[azmanatheart]

Hi,
I had a 12 year upper molar that had a root canal and a gold crown about 10 years old. The other day while eating a soft muffin, it just came off with no apparent reason. Looking at the bottom of the crown, I could see it was almost entirely black,(I assume all decay) with a very small thread like amount of healthy tooth that had been holding it on. I am left with a space and gum that has some decaying pieces sticking up, and I'm sure no way to put a crown back on. I have no wisdom tooth behind it, so there is little left to chew with on that side.
My questions is, I assume this needs to be surgically removed by an oral surgeon, or can it be left like that? My sense is that it is rotten, and I can taste the decay(probably smells in my breath, too), do these decaying roots pose a health risk? Should I be running to the oral surgeon, or do I have time?

Thanks!
Azmanatheart

[Bryanna]

Hi azmanatheart,

Unfortunately your tooth is very sick and it needs to be removed as soon as you can before it becomes a full blown abscess. There is a strong likelihood that the bacteria that has been brewing in this tooth since the root canal was done 10 years ago has already spread to the jaw bone. So this is not something to wait on. Yes, please see an oral surgeon for the removal and not a general dentist or a periodontist.

Let us know how things go. You will be okay, just don't wait.

Bryanna

Originally Posted by azmanatheart

Hi,
I had a 12 year upper molar that had a root canal and a gold crown about 10 years old. The other day while eating a soft muffin, it just came off with no apparent reason. Looking at the bottom of the crown, I could see it was almost entirely black,(I assume all decay) with a very small thread like amount of healthy tooth that had been holding it on. I am left with a space and gum that has some decaying pieces sticking up, and I'm sure no way to put a crown back on. I have no wisdom tooth behind it, so there is little left to chew with on that side.
My questions is, I assume this needs to be surgically removed by an oral surgeon, or can it be left like that? My sense is that it is rotten, and I can taste the decay(probably smells in my breath, too), do these decaying roots pose a health risk? Should I be running to the oral surgeon, or do I have time?

Thanks!
Azmanatheart

[azmanatheart]

Thank you for your previous response, it was very helpful.
I did try to see an Oral Surgeon, who's first available appt(despite telling them I was in pain) was Jan 6th. 4 days ago, this 'root' became extremely painful and needed immediate attention, so I was referred to another Oral Surgeon who was able to take me right away.
He worked very fast and was a bit rough, but thanks to the laughing gas, I was able to handle it. The tooth roots were stubborn, and since they were below the gum line, there was a lot of cutting. At one point he was using a hammer and chisel, I guess to break it apart, but I thought he was going to give me concussion, it felt so hard. When he finally got one of the roots out, I could feel something in my sinus, which I immediately told him. He said he didnt think so, and said' Let's pray to God that's not so', which really got my antenna up.
Post op. my sinus was immediately draining profusely down through the wound the 1st day. He called me that to night to check on me(that was a first for a Dr. to call and see how I was feeling) and I told him about the sinus drainage again. He said that he put 'something' in there to close it up, even though he still didn't think the sinus was perforated! He gave me instructions not to suck on a straw, or other things that might cause that opening to not heal up. Second day, don't feel as much drainage from sinus, but do feel a lot of mucous in the opening of the wound under the stitches. Day 3, my jawbone is extremely tender and the area feels more sore than ever, despite taking Levaquin(nasty stuff).
Question is, do these things heal and does the opening to the sinus heal up and close when there is active drainage? When I think back, I have often had problems with that maxillary sinus, does not drain properly since it dips down so low, and years ago a dentascan revealed a partial septation on the floor of the sinus that trapped fluid. I'm wondering if that root was always slightly in the sinus, and removing created a new method of drainage.
So, what is the downside of having your sinus drain through a hole in the gum, besides the salty taste and extra mucous? Is it prone to infection, does it cause bad breath? And how, if it stays open, can it be closed?
By the way, I got a greeting card from the Dr. wishing me well and thanking me for my business. Is he being nice, or is he concerned about something and not telling me?) Maybe I', a bad person for being suspicious, but I have never had a Dr. be so 'friendly'.
Thank you!

[Bryanna]

Hi azmanatheart,

I am glad that you had the tooth removed and did not wait.

I must admit that I am concerned about what is currently going on. Based on your original description of your tooth problem and especially since the tooth had been root canaled, I had no doubt that you had a severe infection and in all likelihood, even though you did not mention it, the bacteria had proliferated into the sinus area. I still think that is a strong probability.

