[nukuspot]

Hi Bryanna,

It's Nukuspot from a month ago! Hi! First let me start with the good news. The issue you were helping me through with the extraction pain from my root canal molar #19 is getting so much better. It is 7 weeks since extraction and I noticed around 4 weeks the pain was getting better. At 6 weeks the pain was mild and I was sure it would just get better and better over time. I followed all your instructions except I never had to see a periodontist for that weird tissue growth in the socket, as my general dentist looked at it again on my request and said it was normal and it would flatten over time (which at week 7 it is now starting to do.) So yay for a happy update!

Now the new issue. I have another root filled tooth. This one is my upper left canine, #11. The story behind this one is this. When I was very young (age 8/9) I was diagnosed with severely impacted adult canine teeth. They were horizontal I was told, and would never have come in by themselves. So at the young age of 9, I got braces and what I consider to be aggressive oral surgery in which I was put under general anesthesia, the gum cut back, and brackets put on the canine teeth with wires coming down out of the gums attached to the braces. Over the next few years they were tightened and it pulled the teeth down. I remember it being very painful. I had the braces/wires for 3 years. The canines were eventually pulled into place, the left one was always more difficult than the right.

Fast forward many, many years and in 2007 I saw a dentist who said he saw a "dark shadow" around the apex of the left canine during xray. The tooth never had any decay or fillings. He sent me to an endodontist who did vitality testing and said he would like to RCT it, though it was still alive. I elected to not RCT and went home. Many years passed with no issue. All of a sudden in 2011 it abscessed horribly. It was my only abscess I ever had and it was insanely painful. I was in so much pain that I rushed back to that same endodontist who declared it "chronic apical periodontitis" and attempted a same day RCT. However while he was doing the RCT he said the canal was extremely calcified and he could not access the apex. So while I was still in the chair he said he had to go in from the other direction and I had an apicoectomy. He did the whole thing that day, the attempted root canal, the apico, and the permanent filling. I went home and other than swelling, never had an issue with that tooth again for 4 years. Since learning about the issues behind RCTs I planned to get it extracted eventually, but was following a plan that my naturopath had created which was to get the RCT molar out first, wait 6 months for healing, get a zirconia implant, wait 6 months for osseointegration and get a ceramic crown, then get my 2 amalgams replaced (as soon as I was done breastfeeding) and THEN focus on #11. I liked that plan because being that it is a front tooth, I wanted to make sure that I was going to be able to tolerate an implant, and having the molar to have had that implant experience with was crucial. I do not want to get a bridge for my front teeth as they are all virgin teeth, as well as I have short roots on the lateral teeth from those early childhood braces, and it could not be an abutement for a bridge. Being that I am 35, I did not want to live my life with a removable front tooth, so that left implant as the only reasonable option for #11. I wanted to make sure it was all going to be OK. So I was not jumping to get it out right now....

Then a week ago I started to have a gentle throbbing feeling from "somewhere" in my upper front left teeth. I panicked because I just had finished that 11 month ordeal of pain relating to my lower root canal molar. I first went back to the original endodontist who did the apicoetomy in 2011 because they offer free lifetime followups on the teeth they treat. He did 3 xrays because he had a hard time getting the apex of the tooth in the photo, which is frustrating. Finally he got one where he could see it. He said it looked fine, bone had filled in well, no sign of failure, etc. He thought it could be a gum pain issue. Soon after, the throbbing turned into pain which moved throughout my upper left teeth from about the premolars to my left front tooth. Then I started to feel the most scary symptom yet--A feeling of pins and needles/numbness/like a crawling feeling under my skin right under my left nostril down to my upper lip. Like the prodromal tingling you get before a cold sore appears! But it was constant. I went to my integrative MD very concerned. She said it could be a sinus issue or a tooth issue, or both. She looked in my nose and could see congestion. I did not feel congested but when she pushed on my face the left side around my cheekbone really hurt. I had post nasal drip as well. She said that the diagnostic test would be a facial/sinus CT but she knew I would be adverse to it because of the high amount of radiation. With all the xrays I have had over this last year, I can't risk that.

So I went back to my general holistc dentist. I brought the xray from the endodontist and told him what my MD said. Without even looking at me he said he was worried it was #11 because, like you, he did not trust RCT teeth. I explained to him that unlike when I extracted #19, because this was a visible front tooth, I did not want to just guess it was the cause and extract it to see. Personally and professionally, I cannot be missing a visible tooth, so I only wanted to go ahead with extraction at this point if he was sure the issue was from the tooth. He did a tapping exam on all my upper left teeth. They all felt fine. He ran his finger over all the upper teeth at the gumline. They all felt fine. He looked at the xray (which I will attach here) and said he also did not see anything on it.) I asked him if he could take another 3D scan as it would show all the teeth plus the sinuses. He agreed. We did the scan. It looked identical to the 3D scan I had before my extraction in January. He showed me that #11 has a small black circle above it, but it had not grown since January, and was not visible on any 2d Xray. He said that most dentists would call it a scar from the apicoectomy, though he "didn't like scars". However without any change in the size, he could not say it was anything else that would warrant extraction of that tooth. He did what he called a "diagnostic" ozone injection above #11. He said that ozone would kill anything it came into contact with and be antiimflammatory though it would not be permanent. Most likely a few days of relief, but if it got better than it would be diagnostic the pain was coming from that area. It did get confusing because he said that injection might also affect the sinuses too. I saw no change for the first 24 hours but day 2 I saw about a 50% improvement in the numbness and about a 30% improvement in the pain. Like he said, it was short lived. It is now day 3 and it is all back.

I guess I am not sure what to do with this info. I find it so inconceivable that my two root filled teeth would coincidentally fail one after the other, when they aren't even in the same quadrant. But it looks like either that or sinus issues are the best diagnoses I have.

Do you have any advice? I am very very afraid to disfigure myself by pulling a front tooth if it might not be the problem. If it had visible issues on the scans, I would rush to do it. But I am just so concerned that I would do it and it wouldn't solve anything, I would go through more pain, still have this pain, and then have to go through 2 implants in different quadrants of my mouth right after each other. With the zirconia implants you have to wear an Essix plastic appliance on all your teeth to protect the implant as the bone heals since it is one piece for 6 months until it is ready for the permanent crown, not like the titanium ones. If I have to wear a top and bottom Essix at the same time it will greatly affect my speech. I really wanted to avoid having to do that.

I know this is long. You have been such a great support and help in the past. Is there anything you can add or recommend? What do you think I should do from here?