[fscot]

My dentist recently informed me that my root canal and crown (tooth 19) has to be removed. The root has cracked. The crown felt quite loose, but wouldn't come off when the dentist tried removing. Apparently it's still attached well, but the fractured root is moving around. There's no pain at all.

My appointment is three weeks out for extraction. What do you think the risk of infection would be if I'm waiting that long? I've had the root canal/crown for probably 20 years. What can I expect during the removal process? I've only had top wisdom teeth removed, so it's a bit startling losing this tooth.

Thanks!

[Bryanna]

Hi fscot,

I am in the dental field and can offer you some information here.

Based on your description, due to the mobility of this tooth it indicates that it has been infected for a very long time. Probably many years. One reason that you would not have had tooth pain is because the infection has been draining which alleviates the build up of pressure from the infection preventing the swelling that often occurs with this type of infection. That may sound like a positive thing, especially since it prevented the pain. However, the draining of the infection means the infection has spread to at least the jaw bone.

If you read through some of the threads on this forum you will come across people who have or had post op complications after their root canaled teeth were extracted. In many of these cases, the complications were caused by an incomplete extraction procedure in which the tooth was removed but the diseased periodontal ligament and diseased bone were not. Both the ligament and unhealthy bone needs to be physically removed and the bone needs to be scraped clean after the extraction to allow the site the best chance to heal properly. However, for unexplainable reasons many general dentists and some oral surgeons miss those critical steps and post op complications ensue. Therefore it is ""always"" wise for the dental patient to be their own advocate and let the general dentist or oral surgeon know that they expect those steps to be done to help prevent post op complications and to help give the site the best possible outcome.

Also, most general dentists have limited oral surgery education and experience as their primary focus is on restoration of teeth, not removal. Very few of them have extended teachings and extensive experience especially with the removal of infected root canaled teeth. Therefore it would be ideal to see an oral surgeon for the complete removal of the tooth as this is what his education and experience is focused on.

As for the 3 week wait, this tooth had been infected for 20 years since the time it was root canaled. Because teeth cannot be sterilized or debrided clean of all of the nerve tissue, the root canal procedure does not cure the original problem with the tooth. It is the only attempt at "retaining" an unhealthy tooth for an uncertain amount of time. This means that the bacteria has been residing inside of the dentin tubules (microscopic canals) for 20 years and has been making its way beyond the tooth into the bone. As a result of the longevity of this infection, the bone has deteriorated around the tooth causing the tooth to become mobile. So the tooth most likely is not anchored in too much solid bone at this point, it is attached to infected fragile bone and soft tissue. These are the areas that need to be removed and scraped clean after the tooth is extracted.

This extraction will be different than the wisdom teeth because of the degree of infection an amount of bone loss. Sometimes the local anesthetic is not totally affective because the bacteria is acidic and the anesthetic is alkaline. So the acidity of the bacteria blocks the alkalinity of the anesthetic. Most times the patient is prescribed antibiotics beginning 3 days prior to the extraction as a way of reducing the acidity of the infection which would make the anesthetic more affective. Sometimes it is best to have some IV sedation for this type of tooth extraction to be certain that there is no discomfort during the removal of the tooth.

When you consult with an oral surgeon about the removal of this tooth, he will be familiar with all that I have shared with you so just be sure to review all of these things with him and he will give you the option of the IV sedation which would have to be pre arranged as there are specific instructions for you to adhere to the night prior to and the morning of the extraction.

I hope this information was helpful to you. I know it's a bit scary, but you will be okay. Just be forthcoming with what your expectations are with the surgeon and be sure to follow his post operative instructions and the outcome will be much better.

Keep us posted on how you're doing....
Bryanna

Originally Posted by fscot

My dentist recently informed me that my root canal and crown (tooth 19) has to be removed. The root has cracked. The crown felt quite loose, but wouldn't come off when the dentist tried removing. Apparently it's still attached well, but the fractured root is moving around. There's no pain at all.

My appointment is three weeks out for extraction. What do you think the risk of infection would be if I'm waiting that long? I've had the root canal/crown for probably 20 years. What can I expect during the removal process? I've only had top wisdom teeth removed, so it's a bit startling losing this tooth.

Thanks!