Hello,

I find this forum extremely information and after reading your comments on root canals and infections I already know what you will say but I figured I might as well share my issue and hear it for myself

About 10 years ago I received a root canal on my lower left tooth- the second one from the back (not sure what number that is-number 16?). All was well for a few years and then all of a sudden about 4 years ago I would get a fistula on the gum next to the tooth. It would come and go (which I regret not having it taken care of sooner since I let it go for a few years before having anything done) and I got a root canal retreatment last year in January of 2014 as per my dentist and the endodontist. All was well again and then in June the bump came back and I went back to the endodontist who took an xray and we found that post that was put in by my general dentist after the retreatment was too large and causing an infection.(originally for this retreatment my general dentist prepped the tooth and took mold for the crown, the endodontist did the retreatment and then I went back to the general dentist for the post and crown to be put on). So my GD took off the crown and replaced the post and crown (luckily at no charge since he messed up)

Now it's March 2015 and the fistula is back. Luckily I found this forum and read many of the threads with people with the same problem. I had an appointment anyways with the GD for another crown on the opposite side to be put on so I had him look at the tooth. He put me on Clindomycin and said that the antibiotics should take care of it unless I want the tooth extracted. after reading your forum I knew that extraction would be best and happy that an apicoectomy wasn't suggested. I told him that I want the tooth out and want to leave it alone for a long time (have no desire for a bridge or implant) although, of course, he is suggesting an implant. I attached a picture of the tooth that i took while it was up on his screen so I'm not sure if you can really see anything-it's the picture of the tooth in the lower left of the screen.

I don't want a bridge and I don't like the idea of a screw holding up a tooth from my jawbone for an implant. Just doesn't sound right to me. Luckily, he says that whatever I want to do is best so he's not super pushy but says that if it was him he would get an implant and that having the tooth pulled can lead to the other teeth closing in on it a bit (doesn't sound too bad) and the upper teeth getting longer since there will be a gap and shared that eating will not be fun or easy. Still- doesn't sound too horrible to me since a recurring infection scares me and makes me wonder what it's doing to my overall health.

Also- about 3 years ago I was diagnosed with Hashimotos Thyroiditis- an autoimmune disease that attacks my thyroid and am worried that my lingering infection might have been the cause or atleast contributed to the problem. Since my diagnosis I'm gluten free and slowly working on dairy free but I guess that information is for another post on a different thread.

Besides offering advice on what to do next on my tooth, do you have suggestions about what to do to maintain the health of my teeth besides brushing, flossing, mouthwash- any supplements?

Anyways, based on the previous posts tooth extraction is probably the best without a bridge or implantation, right?

Please advise at your earliest convenience and I apologize for asking for help with something I've seen that has been explained many times here.

Thank you,
CJ

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Hi cjuch,

Thank you for posting the radio graphs.

Because you mentioned that you are concerned about your physical health and how your teeth relate to that, let me first clarify the systemic health risks associated with all root canaled teeth. Due to the biology of bacteria and the intricate anatomy of both the teeth and the jaw bone, there are no exceptions when it comes to non vital teeth being inflamed and diseased.

Irrelevant of how many times the teeth are root canaled, the status of the vitality does not change and the inflammation and infection does not dissipate. Because the blood vascular system of the mouth is the same system that supplies blood to the rest of the organs and body, the bacterias and toxins that live in our teeth, jaw bone and gum tissue continually travel throughout our entire blood system. So the potential for systemic health problems are greatly increased in people who have retained their non vital and infected teeth.

Regarding the post.... any size post is damaging to the delicate structure of the tooth. The post acts like a wedge in a very confined area and eventually bacteria forms around the post and decay occurs.

A side note about the thyroid gland and something to think about and even do some research on. The thyroid has numerous important functions but it is also a major filtering organ for the entire blood supply that is continually being utilized by the body. So the bacterias that end up in our blood from infected teeth, filter through the thyroid before they move on to other areas.

If all of those radio graphs on the screen pertain to your teeth, then you have several root canaled teeth. All of which appear to have posts in them. Since you are writing here today about your lower left first molar which is tooth #19, I will focus on just that one.

