New comer here and I'm very stuck at what path I should take with my teeth.

I've had several autoimmune markers come up in my blood and I'm wondering if my root canal tooth is involved in it. I'm attaching a pan and close up of the root canal tooth.

Here is what I need to decide:

1) Does tooth #11 which is showing some possible infection related to my autoimmune issues or is there no connection.

2) Should I just leave #11 as is or
a) Perform Apicoectomy
b) Extract

3) If I do extract, I want to get an implant (Zirconium instead of titanium).
a) Should I wait for the bone to heal or implant immediately.


I don't want to lose a front tooth as I'm still young and I haven't found any scientific data that back up an infected tooth with autoimmune issues. Will I just be wasting a tooth or is this a good shot at helping me heal.

Attached Images

	chriscpan.jpg (204.7 KB, 109 views)
	chriscroot.jpg (95.9 KB, 119 views)

Hi chrisc,

I am in the dental field and can offer you some information here. I am going to repost your questions and answer you in bold type. Thanks for posting the xrays!!

<<I've had several autoimmune markers come up in my blood and I'm wondering if my root canal tooth is involved in it. I'm attaching a pan and close up of the root canal tooth.>>

WHEN YOUR BLOOD INDICATES AUTOIMMUNE PROBLEMS THAT MEANS THAT YOU NEED TO LOOK AT EVERY ASPECT OF YOUR DIET, LIFESTYLE, MEDICATIONS AND ENVIRONMENT AS ALL OF THESE THINGS ARE CONTRIBUTING FACTORS TO AUTOIMMUNE DISORDERS. GENERALLY OUR IMMUNE SYSTEM ACTS UP WHEN WE CHRONICALLY BOMBARD IT WITH IRRITANTS AS ANYTHING CHRONIC CAN LEAD TO A CUMULATIVE AFFECT IN OUR IMMUNE SYSTEM. ANOTHER ANALOGY IS CALLED THE BUCKET THEORY. IF YOU SLOWLY FILL A BUCKET WITH WATER YOU EVENTUALLY REACH THE RIM OF THE BUCKET...KEEP FILLING IT AND THE WATER SPILLS OVER AND THE BUCKET CONTINUES TO REMAIN FULL. OUR IMMUNE WORKS SIMILARLY TO THAT BUCKET.

<<1) Does tooth #11 which is showing some possible infection related to my autoimmune issues or is there no connection.>>

YES THE XRAYS INDICATE NEGATIVE PATHOLOGY GOING ON IN THE BONE WHICH IS POSSIBLY IN CLOSE PROXIMITY TO YOUR SINUS. IN YOUR ANATOMY IF THE PATHOLOGY HAS NOT INVADED THE SINUS MEMBRANE IT PROBABLY WILL EVENTUALLY. ANY INFECTION CAN BE RELATED TO ACQUIRING AN AUTO IMMUNE DISORDER. ORAL INFECTIONS ARE NOT EXCEPTION TO THAT FACT. HERE IS A BRIEF ARTICLE..
http://www.everydayhealth.com/autoim...nfections.aspx

<<2) Should I just leave #11 as is or>>
a) Perform Apicoectomy
b) Extract

TO LEAVE TOOTH #11 ALONE OR TO HAVE IT RE TREATED WITH ANOTHER RC PROCEDURE OR TO HAVE AN APICOECTOMY MEANS TO KEEP THE INFECTION AS THE TOOTH WILL BE THE SOURCE OF THE CHRONIC INFECTION. IRRELEVANT OF HOW MANY TIMES THE RC PROCEDURE IS DONE, IRRELEVANT OF HOW MANY TIMES THE THE APICO IS DONE... IRRELEVANT OF HOW WELL EITHER OF THOSE PROCEDURES ARE DONE... THE TOOTH WILL REMAIN INFECTED BECAUSE THERE IS NO ACCESS TO THE HUNDREDS OF CURVY MICROSCOPIC CANALS CALLED DENTIN TUBULES THAT ARE IN THE TOOTH. THESE CANALS HARBOR NECROTIC AND OFTEN GANGRENOUS NERVE TISSUE. THIS BACTERIA IS NOT SELF LIMITING TO JUST THE TOOTH AS EVIDENCED IN THE PATHOLOGY INDICATED ON YOUR XRAYS.

