New to this Forum and this is my first post. Please bear w/ me in my account of what happened My son is 15. His 2 front teeth, #8 and #9, were injured at a basketball game in February. Went to an oral surgeon 2 hrs after the accident. Had a splint put in for 8 weeks. Was told there's abscess and need root canal. After reading all the horrible things about root canal, I couldn't bring myself to do it. Consulted w/ several other dentist. Was told the stuff I read was 'nonsense'. My son was leaving to study abroad for 6 weeks in the summer. I was under intense pressure to do something. He's been having congestion ever since the accident. I thought it might be related to his injury. Went and saw a new endodontist. Was told the pulps were alive, but he has root resorption (subacute apical periodontitis). Told me there were no infection because the pulps were alive, but teeth will fall out. Had root canal done and treated w/ Ca[OH]2 for 8 wks. He had no symptom of congestion while abroad. Came back home and the symptoms came back. Found out that we had mold in our attic. He had gutta percha and cotton put in last week. Was sent to general dentist for final restoration. Went to our dentist yesterday and she didn't want to take cotton out. Said that you'll need it for post and crown. The endodentist said that he'll not need post and crown. Who is right? Please help. He's only 15 and I don't know what other options there are. Thank you so much!

Hi AKDENTAL,

I am in the dental field and can offer you some information here.

I don't know where you have been looking for information about root canals or what you have read but the information that I provide here is not nonsense at all. Every dentist is well aware that the root canal procedure cannot cure an infected tooth or ever make that tooth healthy again. They also know there are systemic risks associated with keeping chronically infected teeth. They all learn this early on in their education but lose sight of it as they focus more on the "carpentry" aspect of their education as that is where most of the emphasis ends up.

I am sorry that your son has experienced this trauma and only at the age of 15. I don't know if any of the dentists have informed you of the risks of keeping these teeth but they certainly should have before you consented to having the root canals done.

It is important to know that these teeth will be a chronic source of infection, they will continue to abscess and the bacteria will become more widespread. The sinus issues that he has, even if they are on and off, are a common and often overlooked symptom indicating that the inflammation and bacteria is making it's way into the sinus. The longer this goes on, the more widespread the problem will become. Irrelevant of how many times these teeth are root canaled the necrotic infected nerve tissue cannot be removed from the tiny canals. So the teeth will remain infected. ALL dentists are aware of this.

If you have not been informed you should know that what usually happens in cases like your sons.... he will get recurrent fistula's (abscesses) that break through the gum tissue above the teeth. He will be told he needs another root canal procedure done as the originals failed. He will continue to have further bone loss. His crowns will eventually not fit properly and he may get decay underneath them. Then he will be told he needs a surgical root canal which is called an apicoectomy. This surgery is very painful and it does nothing to alter the chronic infection inside of those tiny canals that are causing this brewing infection and it results in more bone loss. The bacteria from these teeth can easily spread to the adjacent teeth. Again, all dentists are very aware of these facts.

Keep in mind that dentists are tooth carpenters. They have been taught to "keep" teeth, not "cure" them. They offer rc and apico procedures in an attempt to help a patient "keep" their non-vital and infected teeth for an undetermined amount of time. Obviously there are many problems with that train of thought as it is never healthy, or medically acceptable, to "keep" any non vital body part anyplace in the body.

The only way to attempt to cure the infection and preserve the bone for replacement of those teeth is to have those teeth extracted to attempt to eradicate the infection that is already gone into the jaw bone. Extracting them will help preserve the healthy bone that he still has by decreasing the overall loss of bone in the future. The more bone loss he has the more difficult it will be to replace those teeth in the future as the bone and cartilage in the upper front area of the mouth cannot be replaced well enough to support dental implants.

It sounds extreme to remove those teeth at his age. However, in doing so you remove the source of the chronic problem and give him a better chance of saving the health and integrity of the jaw bone so that dental implants can have a chance at having an indefinite life span. Removing the teeth also stop or severely decrease the systemic health consequences that typically occur with chronically infected teeth.

The controversy with the post and crown issues between the 2 dentists....
The endodontist knows these teeth are not healthy. To prep these teeth for posts and crowns adds further trauma and bacteria to these fragile teeth. To put a post into these teeth will likely cause them to fracture and/or perforate the apex (the root of each tooth) causing further trauma and bacteria at the site of the already inflamed tissue and bone. He knows these teeth have a limited life span before more problems occur and knows the money spent on them is not worth it.