Tooth #19 is root canaled, has a large post in it and it is indeed infected. It has a very pronounced infection in the jaw bone in at least 3 different places. One is surrounding the mesial or front root, another is at the distal or back root and the third place is at the furcation which is located at the junction where the top of the root structure comes together. There is diseased and moderate bone loss around the circumference of this tooth as well as at the furcation. Also the distal, back root, appears to be fractured about a third down from the top of the post.

Regarding the replacement of this tooth.... to be truthful, placing an implant in this area would carry an elevated risk of failure and infection because of the longevity and intensity of the infection in the bone. It is imperative that if you have this tooth extracted that you see an oral surgeon for the procedure. A general dentist will most likely have some difficulty removing this fragile tooth. It is equally important that you advise the surgeon that you want him to be sure he is very thorough in removing the entire tooth, the periodontal ligament and all visibly diseased bone to try and prevent further problems down the road. Although these surgical steps are suppose to be done with every extraction, you cannot just assume they will be.

Regarding the antibiotics.... the most an antibiotic drug will do for you with tooth #19 is temporarily subside some bacteria and inflammation. The only attempt at curing this infection is to remove the source, which is the tooth along with the rest of the diseased tissue and bone.

Regarding oral home care.... Thorough tooth brushing with a soft bristle brush or an electric tooth brush twice a day and thorough flossing and tongue scraping before bed are what will keep the plaque from accumulating on and in between the teeth. Avoid mouthwash that contains anything other than herbs or essential oils as most mouthwashes are derived from toxic chemicals and alcohol. All of which irritate the oral mucosa and reduce the flow of saliva predisposing the user to tooth decay, gum disease and in some instances oral cancer. To freshen you breath you can put a few drops of peppermint oil in warm water and swish around. Another therapeutic measure for the health of the gum tissue is called oil pulling. You would use a teaspoon or so of coconut oil and swish it around in your mouth for about 30-60 seconds, spit and rinse out.

Regarding supplements that benefit oral and dental health... there are many of them. However, they would be most beneficial to someone who does not have any root canaled or infected teeth because supplements cannot alter the process of disease that is going on inside of a tooth causing further breakdown in the bone. So it would be a waste of your money to invest in them and misleading for me to suggest them to you at this time.

Be careful of what you are eating while avoiding gluten and dairy. Many products on the market that proclaim to be gluten or dairy free are highly processed and loaded with unhealthy additives. I always suggest that when someone really wants to get their diet on track, to work with a nutritionist for the proper guidance.

I hope this information has been helpful to you.
Bryanna






tooth #19 your lower left first molar.

Hello Bryanna,

Thank you for your quick reply and I especially appreciate your honest advice and taking the time to read my post and look at the attached xray! Your opinion is greatly valued and I appreciate you sharing your thoughts on this forum.

Yes- all of the graphs on the screen are my teeth. I have two other root canals, both of them being in the upper jaw-one on the right side of my mouth which is the second tooth from the back and the other is on the left side of my mouth the third tooth from the back. I have a crown on my lower left side-second tooth from the back and some fillings on other teeth- can't remember which ones exactly. You mentioned you would focus on tooth 19 so I'm wondering what are your thoughts on those teeth that you saw with root canals?

Finding out about having thyroid disease was extremely life changing and I have been making great efforts to learn more about the disease and have found more answers from a holistic/alternative/functional medicine direction than from traditional medicine. I've read many articles about the negative effects of root canals and fillings on our bodies and have considered having the teeth that have had root canals removed if that is something that I should consider? If so, are there any negatives/cons to having teeth extraction? After having teeth extracted, especially some of the back teeth that are used to chew, are there any recommendations to make eating easier? Partial dentures?

I appreciate you letting me know about the various places where there is an infection in tooth 19- my general dentist did not share that with me and I'm disappointed that he was considering just leaving me on antibiotics-although I think he mentioned having the tooth pulled since I kept saying it to his other staff while they were talking with me prior to meeting with him.

I will be contacting an oral surgeon about extraction and will share with him/her what you shared with me. I'm nervous that not everything will be removed as you mentioned. Worse case scenario....let's say it is not (I'm used to something going wrong at this point so that's why I'm asking), can I have that taken care of after the original extraction procedure? I've become very weary of doctors and due to prior experience- especially with this tooth- i think I would like to get a second opinion from another oral surgeon or dentist after the extraction just to cover all bases.