<<3) If I do extract, I want to get an implant (Zirconium instead of titanium).
a) Should I wait for the bone to heal or implant immediately.>>

I WOULD SUGGEST THAT YOU NOT HAVE AN IMMEDIATE IMPLANT AFTER THE EXTRACTION BECAUSE THE BONE IS OBVIOUSLY NOT HEALTHY WHICH MEANS THE IMPLANT WOULD NOT ONLY BE COMPROMISED BUT YOU COULD END UP WITH A SECONDARY INFECTION. IT WOULD BE BEST TO ALLOW THE AREA TO HEAL FOR SEVERAL MONTHS, HAVING IT MONITORED WITH ONE SINGLE PERIAPICAL XRAY AT MONTHLY INTERVALS TO BE SURE THAT THERE IS NO RESIDUAL INFECTION AND IT IS HEALING WELL.

IT IS IMPERATIVE THAT YOU HAVE AN ORAL SURGEON REMOVE THIS TOOTH AND NOT A GENERAL DENTIST... UNLESS THAT GD HAS HAD ADDITIONAL TRAINING IN ORAL SURGERY AND IS WELL EXPERIENCED IN IT. WHOMEVER YOU SEE FOR THE EXTRACTION BE SURE TO MAKE IT CLEAR THAT YOU WANT THE PERIODONTAL LIGAMENT AND ALL NECROTIC TISSUE AND BONE REMOVED AT THE TIME OF THE EXTRACTION. I KNOW IT SOUNDS STUPID TO HAVE TO BE THE ONE TO TELL THE DENTIST TO DO THIS BUT UNFORTUNATELY SOME ARE A BIT LAX ABOUT IT. LEAVING ANY OF THIS BEHIND WILL PREVENT THE BONE FROM HEALING AND CAN RESULT IN A CHRONIC INFECTION OFTEN REFERRED TO AS A CAVITATION. WHICH MOST DEFINITELY WILL COMPROMISE YOUR IMMUNE SYSTEM. YOU ALSO WANT TO KNOW HOW CLOSE THE ROOT AND THE INFECTION WAS IN PROXIMITY TO THE SINUS AND IF THERE WAS A SINUS COMMUNICATION. THOSE THINGS ARE IMPORTANT AS THEY WILL BE PART OF YOUR DECISION AS TO WHETHER OR NOT TO HAVE THE IMPLANT DONE LATER ON.

<<I don't want to lose a front tooth as I'm still young and I haven't found any scientific data that back up an infected tooth with autoimmune issues. Will I just be wasting a tooth or is this a good shot at helping me heal>>

THERE IS NO QUESTION ABOUT THE CORRELATION BETWEEN INFECTION AND AUTOIMMUNE ISSUES. IF YOU GOOGLE THAT PHRASE YOU WILL COME UP WITH AN ABUNDANCE OF INFORMATION. WHEN EXPLORING THE INFORMATION WHAT YOU NEED TO KEEP IN MIND IS THAT OUR TEETH AND OUR ORAL HEALTH CAN BE HUGE SOURCES OF BACTERIA AND INFECTION. KEEPING A ROOT CANALED TOOTH OR ANY INFECTED TOOTH IS A CHRONIC SOURCE OF INFECTION IRRITATING TO THE IMMUNE SYSTEM.

NO ONE WANTS TO LOSE THEIR TEETH, YOUNG OR OLD. IT IS UNDERSTANDABLE TO WANT TO HANG ON TO THEM FOR AS LONG AS WE CAN. BUT IF YOU PUT INTO PERSPECTIVE WHAT IT IS THAT YOU WANT TO HOLD ON TO AND HOW THAT WILL AFFECT YOUR HEALTH FOR THE LONG TERM... THE DECISION MAY BECOME MORE CLEAR AND A BIT EASIER TO DEAL WITH.

REGARDING THE DIFFERENT DENTAL IMPLANTS.... IT WOULD BE BEST TO GET YOUR BLOOD MARKERS UNDER CONTROL BEFORE HAVING ANY IMPLANT DONE AS THE IMPLANT IRRELEVANT OF THE TYPE CAN BECOME A CHRONIC SOURCE OF IMMUNE BURDEN IF YOUR IMMUNE SYSTEM IS NOT FUNCTIONING PROPERLY.