If the extraction site keeps filling with mucus and/or you have mucus from the sinus draining from the extraction site, then you most definitely have a communication into the sinus. The severity and areas affected by the infection along with what the oral surgeon did during and after he removed the tooth can be a help or a hindrance in how this heals. With that said, even if he did everything he should have, the bone around all root canaled teeth becomes compromised due to the chronic infection. The longer the tooth is present, in your case 10 years, the greater the compromise. So this can be a difficult problem to treat. Chances are this tooth had infected your sinuses a long time ago, thus the history of sinus problems above this tooth. You may have developed some scar tissue along the floor of the sinus which was trapping bacteria and showing up as an abnormality in the scan you had years ago.

The antibiotic Levaquin is usually only prescribed for dental infections if the sinus is involved in the infection. So again, this tells me that he is suspecting the sinus is involved. Yes, Levaquin is an antibiotic that can cause some very serious and long term side effects. So it is necessary to monitor your side effects and if you experience anything that you feel is extreme or unusual, call the pharmacist and explain your symptoms.

I must say that I do not find it unusual for the oral surgeon to give you a follow up phone call. I know many dentists, surgeons who do that. However, it is a bit unusual for him to send you that card. But maybe he is just that compassionate.... and he knew he put you through a lot.

To answer your other questions......

<<do these things heal and does the opening to the sinus heal up and close when there is active drainage? >>

No, it will not close up or heal as long as there is drainage. Drainage indicates that there is an opening. With that said, the opening can develop a biofilm or a thin scar tissue that slows down or stops the bacteria from draining. This is okay so long as the infection is not still brewing in the sinus above the biofilm.

<<So, what is the downside of having your sinus drain through a hole in the gum, besides the salty taste and extra mucous?>>

The downside is that the opening can also allow bacteria to get up inside of it which could travel to the sinus. So it is not ideal to have this opening for a long period of time. Also, anytime infection is draining into your mouth, whether it be from a tooth infection and/or a sinus infection, the bacteria is also being swallowed. So it is traveling through the digestive tract as well. The antibiotic may help with that but at the same time the antibiotic is also compromising your intestinal health because the meds kill off the good bacteria that lives in the intestinal tract. So it is imperative that you take a multi strain probiotic supplement at least twice a day while on the antibiotic and for several weeks thereafter if not indefinitely at one dosage per day to help rebuild the healthy bacteria up again. A probiotic needs to be taken an hour prior to the antibiotic or 2 hours after the antibiotic or they will each interfere with the absorption of one another.

<< Is it prone to infection, does it cause bad breath?>>

Yes, the infection draining from the sinus can and most often will cause bad breath. But do not use mouthwash to try to mask it as the chemicals in the mouthwash can prevent the area from healing. Be sure to brush and floss all of your teeth to keep the plaque down and use a tongue scraper to remove the debris from your tongue as these things will help reduce the odor.

<< And how, if it stays open, can it be closed?>>
This area needs to be closely monitored by the oral surgeon at least within the first few weeks post op. So be sure to get in an see him within 7-14 days post op and then as recommended. You should keep a daily diary of your physical symptoms/sinus draingage and notify him if you develop a fever or unusual swelling. This can take a long time to heal completely. If it does not close, then the oral surgeon may have to intervene. But generally if the infection clears and you do not smoke, the opening will close. The chemicals in tobacco along with the sucking action of smoking can prevent the sinus opening from closing. Even an opening the size of a pin head can keep the infection going. So this is something that needs to be taken care of properly until the healing is complete.