I knew a bridge or implant was not the best choice and I'm disappointed that my dentist is being so pushy about it- but I would imagine that that is the route he has been taught to take or I'm sure he wants the money from me and my insurance company.

Thank you for your advice about oral care, I've tried oil pulling before and have read many articles about it so I will make it my regular routine. You didn't mention supplements since I have root canaled/infected teeth so it wouldn't be worth it but out of curiosity- what would be supplements you recommend?

Thank you for your advice on on gluten and dairy free products- I do try to stay away from them due to the reasons you've mentioned. Like I mentioned before, once I found out about my thyroid disease - I conducted a ton of research on my own via the internet and library (mainly holistic and alternative and functional medicine) and I've been amazed at the amount of information that is out there but is not being used by traditional doctors. My autoimmune/thyroid disease has been life changing and I'm continuously making efforts to better my health. I refuse to just let a doctor prescribe me a pill to take rather than researching other options while taking medicine.

Again- I am extremely grateful for the light you've shed on my personal situation! The fact that you have taken the time to read my post, examine my picture, and take time away from you day to write a response and offer advice is above and beyond what I expected. Words cannot express how thankful I am that you are offering your help/opinion here for free online without asking for anything in return! I'm glad to see that there people are so helpful and generous in sharing their knowledge with others.

Thank you,

~CJ

Yes, Enna! I've been reading reading many of the posts here within the dental portion of this form and I really feel that Bryanna needs to be recognized for her advice- I am quite impressed with her consistent responses to people looking for help!!!!

Hi CJ,

You are welcome

I am thrilled to read that you are interested in Functional Medicine! This area of medicine is perhaps the healthiest form of healthcare offered at this time. Thanks to Functional Medicine practitioners like Dr Mark Hyman, FM is making it's entry into the curriculum of some traditional medical schools!! Are you familiar with this physician at all? He does a lot with auto immune disorders. If you haven't done so already, please google him.

According to the radio graphs that you posted here..... you have 3 other root canaled teeth. Two in the upper left #'s 13 and 14 and one in the upper right #3. You are also missing a tooth #11 and have a multi unit bridge to replace #11. Looks like the bridge came out and was being re-cemented or is this a new bridge? When was tooth #11 extracted and had that tooth been root canaled previously? I ask about it because the bone has not filled in where #11 was removed.

Regarding your other root canaled teeth.... every root canaled tooth is toxic and has some degree of chronic disease going on. The infection is usually not visible clinically or radio graphically until the bacteria has proliferated beyond the tooth. Every root canaled tooth irritates the immune system and is a host of infectious bacteria that filters through your thyroid and blood stream. The more virulent the infection becomes the more systemic it can become.

Regarding teeth extractions in general... it is ideal to keep your teeth healthy simply because there is nothing like having your own natural teeth. Every extraction results in some degree of bone loss and shifting of the bite. So it is not ideal to leave spaces where teeth have been removed. There are exceptions to that rule and it depends on the individual case. The degree of bone loss and shifting also various from one person to another.

Regarding the extraction of #19, it is imperative that you be your own advocate and in a gentle but assertive manner tell the surgeon your concerns about not wanting a lingering infection and you want him to be thorough in removing the ligament and all diseased tissue and bone. When the tooth socket is not thoroughly debrided after the tooth is extracted, the infection will prevent the bone from healing properly and the bacteria will continue to deteriorate the bone. This can lead to all sorts of physical issues with your jaw bone, with the bundles of nerves that line the face and even systemically. It is not ideal to have to have a second surgery to reopen the wound and debride the bone. It should all be done at the time of the extraction.

Regarding nutritional supplementation for oral health.... the best and easiest way to get all the vitamins and minerals you need it to eat a healthy diet of organic, whole fresh foods, pasture raised chicken and meat, and drink plenty of filtered water. Avoid sugar and genetically modified foods, as well as processed, refined, and fortified food products. Supplementing with a probiotic every day is ideal for most people as it helps to keep the bacterial flora in the intestines in a healthy balance. Other supplementation really depends on the individual needs of that person.

Bryanna

Thank you again for your advice!

In regards to the other xrays on the screen, being that I don't have a missing tooth or have had bridge work done on any of my teeth and definitely not tooth 11, I'm thinking that they are the xrays from the patient before me?

