I have the same feeling you do. There are alot of dentists who are not truthful about the conditions of our mouths. Morally they are out in left field, and at worst can cost a life if these infections go to the brain. I felt like I just came through a mine field intact with bryannas guidance. I hope you are getting the care you need. I have an absess in which the tooth will be extracted on tuesday. I feel good about this decision, as I am possitive it was the right course of action. Take care PJ, get treated, and let me know how you are doing in the course of things. I actually feel no fear, as this time I know for sure I am in good hands. ginnie

PJ,

I just saw your threads with x-ray and the responses to it and felt compelled to respond.

I am a retired oral and maxillofacial surgeon of 35 years practice. I do not generally advise people on the internet as even with x-rays, I cannot possibly diagnose without undertaking a full oral examination of the patient.

However, I feel that you've been given a mix of good and not so good advice here. There is undoubtedly infection in the molar and I can also see a communication with your sinus. You obviously know this from the purulent discharge from the area. I would also concur that the 2nd molar appears beyond repair.

Regarding the treatment though, I see no reason why, with careful planning by an experienced surgeon, the extraction cannot be done and with natural healing proceeding thereafter. It is not likely that you'd need follow-up surgeries to clear necrotic tissues etc, and the chances of a brain abscess from dental infections are very very slim.

However, the risks increase the longer you leave the infection and I think contributors are trying to make that point so that you do not delay in getting it treated.

To make a better judgement you will almost definitely be required to have a full panoramic x ray as this will allow the surgeon to view the sinus region and the whole infected area. Your x ray is only of the local teeth and it can be seen that the infection goes up beyond that point.

Get yourself referred and treated but don't worry about complications or things going wrong. Experienced surgeons would not struggle to treat this promptly and efficiently.

Regards

[Hi chemar, sorry you have to go through that. The best person to ask or PM is bryanna. I have been on that forum months dealing with my own tooth problems. She has 35 years experience and can even look at your x-rays. Very experienced and kind lady. she will tell you the truth about what is going on with you. I will be thinking of you, and hoping for a good solution. ginnie

....you go to an oral surgeon. I mean an MD/DDS who does this stuff all the time. I had a molar removed today that on panoramic looked like it ended in the sinus (super long roots). It had had a root canal and I was having sinus pressure again localized around that tooth, so I felt it wasn't safe to keep any longer.

I was very nervous, but Ginnie and Bryanna talked me into doing the right thing, which was extraction of a dead, rotting tooth in my head, near my brain! I will later get an implant, but this is step one.

I was talking to my neighbor, a nurse, and I"m a pharmacist, and we know that the body DOES NOT retain dead material. If a cell dies, the other cells destroy it. Tissue that is not destroyed becomes necrotic and that spreads, killing other tissue. You get the picture. Trying to retain a dead tooth just leads to more problems over time. How much time? I don't know, depends on the person and their general health, but why take that risk?

So it's not uncommon to have a tooth root near a sinus, but the person to deal with this is an oral surgeon, not a regular dentist. Then you should have no concerns about the procedure.

Good luck!!
Stacy

Hope your recovery goes just fine. I go next tuesday to have a tooth removed also. I agee, the teeth that are bad, gotta go.... I feel good knowing I have the knowledge to make a good choice. Take care and be good to yourself. ginnie

Hi tician,

Welcome to neurotalk, it is a pleasure to have you here! Hope you share more of your expertise in the future.

I agree that diagnosing people on the internet is not ideal. Frequently, people come here out of desperation because their dentist has not provided them with adequate information on their dental health. Often x-rays of diagnostic quality will tell at least part of the story so that a suggestion to seek help can be made to the poster. Sometimes I will inform them of serious possible consequences as a means of prompting them to get help sooner than later.

As you mentioned, brain abscesses are rare, but they do happen and they can be life threatening. I would hate for someone here to have that happen to them because their dentist overlooked/misdiagnosed a long standing oral infection. The case that PJ presents is all too familiar and is indicative of either being improperly informed by his dentist or patient neglect.... or both!

Thanks so much for your comments ... hope to see you here again!

Bryanna

Stacy,

You explained p.e.r.f.e.c.t.l.y
what a root canaled tooth is and how it causes further damage in the tissue and bone that it sits in.........

<<the body DOES NOT retain dead material. If a cell dies, the other cells destroy it. Tissue that is not destroyed (ROOT CANALED TEETH) becomes necrotic and that spreads, killing other tissue. You get the picture. Trying to retain a dead tooth just leads to more problems over time.>>

I am so glad your extraction went well and SO glad to have you here! We can use all the support on this subject that we can get..... thank you so much!!!!!