The general dentist is only thinking about the "carpentry" portion of the tooth and he knows that the teeth are fragile and wants to make them more stable with a post and crown. However, he is not giving consideration to the trauma or inflammation or injury that the preparation of the post and crown will cause both teeth. He also knows that placing large composite fillings on these teeth is not going to hold up for very long either ... but he will then blame the recurrent symptoms on the fact that you did not crown these teeth. So most likely he will try to convince you to do the post and crown before the next round of symptoms occur as then he can blame them on the endodontist or just say... the rc procedure failed, do it all again.

This is a terrible situation to be in. I feel so badly for you and your son. I have seen many hundreds of patients over the years who have been in the same situation and if they had only been properly informed in the beginning, it would have saved a whole lot of stress, anxiety and money for the parent while saving stress, pain and bone loss for the patient.

I would suggest that before you do anything else... consult with an oral surgeon about the health of these teeth and the health of his jaw bone. Explain to him that you are concerned about the long term risks of retaining these teeth... how will these teeth affect the health of his jaw bone... would the bone loss make it more difficult to replace these teeth with implants in the future.... express concerns about your son's systemic health as he is already showing signs of sinus problems. These are issues that parents and patients need to bring up at the consultation with their dentists and their oral surgeons. Once this issues are put on the table by the parent or the patient... a wise dentist will provide a more straight forward picture of the situation. If you wait for the dentist to discuss these things... it will not happen. Remember, they are tooth "carpenters" and they are taught to "keep" teeth irrelevant of the systemic risks.

Please feel free to come back with more questions and please keep us updated on everything.

Bryanna

Dear Bryanna:

Thank you so very much for your reply and advice! I was told that he's too young to do post and crown, that he needs to be at least 18 before it's done. Is he also too young for implants? Something about jaw bones not fully developed. I have hear/read problems associated with implants also. Wouldn't the implants block the energy flow of the meridian? Wouldn't it be bad to have metal in the mouth that can cause magnetic field and interact with other signals that's flying around in the air around us?

I have read through lots of medical/scientific journal and papers since the accident. Most of them are difficult for me to decipher. I blame myself for allowing the RC. He is a very thoughtful and considerate boy and I couldn't believe I'm the one that kill the teeth.

Do you think oil pulling with coconut oil can cut down the bacteria?

May I also ask your thoughts on wisdom teeth? I'm taking my 18 year old to have his wisdom teeth checked, possibly removed tomorrow upon the general dentist's recommendation. I'm loosing faith in my dentist. I have been going with her for 20+ years. The fact that she thinks that rc'd tooth harbor bacteria is nonsense really bothers me. If the bottom wisdom tooth is not coming out straight, if it comes in horizontally or at an angle, is it reason enough to have it removed? If the bottom one is removed, should the top one be removed even if it's coming in straight? Do you need a counter force of the bottom tooth to keep the top one healthy?

Thank you so very much again. I really appreciate you time and advice!

Hi AkDental,

I am so glad to read that you are aware of the energy meridians, magnetic field in the body, etc. People who are not familiar or in denial about this subject find it to be a bit "odd". Not me... I get it!!

So here's the thing with the dental implants and the flow of the energy in that area of his mouth. First there are implants that are made from zirconium that do not conduct static energy as the titanium do. They also are more resistant to certain bacterial biofilms compared to titianium. Both materials are considered bio compatible so most people do well with either one. You could have him tested for sensitivity to both of these. Are you familiar with the Clifford or Peak test? Or even kinesiology?

Yes, it is true that ideally he should wait until he is 18 or until his growth pattern slows down before getting the implants. However, that is not a healthy or wise reason to retain infected teeth because the longer those teeth are present the more bone loss will occur and the further the bacteria will spread. So not only are those teeth a health concern but once the bone is gone in that area, there is really no great solution to replace it. Which means he would not be a candidate for dental implants in the future. That would mean he would have to go with a conventional bridge which would entail cutting down at least one adjacent tooth on each side if not two adjacent teeth on each side. Or he would have to wear a partial denture.

One of the options is to remove both teeth, if the infection can be removed in it's entirety and healthy bone can be seen and felt, then have bone grafts placed to help encourage the growth of new bone. If the bone is badly infected, then the grafting would be done in a second surgery after the area has a chance to heal. The sooner this is done the better the outcome.

Because he is young, his own bone will be eager to fill in that space increasing his chances of having adequate, healthy bone for implants at 18 yrs of age. The replacement options for those teeth at this time would be either a removal partial denture, called a flipper or a maryland bridge. Neither of which cut down the adjacent teeth. Neither of these replacements are ideal for the long term and he will need to be extremely careful with eating. However, either one is only being used as a temporary measure until his growth rate slows down or stops and either one will provide him with the opportunity to have the implants later on.

