Originally Posted by Bryanna

Hi Terry,

I'm in the dental field and can offer you some help here. I am going to list some significant issues that need to be addressed PRIOR to your bariatric surgery. It may be in your best interest to postpone that until your mouth is in better health because the overall infection (from the teeth and your periodontal disease) are a systemic concern and the bacteria could compromise your surgical outcome. Antibiotics are NOT enough to bring your situation under control. So please understand that irrelevant of how much antibiotics you are taking, the infection is still present until it is physically removed.

1) ALL of the teeth that are to be extracted, should be done ASAP and definitely before any periodontal treatment. Infections in the teeth, especially long term, are not limited to just the teeth... the bacteria rapidly spreads to the jawbone and surrounding tissue which means it is also in the blood stream.

2) Periodontal disease is not limited to just the mouth. When left untreated, it becomes a systemic infection in which the bacteria flows through the bloodstream throughout the rest of the body. Various organs can become affected over time and often symptoms of that go unnoticed or misdiagnosed. So it is imperative to get this disease under control especially BEFORE undergoing any other surgical procedure or you risk systemic complications.

3) The physical problems you are having associated with tooth #2 indicates the spread of that infection. In order for it to travel into the palate, the sinus and the tonsil means it is has become systemic. Removing the tooth is an integral part of the treatment to reduce this infection because the tooth is the original source. Some of your symptoms may temporarily subside once this tooth is removed. However, the bacteria from your periodontal disease and your other infected teeth will keep the infection active.

With regard to the injectable antibiotics that are done following periodontal treatment..... these are given via a syringe but they are not "shots" as you may imagine. A cartridge of the medication is loaded into a syringe that has a skinny tube at the end. This tube is gently placed in the pocket between the tooth and the gum. This procedure is done after the root planing procedure.

I know this information is not easy to hear and I'm pretty certain your dentist has not gone into such a descriptive explanation. I believe patients have the right to be properly informed. It is the only way for you to understand your situation and make smart decisions that you believe to be in your best interest.

In your case regarding the extractions... an oral surgeon is most experienced at dealing with these cases. With the proper radiographs he will be able to see the relation between the tooth, the infection and your sinus cavity.

Ideally it would behoove you to get a game plan down with your dentist. Discuss the removal of the infected teeth and get yourself scheduled to have them removed. The spaces caused by these missing teeth is really a secondary concern at this point. Then treat the periodontal disease... let everything rest for about 3 months then follow up with your dentist for a professional cleaning and see where everything is at. This allows time for unexpected issues to arise and be treated with regard to the infection. If your oral health is stable, then go forward with the bariatric surgery.

It has been my professional experience (30+ years) that patients who treat their oral health first generally recover very well from future surgeries. On the opposite side of the coin, those who have long term untreated perio disease and/or infected teeth generally have a more difficult or complicated recovery with their surgeries.

I hope this information is helpful to you and rather than being alarmed by it, hopefully you feel empowered by it and will seriously consider treating your oral health first.

I wish you the best of health.
Bryanna

Originally Posted by terravue

Thank you for responding Bryanna,
It is so frustrating to go to a "professional" pay the money and not get the right treatment or in this case in the right order. The dentist I am seeing has the three extractions at the end of the treatment plan! I have done all the periodontal root planing and the injectables in the last 6 months as well as getting the night guard which still allows me to clench my back teeth and puts pressure on my #27, a tooth we are trying to save.

I am going to call about getting in to get the #2 extracted on Monday but I guess I better get the others done as well now. From the plan and the way it was being done I was kind of thinking I might be able to save these teeth. False hope, would have been better if he had been straight with me.

Thank you for your explanation of what is happening with this infection, I had kind of put the clues together myself but finding this site and your explanations put it all focus for me and although I should have had the tooth pulled last Tuesday I wouldn't have known to clue the oral surgeon into the sinus activity.

It will be frustrating if I have to put off my Bariatric surgery since that is why I went to the dentist 6 months ago , to get this under control and get ready but I understand your reasoning.

With a lot of bone loss is there really any way of replacing these teeth? # 2, 14, and 18. Or can I live without something there?