I HAVE A QUESTION ABOUT YOUR LOWER RIGHT DENTAL IMPLANT....
WHAT WAS THE HISTORY ON THAT TOOTH AND DO YOU TEND TO GET FOOD TRAPPED UNDERNEATH THAT CROWN?

Bryanna

Thank you so much for the information. Please check my replies under each quote.

When I talked to the endodontist, he said that it's not always an infection but a scar? Does that sounds remotely logical or is this definitely 100% an infection in the bone?

My dentist did mention they can run a current that will zap all the bacteria dead in those 100's of tubes, if they open it up.


Hm, the dentist told me if I do not do an immediate implant I will lose bone and will need gum grafts? Is this correct, from you experience how much bone would be lost in a few months? Obviously I would like to keep the gum line relatively the same from a cosmetic point of view.

In terms of removing all infection, I see that the tooth is very deep rooted. Will the doctor be able to reach all the way in to clear the infection, since the root is so long?

That tooth was root canalled 10 years ago and developed a cyst / infection under it in the bone. I had the tooth extracted, waited 3 months and had a Zirconium implant put in 3 years ago. Yes, food traps there, but I make sure brush my teeth after each meal and clean all areas of food.

Posting an update.

Well I went to the oral surgeon to ask about #11. I did a cone beam ct scan of that tooth and it looks like the infection is 3x bigger on the front area and is quite large.

The oral surgeon insisted that I should try getting the root canal done again and get an Apicoectomy. He said there is plenty of tooth structure and healthy bone and that I can save the tooth.

So I'm ultra confused now, who to listen too. I still feel like I should extract and get rid of the chronic infection and then get an implant, but all the dentists tell me to do after all other options are exhausted.

Would an Apicoectomy compromise a future implant if it fails?

Hi chrisc,

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

<<Well I went to the oral surgeon to ask about #11. I did a cone beam ct scan of that tooth and it looks like the infection is 3x bigger on the front area and is quite large.>>

SO THIS CONFIRMS WHAT I SAID ABOUT THE RADIO GRAPHIC PATHOLOGY IN THE BONE. KEEP IN MIND THAT YOUR JAW BONE IS RELATIVELY SMALL AND COMPACT COMPARED TO OTHER BONY AREAS OF THE BODY. SO A LARGE INFECTION IN THE JAW BONE MEANS THAT THERE IS A LOT OF AREA INVOLVED. THE FRONT PORTION OF THE BONE IS CALLED THE BUCCAL AND IT IS THIN AND FRAGILE COMPARED TO OTHER AREAS OF BONE. WHEN AN INFECTION HAS CONSUMED THE BUCCAL BONE, IT RESULTS IN SUBSTANTIAL BONE LOSS THAT IS NOT ABLE TO BE REBUILT WELL ENOUGH WITH A BONE GRAFT MATERIAL. EVEN BONE HARVESTED FROM YOUR MANDIBLE OR FEMUR MAY NOT BE ABLE TO REBUILD THIS AREA OF BONE AS IT HAS NOTHING TO HOLD ON TO OR GROW INTO. AT THIS POINT, DUE TO THE LONGEVITY OF THE INFECTION WHICH HAS BEEN BREWING AT LEAST 10 YEARS AGO WHEN YOU HAD THE ROOT CANAL, THERE IS LITTLE TO NO HEALTHY BONE IN THAT AREA AS IT HAS DETERIORATED FROM THE BACTERIA. THIS CONDITION IS COMMONLY SEEN WITH ANTERIOR ROOT CANALED TEETH.

<<The oral surgeon insisted that I should try getting the root canal done again and get an Apicoectomy. He said there is plenty of tooth structure and healthy bone and that I can save the tooth.>>

THE OS KNOWS THIS TOOTH IS HOPELESS AND THAT IT IS INEVITABLE THAT IT WILL NEED TO BE REMOVED. HE THINKS YOU WANT TO ATTEMPT TO BUY SOME MORE TIME AND THE APICO WOULD BE YOUR ONLY OPTION. HOWEVER, WHAT HE MEANS WHEN HE SAYS "SAVE" THE TOOTH, IS SIMPLY "RETAIN", NOT "CURE". THE LONGER THIS TOOTH IS PRESENT THE FURTHER THE INFECTION WILL SPREAD BECAUSE THE TOOTH IS CAUSING ALL OF THIS PROBLEM AND THERE IS NO DENTAL PROCEDURE OR MIRACLE ZAPPING MACHINE THAT CAN REMOVE THE NECROTIC TISSUE INSIDE OF THE MICROSCOPIC CANALS THAT IS HOLDING THIS TOOTH HOSTAGE TO INFECTION. THAT NERVE TISSUE IS SO SICK.... JUST LOOK AT WHAT IT HAS DONE TO YOUR JAW BONE ALREADY.

