Hello,
Just wanted to ask about anaesthesia for extraction. I am going today to discuss all the options for my dental problem, mostly for the post extraction solutions. I have a problem with anaesthetics with adrenaline/epinephrine. I always ask for one without it. Will this affect extraction of root canal teeth?
Also I am taking antibiotics and will that calm down infection before extraction or should I worry about some complications?
What should I discuss with the oral surgeon before extraction? I read about cleaning the site of infection. Most of the people in medical field do not like if you tell them what they should do and how to do their job and then they are rude to you.
Thank you

Hi Marija,

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

<< I have a problem with anaesthetics with adrenaline/epinephrine. I always ask for one without it. Will this affect extraction of root canal teeth?>>

I UNDERSTAND YOUR CONCERNS. IT IS IMPORTANT FOR YOU TO KNOW THAT ADRENALINE IS A NATURAL OCCURRING HORMONE THAT OUR BODY PRODUCES ON IT'S OWN FROM OUR ADRENAL GLANDS. ADRENALINE SERVES MANY PURPOSES IN OUR BODY BUT IT ALSO PROVIDES ENERGY FOR US TO FEEL EMOTION, EXCITEMENT, FEAR AND ANGER BY INCREASING OUR BLOOD PRESSURE, PULSE, AND HEART RATE. JUST TO BE CLEAR, NO ONE IS ALLERGIC TO ADRENALINE.

EPINEPHRINE IS AN INGREDIENT THAT IS FOUND IN MOST ANESTHETICS. IT REACTS SIMILARLY TO ADRENALINE IN THE BODY BY INCREASING THE BP, PULSE AND H-RATE. SO A "FAST" INJECTION OF EPINEPHRINE CAN CAUSE A TEMPORARY UNPLEASANT, EVEN FRIGHTENING PHYSICAL REACTION.

SO SOMETIMES WHEN A PERSON IS ANXIOUS OR FEARFUL AND THEY GET AN INJECTION OF EPINEPHRINE, THEY GET THAT VERY UNPLEASANT REACTION.

ONE WAY TO HELP PREVENT THAT REACTION FROM OCCURRING IS TO TAKE MEASURES TO BE CALMER DURING THE DENTAL PROCEDURE. ALONG WITH THAT, TELL THE DENTIST YOU DO NOT WANT THAT REACTION TO HAPPEN AND ASK HIM TO PLEASE GIVE THAT INJECTION VERY SLOWLY TO REDUCE THE CHANCE OF HAVING THAT REACTION. A SLOW INJECTION ALLOWS THE BODY TO METABOLIZE THE CHEMICAL RATHER THAN SHOCK THE SYSTEM.

THE REASON EPINEPHRINE IS USED IN DENTISTRY IS TO GIVE A MORE PROFOUND ANESTHETIC AFFECT AND IT ALSO ALLOWS THE NUMBNESS TO LAST LONGER. HOWEVER, IT IS NOT ALWAYS NECESSARY TO USE IT. DISCUSS YOUR CONCERNS WITH THE ORAL SURGEON AND MAKE SURE HE KNOWS THAT YOU DO NOT WANT TO EXPERIENCE AN UNPLEASANT REACTION FROM THE ANESTHETIC.

<<Also I am taking antibiotics and will that calm down infection before extraction or should I worry about some complications?>>

YES, THE ANTIBIOTIC WILL REDUCE SOME OF THE INFLAMMATION FROM THE INFECTION WHICH CAN REDUCE THE CHANCE OF SURGICAL AND POST OP COMPLICATIONS. IT WOULD BE IDEAL FOR THE EXTRACTION TO BE BE DONE WHILE YOU ARE TAKING THE ANTIBIOTICS. THE MEDS ALSO REDUCE THE ACIDITY OF THE INFECTION ALLOWING THE ANESTHETIC TO WORK MORE EFFECTIVELY.