Thank you very much for your time in answering here, You seem to have a really good grasp of all this and I am grateful to talk to you, Terry
infection,etc

Originally Posted by Bryanna

Terry,

Believe me, I know just how frustrating this whole situation can be. That's why I wholeheartedly believe that every dental office should have an educated patient advocate, like myself, to be the liaison between the dentist and the patient. This way the patient can be well informed, the dentist can do his work and the treatment plan is straight forward right from the beginning.

It has been my experience time and time again that dentists are afraid to give the patient the "bad news" at the onset. Which is not an easy thing to do and the concern is that the patient will become too afraid to move forward. So they are vague about certain things or they set up an *** backwards plan just to get the patient to commit to some treatment. They hope the patient will follow through with the easier stuff and continue forward with the rest of it. On the other hand, some dentists are not all that concerned about their patients systemic health and have to be reminded about the whole body connection. In this day and age... this should not be happening at all, but unfortunately it's a huge flaw within the dental profession.

If your night guard is not fitting well, it is imperative to have it adjusted because the teeth that are hitting too hard will continue to deteriorate irrelevant of what treatment you have done.

It is important to know that anytime you try to retain teeth that are not healthy, the infection will always be present because bacteria continues to thrive in and around these teeth. It can be very defeating to the rest of your teeth as the bacteria makes it way around your mouth.... not to mention the continued systemic consequences associated with retaining ill teeth.

I know it's hard to lose teeth but it's important to always think of the big picture and if being healthy is the goal..... then the best solution is obvious.

Anytime you have teeth removed there is always the chance that the other teeth next to or above/below the missing ones will shift. Every case is different due to what other teeth are already missing. It is difficult and sometimes not favorable to replace teeth in areas that have extensive bone loss. Again, each case is different.

Discuss replacement options with your dentist and you and he can work out a plan that feels right to you. In the meantime, remove the ill teeth so you can get on with your plan to have the other surgery without worrying about complications brought on by your teeth.

Hope this was helpful..... keep us posted!
Bryanna

Originally Posted by terravue

Yes Bryanna,
That would be a good idea, someone who can lay it all out, my dentist is really nice and he knows I have been through a lot so he may have been like that initially with me because of that and then I didn't see him so much as the different hygienists.

He did work on the night guard and sent it back to the lab because it had a really big part that stuck out and I think they ground it down too much and because my teeth weren't slamming against each other anymore I thought it was better. Now it needs to be built back up again!

Thank you very much , you do have a good explanatory manner. I wasn't really thinking in terms of the actual tooth being bad as I was about the gums and kept thinking if the infection in the gums could be eradicated then it would be all right.

Appreciate your help, Terry

Originally Posted by Bryanna

Terry,

Most people think of periodontal disease as only gum related. That's because it is mistakenly referred to as gum disease and usually the dentist does not offer any further explanation. The fact is that when a tooth has lost a moderate amount of the surrounding support system ... referred to as long term bone loss... the root of the tooth becomes fragile due to the lack of support and vulnerable to bacteria and tooth decay. These teeth often die without showing initial symptoms and this only leads to more build up of bacteria. This is a good example of why teeth in a guarded to hopeless condition should be removed before the root planing procedure and before the bacteria spreads any further.

You are welcome for the information. We are here to help!
Bryanna

Originally Posted by terravue

Hi Bryanna,
You certainly know a lot. for sure I always said "my teeth are fine it's the gums that are the problem" up to today. Makes me wonder if all that root planing actually made this infection worse, though it doesn't matter because it was there anyway. I had some help with deep pockets closing up with the injectible antibiotic so I actually had them put some in that #2 tooth last week but it just got worse with the radiating pain. They did tell me it was a last ditch effort and when I called to say it was worse they made an appt. with the oral surgeon to have it pulled. when I asked for oral antibiotics again instead of having it pulled they probably should have said it was worthless and I wouldn't have had this week of horrible pain waiting for the antibiotics to work when they really have no chance of working at this point.
Just posting more background info in case any body needs this info. thanks, Terry

Originally Posted by ginnie

I learned the hard way too about oral issues. I wasn't told the truth either, and spent alot on my oral care, that was just a money making issue for the dentist. Then I found this site, and learned all I could. This was followed by a very very knowledgeable dentist, who also has compassion. Rare find.....
Your mouth will get healthy in time. Just keep doing all the right things and question all proceedures. Sorry you have had to go through so much. ginnie