TO REPEAT THE RC PROCEDURE AND DO AN APICO IS 100% A WASTE OF TIME, MONEY AND PAIN. NEITHER OF THOSE PROCEDURES WILL ALTER THE SICK NERVE TISSUE INSIDE OF THOSE TINY CANALS. YOU WILL NOT ONLY BE LEFT WITH THE SAME PROBLEM THAT YOU HAVE NOW BUT ADDITIONAL INFLAMMATION AND PERMANENT BONE LOSS FROM THE APICO SURGERY.

<<So I'm ultra confused now, who to listen too. I still feel like I should extract and get rid of the chronic infection and then get an implant, but all the dentists tell me to do after all other options are exhausted.>>

THE DENTISTS ARE IN THE BUSINESS TO SELL DENTISTRY. THERE IS A LOT OF MONEY TO BE MADE WITH REPEATED ROOT CANALS AND APICOECTOMIES AS THEY ARE NOT INTENDED TO "CURE" THE PROBLEM. SO THE PATIENT INEVITABLY HAS TO REMOVE THE TOOTH AND THEN DEAL WITH THE COMPLICATIONS OF REPLACING IT DUE TO THE EXTENSIVE BONE LOSS.

ALSO, HAS ANY OF THESE DENTISTS GIVEN YOU ANY INCLINATION ABOUT HOW THIS INFECTION IS AFFECTING YOUR IMMUNE SYSTEM?

<<Would an Apicoectomy compromise a future implant if it fails?>>
YES, AN APICO WILL ALWAYS COMPROMISE THE SUCCESS OF A DENTAL IMPLANT BECAUSE THE APICO PROCEDURE CAUSES IRREPLACEABLE BONE LOSS. WHICH WOULD JUST FURTHER THE BONE LOSS THAT YOU ALREADY HAVE.
REGARDING A DENTAL IMPLANT.... ANY TIME THE BUCCAL PORTION OF THE BONE IS LOST TO DISEASE, IT IS VERY RISKY TO PLACE AN IMPLANT IN THAT AREA AS THERE MAY NOT BE ADEQUATE BONE TO COVER THE FRONT PORTION OF THE IMPLANT. IT IS NEVER IDEAL TO PLACE AN IMPLANT IN AN AREA LIKE THAT WHICH WOULD LEAVE ONE SIDE OF THE IMPLANT COVERED WITH GUM TISSUE AND NO BONE.

I know this is difficult to go through and I wish your dentists would be more informative with you... but so far they are not. You are experiencing a typical cluster mess because you are being sold tooth carpentry rather than healthy dental care.

Here are two links, from dental sites that I am unaffiliated with, that go into detail about root canaled teeth and the aftermath that they leave behind.

http://biologicaldentalhealth.com/co...ticle/106.html

http://toothbody.com/unexplained-den...ntal-ligament/

Also, re read through my posts to you. I think you know intuitively what you need to do. Listen to your intuition.

Bryanna

I'm attaching the CT scan images to give you an idea of how large or small the infection is. The bone does indeed look thin at the buccal side.

Yes I believe the dentist believes I can buy more time with it, he's not interested in selling unnecessary procedures, he genuinely believes why not give the tooth a chance to live for another 5-10 years or longer. I guess the question is what is the probability of reinfection in that situation. I would assume high in the 60% range?

Everytime I ask them about my immune system, they shrug and have no idea.. Yes I do believe logically removal of the tooth will give me a higher chance of getting rid of the infection permanently (at the cost of a lower cosmetic result) and possibly helping my immune system to heal.

Looking at the CT scans, how would you proceed with this situation, extract and wait for 1-2 months for the bone to heal then implant, making sure no infection is left? Do you think I have enough bone for an implant?

Attached Images

	ct1.jpg (43.9 KB, 67 views)
	ct2.jpg (73.4 KB, 66 views)