Bryanna

Hello Doctor, I know without the complete evaluation, and the full mouth x-rays, conditions can be difficult to give advice with. I was really in trouble when I came here, an felt I got an education,where my own dentist didn't tell me the truth, and was insisting I get work done, that would not save my tooth. I really hope you keep responding here. We need you too, to help with the decision making concerning the treatment of our teeth. Thank you for responding, Doctors are needed here very much. Not too many physicians come to Neuro talk, and I for one hope you stick around. I often hoped my own PCP and neurologist would peek in on this site, but I do know they are very busy with a heavy case load. This site no doubt was created as part resource for those of us who do not get the complete information from our physicians. Here we get direction, truthful information and alot of comfort.
Thank you again for your responce. ginnie

Thanks to all for the responses.

I could go over the history of this tooth and the area, but it's water under the bridge and the only important thing now is getting things sorted. I wouldn't say I deliberately neglected the area but I did end up ignoring some things because my previous dentist insisted it was all about 2nd premolar roots that would settle down! It is now certain this is not the case.

Tician - thanks for the reassurance. It just so happens that members of my family work at our local hospital and know the oral surgeons there. It looks like one of them is happy to give his email address and analyse the x-ray as a favour. That will be a relief as I may have to wait a bit for my consultation and surgery. I've also spoken to someone who works within the operating theaters and from my symptoms he insisted that it sounds purely infection based and is a common reason for referral to the oral surgeons.

I don't know if anyone's really interested in the outcome of this but if you want me to advise what the surgeon says i'll let you know. I'm hoping to get an email address on Monday but of course he might take a few days to respond.

Bryanna - I do appreciate the very real complications that you warn of. Trust me though, i'm not ducking out of the treatment and will get this sorted. I kind of expect a course of antibiotics along with the surgery but was a little shaken at the prospect of a stubborn bone infection which they can't entirely remove. That sounded like it would eventually eat your face off with the surgeons being helpless, but I don't really know what i'm talking about so am easily lead to exaggerate the things that could go wrong. When you told Tician that my case was "all too familiar" though, this actually helped as I felt that I was the only person with this going on.

I just hope that the treatment is relatively simple, e.g a careful extraction under local anaesthesia. That wouldn't bother me whereas a plan to go gung ho on half my face will be quite daunting.

PJ,

I'm glad you are pursuing some action to deal with your tooth problem. However, please do not misunderstand our reassurance to mean this problem can wait. Right now one of the biggest concerns with your dental situation is time because you have already gone several years with infection in this area of your mouth including from your (extracted) 2nd premolar. The longer these teeth are present, the more complicated the entire process and it would be ideal to keep this process as simple as possible. I also was not exaggerating when I wrote about the complications that can occur from long standing oral infections. My intention is not to alarm you, but rather to inform you while not going into any of the explicit details because there is no way to gauge the extent of your dental problem based on one x-ray and some back and forth online discussion.

As I'm sure you are aware, there are a lot of people who read these posts who may (or may not) be in a similar situation. So when I reply to a post, I feel like I am replying to all of the readers as I have no idea who may be reading this or for what reason.

May I ask..... is there a reason why you are not consulting with an oral surgeon on your own? I still get the feeling that you are unsure of the depth of your dental problem and perhaps that is because your previous dentist, as stated by you, hadn't diagnosed any problems with these molars. I may be way off with that feeling, but either way I truly hope that you will get in to see the OS very soon.

And yes, please do share the events along this journey. We do care how you are doing and it may also be helpful to someone else in a similar situation.

Bryanna



TE=pjsavvy;838894]Thanks to all for the responses.

I could go over the history of this tooth and the area, but it's water under the bridge and the only important thing now is getting things sorted. I wouldn't say I deliberately neglected the area but I did end up ignoring some things because my previous dentist insisted it was all about 2nd premolar roots that would settle down! It is now certain this is not the case.

Tician - thanks for the reassurance. It just so happens that members of my family work at our local hospital and know the oral surgeons there. It looks like one of them is happy to give his email address and analyse the x-ray as a favour. That will be a relief as I may have to wait a bit for my consultation and surgery. I've also spoken to someone who works within the operating theaters and from my symptoms he insisted that it sounds purely infection based and is a common reason for referral to the oral surgeons.

I don't know if anyone's really interested in the outcome of this but if you want me to advise what the surgeon says i'll let you know. I'm hoping to get an email address on Monday but of course he might take a few days to respond.

Bryanna - I do appreciate the very real complications that you warn of. Trust me though, i'm not ducking out of the treatment and will get this sorted. I kind of expect a course of antibiotics along with the surgery but was a little shaken at the prospect of a stubborn bone infection which they can't entirely remove. That sounded like it would eventually eat your face off with the surgeons being helpless, but I don't really know what i'm talking about so am easily lead to exaggerate the things that could go wrong. When you told Tician that my case was "all too familiar" though, this actually helped as I felt that I was the only person with this going on.

I just hope that the treatment is relatively simple, e.g a careful extraction under local anaesthesia. That wouldn't bother me whereas a plan to go gung ho on half my face will be quite daunting.[/QUOTE]