<<What should I discuss with the oral surgeon before extraction?>>

NEVER BE INTIMIDATED BY SOMEONE TAKING OFFENSE TO YOUR QUESTIONS OR CONCERNS. YES, IT IS THEIR OBLIGATION TO KNOW WHAT THEY ARE DOING AND TO DO IT CORRECTLY. HOWEVER, IT IS YOUR BODY AND YOU ARE IN CONTROL OF WHAT HAPPENS TO IT, NOT THEM. SO MY SUGGESTION IF TO POLITELY, NOT AGGRESSIVELY, DISCUSS ALL OF YOUR CONCERNS AND WISHES AND MAKE IT PERFECTLY CLEAR THAT THESE ARE YOUR DESIRES.

DISCUSS:
THE ANESTHETIC ISSUES .... THE POSSIBILITY OF A BONE GRAFT, WHY AND WHAT MATERIAL WOULD BE USED ..... YOU ONLY WANT A GRAFT PUT IN IF THE BONE IS HEALTHY ENOUGH TO RECEIVE IT AS YOU DO NOT WANT UNNECESSARY POST OP COMPLICATIONS OR HAVE TO REMOVE THE GRAFT DUE TO INFECTION .... YOU WANT TO KNOW IF HE THINKS THERE IS ANY SINUS COMMUNICATION NOW AND AGAIN AFTER THE TEETH ARE REMOVED .... YOU FEEL IT IS IMPORTANT FOR THE SITE TO BE THOROUGHLY DEBRIDED CLEAN OF THE PERIODONTAL LIGAMENT AND ALL NECROTIC TISSUE AND DISEASED BONE.

ALSO, I KNOW YOU ARE FOCUSED ON JUST THE ONE TOOTH BASED ON WHAT YOUR DENTIST HAS TOLD YOU. HOWEVER, LEAVING EITHER ONE OF THESE TEETH IN YOUR MOUTH MEANS KEEPING THE INFECTION AS THEY ARE BOTH INFECTED. REMOVING ONLY ONE OF THEM IS NOT GOING TO GIVE YOU ANY LONGEVITY WITH ANY REPLACEMENT THAT YOU DO WHICH MEANS YOU WILL BE DOING THIS ALL OVER AGAIN SOONER THAN LATER.

<< I read about cleaning the site of infection. Most of the people in medical field do not like if you tell them what they should do and how to do their job and then they are rude to you.>>

THE ONLY WAY A DOCTOR CAN BE CERTAIN OF WHAT THE PATIENTS EXPECTATIONS ARE IS FOR THE PATIENT TO OPENLY EXPRESS THEM. YOUR INTENTION IS NOT TO TELL HIM HOW TO DO HIS JOB, IT IS TO INFORM HIM WHAT YOU ARE CONCERNED ABOUT AND WHAT YOU EXPECT OF THE OUTCOME. IF YOU APPROACH YOUR CONCERNS WITH A GENTLE BUT FIRM AND KNOWLEDGEABLE DEMEANOR, YOU WILL MOST LIKELY BE TREATED WITH RESPECT AND HE WILL HONOR YOUR REQUESTS.

I hope this list is helpful to you. Please let us know how things go today!
Bryanna

Thank you Brayanna very much.
I was yesterday at the clinic and discussed everything with the surgeon. I have an appointment for Friday morning. The both teeth will be extracted as I asked for. The bridge will be cut so I can be left with one healthy tooth which was keeping the bridge on (no rc tooth) and the two problematic ones for which I posted the x-ray will be extracted. He wanted to leave one of rc teeth, claiming that is good but I was clear about me wanting to take out rc teeth for which I strongly believe are making me sick. I have a total of 5 teeth under the bridge, 2 missing teeth, 2 rc teeth and one healthy for keeping the bridge on (I hope I explained ok.) So the helthy one will stay under the crown.
The Dr was nice and respectful for everything I ask for. No epi anaesthesia. Will do partial prosthesis. Everything will be ready on Friday morning. And he said he will 'scoop' after extraction if I understood well that expression. I am on Augmentin till Saturday evening. He said that when he removes the teeth infection will clear so AB's are not needed when I finish this round.
Tank you for help. It means a lot.

Hi Marija,

Okay, that sounds like a good plan to me!

