATTEMPT TO CURE THIS INFECTION IS TO REMOVE THE SOURCE OF THE INFECTION WHICH IS THE TOOTH.

REGARDING A DENTAL IMPLANT.... ANYTIME A ROOT CANALED TOOTH IS REPLACED BY AN IMPLANT THE RISK OF INFECTION AND FAILURE OF THAT IMPLANT IS HIGH DUE TO THE LONG STANDING INFECTION IN THE BONE. WHEN THIS TOOTH IS REMOVED THE BONE NEEDS TO BE THOROUGHLY DEBRIDED OF ALL VISIBLE INFECTION AND NECROTIC BONE. BONE GRAFTING SHOULD ONLY BE PLACED AT THAT TIME IF THE CLEANED BONE IS HEALTHY ENOUGH TO RECEIVE IT. OTHERWISE THE INFECTION WILL SPREAD TO THE GRAFT AND IT WILL FAIL. AN IMMEDIATE IMPLANT SHOULD NOT BE PLACED IN THIS AREA AT THE SAME TIME AS THE EXTRACTION ..... AGAIN DUE TO INFECTION AND FAILURE.

THIS TOOTH IS ALSO IS CLOSE PROXIMITY TO YOUR SINUS. SO THERE MAY BE A SINUS PERFORATION AND/OR THE INFECTION MAY HAVE INVADED THE SINUS CAVITY. THIS TOOTH SHOULD ONLY BE REMOVED BY AN ORAL SURGEON... NOT A GENERAL DENTIST.

<<He is strongly recommending the extraction, so my question to you is whether that is reasonable.>>

THIS IS THE FIRST AND ONLY THING THAT I AGREE WITH YOUR DENTIST ON. IT IS NOT ONLY REASONABLE TO REMOVE THIS TOOTH.... IT IS IMPERATIVE THAT YOU REMOVE IT.

<<PS A secondary question would be - what caused the infection in the first place. Why don't all root canaled teeth develop infection if bacteria is prevalent in the tooth structure?>>

THE INFECTION WAS CAUSED BY EITHER DECAY THAT WENT INTO THE NERVE OF THE TOOTH, OR TRAUMA FROM DRILLING INTO THE TOOTH DURING A RESTORATION OR CROWN PREP.

ALL ROOT CANALED TEETH ARE INFECTED. AS SOON AS THE NERVES BECOME DISEASED, FOR WHATEVER REASON (DECAY OR OTHER) THE TOOTH BECOMES CHRONICALLY INFECTED AS THERE ARE NO MEANS OF REMOVING ALL OF THE INFECTED NECROTIC NERVE TISSUE FROM THE HUNDREDS OF TINY CANALS INSIDE OF THE TOOTH.

THE BACTERIA PROLIFERATES FROM THESE TINY CANALS, INTO THE OTHER AREAS OF THE TOOTH, THROUGH THE TOOTH INTO THE PERIODONTAL LIGAMENT, INTO THE JAW BONE AND FURTHER. RESULTING IN BONE LOSS, ETC.

DURING THIS PROCESS, THE IMMUNE SYSTEM TRIES TO DEAL WITH THE INFLAMMATION AND INFECTION AND THE BACTERIA TRIES TO FIND A WAY T RELEASE ITSELF. SOMETIMES THE BACTERIA PUSHES THROUGH THE GUM AND BONE OUT THROUGH THE TISSUE...OTHER TIMES IT PROLIFERATES INTO THE SINUS MEMBRANES AND BEYOND... SOMETIMES IT GOES THROUGH THE BLOOD STREAM AND SETS UP IN AN ORGAN OR A JOINT.

NOT ALL INFECTED TEETH HAVE ORAL SYMPTOMS. ESPECIALLY IF THE INFECTION HAS TRAVELED ELSEWHERE IN THE BODY.

PLEASE SEE AN ORAL SURGEON FOR THE REMOVAL OF THIS TOOTH AND NOT YOUR GENERAL DENTIST.

Keep us posted...... good luck!
Bryanna

Bryanna...Quick note...please don't worry about upsetting/disturbing me. Goodness. Yes, I'm in much pain. Today, again is not good. But, it does no good for me or anyone not to hear the truth. It is hard at times to fully take in what you are saying about rc's ... and of course it's confusing when dentists don't confirm this information. But, I think we each have to do our best to research what we can about our medicines, procedures, etc. and make our own decisions.

When I hear things in medicine that are controversial, things that doctors say are nonsense, I always remember the story of the physician that was ostracized and I think even penalized, because he suggested that women were dying in childbirth because doctors delivering babies weren't washing their hands and were spreading germs. Simple common sense...yet doctors of the time thought that this was "nonsense."

Yes, I do believe I'm in a difficult situation. My health is worsening and it seems to have started with the dentist who had such trouble with putting on a crown....after an onlay fell off. Now I'm wondering if more than one thing went wrong.

On top of the multiple health problems and great pain, I'm concerned about my teeth and likely future repairs and my limited options for the replacement of any teeth removed.

I will probably see for another consultation an oral surgeon who does implants. He is well respected by everyone in my area. He confirmed that I have Trigeminal nerve damage. He is the one dental professional here who semi agreed that rc's are really not good for people. No one else agrees and/or will discuss it. I'm also switching dentists to one that works with this oral surgeon. I always keep my ears open for unusually good dentists...I will travel anywhere in my state.

I ordered the book you suggested used...unfortunately they are sending it book rate....I think it is going to be literally strapped to the back of a snail and sent my way. They said it should arrive by the end of Sept.