I have heard of Dr. Mark Hyman and read many of his articles regarding autoimmune disease but thank you for the recommendation and I hope that other people stumbling upon this forum as I did will look into functional medicine and consider it for their own well-being.

Sounds crazy but I am actually looking forward to this extraction- I will stress everything that you mentioned in the previous posts and I will probably post another picture after to get your opinion. Hopefully all will be well after that.

Do you have any suggestions for that space that will be there? In the future, are partial dentures a possibility for eating purposes? I know everyone is unique so it all depends on the situation but is it something I should just let be?

Anyways, thank you again for the advice and I hope the information you provided will help others who stumble upon this forum as I did.

~CJ

Hi CJ,

Well if those xrays on the screen behind the large one is not of your mouth, then obviously they belong to someone elses! I had no way of knowing that So thankfully you are in better dental shape than THAT person!!

Yes, Dr Hyman is truly an expert in the field of Functional Medicine. He is in Washington DC meeting with the government trying to get legislature passed for FM to be taught in traditional medical schools. So he is incredibly devoted to this form of healthy medicine.

Regarding replacement of #19.......
A partial denture generally replaces more than one missing tooth. There are smaller removable appliances that might work. One is called a Nesbit. But it is not meant to be worn while eating as it could become dislodged and become a choking hazard. But it does work great for maintaining the integrity of the space so the other teeth do not move.

A dental implant would be a big risk in this area due to the longevity and degree of infection.

A permanent 3 unit bridge would require drilling down the adjacent teeth.

If you leave that space open, the molar behind it will move out of it's current position and the molar above #19 could eventually drift down into the open space,

You would have to speak to your dentist about what would be viable options for your mouth.

Bryanna

Thanks a million!

I think the only options that my dentist or the oral surgeon will recommend is a bridge or implant- both of which I do not want. My sister had the same tooth pulled a few years back and the surrounding teeth closed in on it and there is a small gap- I'm hoping that is what will happen with me but I know we are all different and anything can happen.

I will bring up the nesbit and see what they say but I know for sure that there is no way I will get an implant and I'm on the fence about a bridge but leaning more towards "no" on the bridge, I just feel like I will end up having problems with the surrounding teeth since they are both healthy right now. I do like the idea of the nesbit - as to keep the space open and not have the teeth close in, so I will be quite pushy about it.

Bottom line here: that tooth needs to be out and there is no way I'm getting an implant.

Thanks for the advice!

Hi CJ,

Some dentists are not in favor of the nesbit appliance because although it works great if it is used properly, some people will use it to eat with and like I said it could be a choking hazard. So the dentists that don't recommend them do so because they don't want to be sued for someone choking on one of them.

Just some FYI......When the adjacent teeth move toward the open space, it can cause a misalignment of your bite which can cause bone loss and problems to occur with your other teeth. So it is not ideal for those adjacent teeth to move into an unnatural position.

All the best to you!
Bryanna

Hello again,

Sorry for another post but I'm really torn with what to do about this tooth...

I visited another dentist for a second opinion since I'm uneasy about what to do after I get tooth 19 pulled. According to him, my only options are an implant, bridge, or partial denture (if I had more teeth missing although he says that is not ideal) and that if it was him he would get the implant since it will last longer and has a very low change of failure even after having this infection come and go for some time now. I told him my fears of having my jaw bone get infected and according to him once they remove the tooth and everything associated with it there is no way an infection can happen or the changes are extremely low.

I mentioned the nesbit and he said that eventually my bone will shift and deteriorate anyways and that a bridge or implant would be the best bet with him leaning more towards an implant.

I know I want the tooth out. If this was you- what would you do?

I know that the bridge can complicate the other two teeth and that leaving it alone "can cause a misalignment of my bite which can cause bone loss and problems to occur with my other teeth" so I feel like I don't have many options. I know that you are only offering your advice online without having me and ex-rays right in front of you and any advice should not be taken as medical advice-but I just really don't know what to do and the doctors are really pushing me for an implant.

Sorry to drag this post out but i don't feel like i have many options here. I know keeping my mouth healthy can avoid this problem but now that I have it I don't know what to do.

Thanks so much for your advice up to this point!