You have made a healthy choice to remove both teeth. Hopefully you will notice a positive improvement in your health very soon!

It is best to prepare a nutritious diet plan and purchase what you need ahead of time so that you do not have to think about that during the healing phase. A nutritious soft food diet is recommended. Avoid eating things that are not healthy .... sugar, artificial sweeteners, soda, anything diet or low fat, refined foods like white breads/frozen meals/ canned foods/ pre made meals/fast food. It's a good idea to make a large pot of home made soup or stew, freeze it in small glass canning jars so you can just heat it up with little effort. Have plenty of eggs, fruit and vegetables in the house, and drink plenty of water throughout the day.

I am sure you will do fine.
Please keep in touch with us.
Bryanna

Hi, Bryanna:

I am trying to learn how to read x-rays as I have no faith in dentist and would like to know what's going on rather than what they tell me. Can you tell me how you can tell that the infection has spread to the jawbone from the x-ray?

Thanks!

Hello Bryanna,
I wanted to ask about jaw infection. You mention that infection from my rc teeth spread to jaw bone. Will that clear after the extraction? I am somehow scared now. I am taking antibiotics now but pain and neurological symptoms are present still after 3 days on AB. Maybe is still early. Dentist said that after the extraction infection will clear.
You are great help and support. Thank you.

Hi Marija,

The infection in the jaw bone is not always clinically or radio graphically visible unless it is large enough or widespread enough to be seen. Because the bone is so porous and because the mouth is so vascular, the bacteria can migrate to areas way beyond the teeth. Antibiotics will do the best they can at eradicating the bacteria but there is no guarantee the infection will be completely gone. This is why it is never a healthy option to retain an infected or rc tooth for a long period of time.

A few things that do help in eradicating the infection are:

For the surgeon to be very thorough in scraping out the bony socket after the tooth is removed. In doing so, the surgeon can feel with the instruments when he has reached solid bone. Also the color and amount of blood that comes from healthy bone as compared to unhealthy bone is quite different. So these are also indicators that he has either reached healthy bone or there is residual bacteria.

A nutritious diet that is rich in whole fresh foods and low or zero refined and processed foods. Avoiding sugar and artificial sweeteners all all beneficial for our health. A healthy diet is key to keeping a healthy immune system. During times of stress, infection or illness the immune system is compromised and we can only expect it to take care of so much at one time. So eating healthy takes the burden off of the immune system so it can do it's job at fighting the bad guys.

Take a probiotic supplement every day. This provides the immune system with healthy bacteria which helps it to work more efficiently.

I am not surprised that you still have pain and neuro symptoms. Our teeth are intricately connected to so many nerve areas that branch out to so many other distant areas. While those teeth are still present, the antibiotics cannot cure the infection because the bacteria is still brewing inside of those tiny canals inside of the teeth where the medication is ineffective. So the meds are only going to temporarily subside the inflammation until the teeth are removed.

I know you are scared and you are fed up with this pain. You have a ways to go before you feel better, but you will feel better. Removing those teeth will bring great relief to your immune system but in order for it to do its job well, you need to feed it well

If you have any other questions, please feel free to ask me.
Bryanna

I am having some low grade fever on and off during the day, today and yesterday. I've been feeling somehow sick since two days ago and the pain in still there, little nausea an general feel sick. Yesterday afternoon went to the dentist to see what is going on since I've have been using antibiotic since last Saturday and take some panadols and started ibuprofen since panadol doesn't work. He said he can just switch me to some other AB's and will do extraction on Friday (tomorrow). I am so scared that something is wrong. it affects my sinuses and it always does since the beginning and I have some nose bridge pain.

It's done, the teeth are extracted. I am at home and will take a rest. Still a bit emotional and having some pressure in face and anaesthesia still works. I will post a bit detailed later. I hope everything is going to be good.

Marija

Hi Marija,

SO very glad to hear that you had the teeth removed. Please take good care of yourself, rest and eat nutritiously. Follow the post op instructions.

Hopefully you will heal well and all of your pain will be gone very soon.

Please keep in touch with us when you can.

Bryanna