It is imperative that you have a great oral surgeon, someone who understands the future plan so he can prepare and preserve the bone properly. It is equally important that you have a dentist who is experienced, skillful and comfortable in doing the maryland bridge. Not all dentists do these too often and you need someone who does. This dentist will most likely work with a great dental lab which will be equally important.

Oil pulling is great for the health of the gum tissue... but it cannot alter the bacteria that is residing inside those tiny canals in his teeth. Nothing can reach those or alter their contents.

Wisdom teeth that come in crooked or are angled oddly in the bone can cause bone loss and damage to occur to the second molar. So sometimes it is best to remove them. Regarding the upper wisdom teeth if the lower ones are removed.... all teeth ideally need a buddy to bite against. When they don't have one, they tend to drift down or up into the space where there use to be a tooth.

Are you familiar with Biological dentistry? If so, then you may be able to find a dentist who thinks similarly to you on the IAOMT.org website.

Bryanna





QUOTE=AKDENTAL;1092482]Dear Bryanna:

Thank you so very much for your reply and advice! I was told that he's too young to do post and crown, that he needs to be at least 18 before it's done. Is he also too young for implants? Something about jaw bones not fully developed. I have hear/read problems associated with implants also. Wouldn't the implants block the energy flow of the meridian? Wouldn't it be bad to have metal in the mouth that can cause magnetic field and interact with other signals that's flying around in the air around us?

I have read through lots of medical/scientific journal and papers since the accident. Most of them are difficult for me to decipher. I blame myself for allowing the RC. He is a very thoughtful and considerate boy and I couldn't believe I'm the one that kill the teeth.

Do you think oil pulling with coconut oil can cut down the bacteria?

May I also ask your thoughts on wisdom teeth? I'm taking my 18 year old to have his wisdom teeth checked, possibly removed tomorrow upon the general dentist's recommendation. I'm loosing faith in my dentist. I have been going with her for 20+ years. The fact that she thinks that rc'd tooth harbor bacteria is nonsense really bothers me. If the bottom wisdom tooth is not coming out straight, if it comes in horizontally or at an angle, is it reason enough to have it removed? If the bottom one is removed, should the top one be removed even if it's coming in straight? Do you need a counter force of the bottom tooth to keep the top one healthy?

Thank you so very much again. I really appreciate you time and advice![/QUOTE]

Thank you for your reply again. I took my oldest to the oral surgeon today and decided to wait before having his wisdom teeth pulled. I might be phobic about loosing tooth

I'm not familiar with Clifford or Peak test or kinesiology but will look into it.

Thank you for your recommendation flipper and maryland bridge. Why are they not good for long term solution?

Can you also share your view on braces or invsalign? I wonder if part of my son's problem started w/ root resorption from invisalign.

Thank you very much and have a wonderful weekend!


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Hi AkDental,

Many people have some aversion to losing their teeth. No one wants to do that unless it's necessary. When infection or the prevention of infection is at stake, then one has to weigh out the risks of retaining those teeth.

A flipper like the one your son would need is difficult to eat with. Some people even take them out to eat because it is only anchored in the mouth by a few wire or plastic clips. It is not made to last a lifetime and needs to be replaced as often as necessary. Depends on the person and their lifestyle... eating. etc. A maryland bridge is cemented onto the adjacent teeth by a pair of wire arms and it is not meant to be chewed on like natural teeth as the bonding will come loose and the bridge will come out. Again this is not a long time replacement option just an intermittent one.

Conventional braces come is a variety of metals and plastic. Anyone that wears braces to straighten their teeth must commit to wearing their retainer once the braces are removed or the teeth will shift our of alignment. Teeth have memory and braces only alter the placement of the teeth while they are on... thus the need to faithfully wear the post op retainers.

Invisalign are removable braces. Not all cases can be done with these braces. This treatment requires total compliance of the patient to wear the liners as prescribed or the outcome will not be favorable. Again post op retainers need to be worn to keep the teeth in the new position.

Root resorption occurs frequently from orthodontia and it happens when the teeth are moved too quickly. The idea with orthodontia is to move the teeth slow and steady. Root resorption cannot be corrected and it makes those teeth that have it vulnerable to nerve damage in the future.

Bryanna



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Hi, Bryanna:

I was wondering if we should save wisdom tooth for the possibility of pulp transplant - hopefully in the near future? The pulp of a tooth looks complicated w/ nerves and blood vessels so I assume it's very difficult to do a transplant. Do you know if there are any research in that area? I think it's possible to revitalize dead pulp in immature tooth but not mature ones. At what age do tooth apex usually closes? Thank you so very much for your help again!


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