I hope this information is helpful. Keep us posted on how you're doing.
Bryanna

Originally Posted by azmanatheart

Thank you for your previous response, it was very helpful.
I did try to see an Oral Surgeon, who's first available appt(despite telling them I was in pain) was Jan 6th. 4 days ago, this 'root' became extremely painful and needed immediate attention, so I was referred to another Oral Surgeon who was able to take me right away.
He worked very fast and was a bit rough, but thanks to the laughing gas, I was able to handle it. The tooth roots were stubborn, and since they were below the gum line, there was a lot of cutting. At one point he was using a hammer and chisel, I guess to break it apart, but I thought he was going to give me concussion, it felt so hard. When he finally got one of the roots out, I could feel something in my sinus, which I immediately told him. He said he didnt think so, and said' Let's pray to God that's not so', which really got my antenna up.
Post op. my sinus was immediately draining profusely down through the wound the 1st day. He called me that to night to check on me(that was a first for a Dr. to call and see how I was feeling) and I told him about the sinus drainage again. He said that he put 'something' in there to close it up, even though he still didn't think the sinus was perforated! He gave me instructions not to suck on a straw, or other things that might cause that opening to not heal up. Second day, don't feel as much drainage from sinus, but do feel a lot of mucous in the opening of the wound under the stitches. Day 3, my jawbone is extremely tender and the area feels more sore than ever, despite taking Levaquin(nasty stuff).
Question is, do these things heal and does the opening to the sinus heal up and close when there is active drainage? When I think back, I have often had problems with that maxillary sinus, does not drain properly since it dips down so low, and years ago a dentascan revealed a partial septation on the floor of the sinus that trapped fluid. I'm wondering if that root was always slightly in the sinus, and removing created a new method of drainage.
So, what is the downside of having your sinus drain through a hole in the gum, besides the salty taste and extra mucous? Is it prone to infection, does it cause bad breath? And how, if it stays open, can it be closed?
By the way, I got a greeting card from the Dr. wishing me well and thanking me for my business. Is he being nice, or is he concerned about something and not telling me?) Maybe I', a bad person for being suspicious, but I have never had a Dr. be so 'friendly'.
Thank you!

[azmanatheart]

Thanks, Bryanna for your very thorough and thoughtful response to my situation.

So, it is 5 days since I had the extraction and the melting stitches came out yesterday. I am still very, very sore or tender at the extraction site and the surrounding gums, but I guess that is to be expected. I cant see it, but there feels like a pretty deep divot where the roots were extracted, again, probably to be expected. As far as sinus drainage, I must say that I am not aware of any. If there is still a pathway, its not currently draining.
One thing that still bothers me is that up above, when I press on an area just below and under my orbital bone, it is extremely tender, and the floor of my sinus feels like it is going through something, probably an infection trying to clear up. The Levaquin is manageable so long as I take Alka Seltzer gold as soon as the burning starts, and I am taking a wonderful probiotic called 'Prescript Assist' which is 29 soil based bacteria. I am also taking the garden variety probiotics with lacto and bifido type bacteria.

Hopefully, this is all part of the healing process after a very rough extraction; I'm pretty sure my jawbone is bruised from the extraction and the hammering.

Thanks again.
Jeff

[Bryanna]

Hi Jeff,

I would expect you to be very sore and I imagine that you have lost quite a bit of bone in that area which would account for the deep divot where the roots were. That area will fill in with bone to a certain degree but you will most likely end up with a good size indentation there.

Try using very warm moist compresses on the area below your orbital bone. This will get the blood circulating in that area which is a good thing.

It is best to be mindful of any new or different symptoms that occur and be careful not to abuse your sinuses in any way. You have a long way to go before that area heals.

If you are not currently scheduled for a post op visit with the oral surgeon, it is best that you schedule one for about 10-14 days post op.

Be careful with how often you use the Alka Seltzer Gold. Only use it when absolutely necessary or it can mess up your natural production of hydrochloric acid.

Good on the probiotics! After the antibiotic is done, be sure to continue with one of those products for several months, if not indefinitely.

Keep us posted......
Bryanna

Originally Posted by azmanatheart

Thanks, Bryanna for your very thorough and thoughtful response to my situation.

So, it is 5 days since I had the extraction and the melting stitches came out yesterday. I am still very, very sore or tender at the extraction site and the surrounding gums, but I guess that is to be expected. I cant see it, but there feels like a pretty deep divot where the roots were extracted, again, probably to be expected. As far as sinus drainage, I must say that I am not aware of any. If there is still a pathway, its not currently draining.
One thing that still bothers me is that up above, when I press on an area just below and under my orbital bone, it is extremely tender, and the floor of my sinus feels like it is going through something, probably an infection trying to clear up. The Levaquin is manageable so long as I take Alka Seltzer gold as soon as the burning starts, and I am taking a wonderful probiotic called 'Prescript Assist' which is 29 soil based bacteria. I am also taking the garden variety probiotics with lacto and bifido type bacteria.

Hopefully, this is all part of the healing process after a very rough extraction; I'm pretty sure my jawbone is bruised from the extraction and the hammering.

Thanks again.
Jeff