I came across this forum while doing a google search, hoping someone can help me... sorry this might be a bit long.... 14 years ago as a teenager I had fallen while rollerblading and cracked two of my front teeth. They were root canaled and crowned. With tooth #9, the front tooth, I always had issues with how the crown came out and had it re-done a few times until 9 years ago a dentist was able to create the crown the way I wanted it, very natural looking. Then 4 years later I accidentally cracked the tooth while eating something and at the time did not have the money to re-do the entire crown again, so I had asked the dentist to just glue it back together, and it had been holding pretty strong. Well about 2 years ago I noticed a blister thing above that tooth, when I pressed on it, it popped... the xray at the dentist didn't show any thing, but she referred me to an oral surgeon. The oral surgeon said it was an infection that he would have to clean out via an apicoectomy. He said there was only about a 60% chance it would work and if it doesn't work we would have to pull the tooth and do an implant. My dentist wanted me to re-do the crown after the apico was done, but I was hesitant to pay for a crown if the apico failed and I would have to remove the tooth anyway. I got pregnant so I held off on any dental procedures for a while and now I am noticing a large hard lump above that tooth, its not like a puss filled blister like last time, its just really hard and appears to be larger in size. Now I am worried if this infection is spreading throughout my gums? I really hope its not cancer or anything like that... Do I go straight to the oral surgeon and ask about getting an implant done?

Sorry I just wanted to add that the bump is not painful, and I had the baby 6 months ago so I can now do whatever procedure necessary.

Jenny,

I replied to your other post in the thread by Lenzi86. Please go to that thread to see my reply.

I just want to add .... all of the dental saga that you have been through, although traumatic.... expensive ... and time consuming with this tooth, is irrelevant for the simple fact that ALL root canaled teeth are chronically infected. I will attach a diagram of the anatomy of a tooth to show you the magnitude of how many microscopic canals each tooth has that are not accessible during any dental treatment or surgery. These canals continue to harbor necrotic infected nerve tissue irrelevant of what is done to the tooth. This means that the infection spreads at a rate unique to each individual. Sometimes it is rapid, other times it is slow. Sometimes something happens like an injury or illness that causes the infection to speed up.

Although it seems like only #9 has a problem, it is both of the root canaled teeth are infected. One may have more obvious symptoms than the other. Removing just #9 may not be advantageous as the other infected tooth may prohibit the healing of that extraction.

Dental xrays are only 2 dimensional and don't always pick up the extent of the pathology related to root canaled teeth. Aside from that, ALL dentists know that root canaled teeth are chronically infected and that the fistulas that form are directly related to that tooth. Sometimes when there are 2 root canaled teeth next to each other, it can be difficult to determine which one of those teeth has the fistula because the fistula does not always form directly over the most infected tooth. It can form near another tooth due to the path the infection has taken in the bone from the infected tooth to the outside of the gum.

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Thank you Bryanna for your reply. I actually just came home from my consult with the Oral Surgeon. He said that it seems like a cyst forming around the tooth because my body is rejecting it, and that he could go in and clean it out but that the tooth is on "borrowed time" I would need to extract the tooth eventually. So he said that he could extract the tooth and I could have a bridge done, or he would do the extraction and then bone grafting to prepare for an implant. The implant sounded more appealing to me because he made it sound like it was a permanent fix. I did ask him if the infection would go away once the tooth is extracted and the implant is in, and he said yes because the tooth is what is causing it. But based on what I read on your other thread, the bone grafting could possibly not work? Or the infection could be coming from the other tooth? How will I know what the source is? Now I am very nervous on how to proceed. I am supposed to call my dentist to make an appointment to get a flipper made, and then schedule the appointment for the extraction after that...

Also I have another question. He didn't mention that I had to be on antibiotics but I'm not sure if I should call back and ask if I should get them in the meantime for this infection. What do you think?

Hi jenny,

Just to be clear of what the oral surgeon meant by the term "rejection". The actual rejection is your immune system rejecting the chronic infection and the lack of vitality in the root canaled teeth. It has tried to keep this infection and inflammation at bay but it is no longer willing to do that. The formation of the cyst is what typically occurs with most root canaled teeth, irrelevant of how many times they are re treated with conventional or surgical root canal treatment. The "borrowed time" statement refers to the inevitable extraction of the tooth... but it also refers to that fact that you are playing a game of Russian roulette in that your immune system has already let you know that it's done dealing with this and now you are predisposing yourself to systemic health problems from the infection.

The upper anterior (upper front of the mouth) has a much thinner bone than the rest of the mouth. Once that bone is significantly damaged due to infection there is little to no bone to work with. Bone graft material is used to stimulate the body to grow new bone. It has to be placed "inside" healthy bone in order to stimulate those cells. If there is not enough healthy bone to place the graft into, then it can only be placed on top of the existing bone. This placement usually fails because the body rejects the graft as it can't figure out why it's there. Dental implants require the bone to be healthy, solid and adequate in height, depth and thickness in order for them to integrate with the bone. Anything shy of those requirements increases the risk of infection and failure.

Both root canaled teeth are unhealthy. Keep in mind they have been infected for 14 years beginning with the initial rc treatment, not just 2 years. One tooth may be more infected than the other but they are both on borrowed time. Removing the one and leaving the other means compromising anything you do with one or the other. Dentists will go along with removing just the one and then when the other acts up, the patient is floored that they have to go through more surgery and more restorative dentistry.

If you decide to do a bridge to replace #9 and you retain #8 rc tooth, it is only a matter of time before #8 needs to be removed which would mean not only more surgery but the fabrication of a whole new bridge.

I think it's important for you to be clear on the information that I have provided for you.

1) Discuss removal of both front teeth with your oral surgeon. Explaining that you do not want to have to address this area of your mouth again because #8 flares up.

2) Request of the oral surgeon that he remove the tooth in it's entirety along with the periodontal ligament and all diseased tissue and bone. I know that sounds wonky to have to make that request but not all dentists (including oral surgeons) automatically follow a thorough extraction protocol and if the patient presents that request, the dentist is more likely to make sure the steps are followed.

3) Express your concern about placing bone graft in infected tissue or bone. Ask the surgeon to be certain that the sites are healthy enough to receive the graft at the time of the extractions. Let him know that you are okay if he feels once he gets in there that it would be best to place the grafts a couple of weeks later. Again, I know this request sounds wonky but it really behooves you to make it.

4) Antibiotics.... yes most definitely discuss putting you on antibiotics starting 3 days prior to the oral surgery. This is enough time to reduce the acidity of the infection so that the local anesthetic (which is alkaline) is more effective.

None of this is intended to tell the oral surgeon what to do. It is just letting him know what your expectations are and that you are willing to comply with his decisions based on your concerns.

I know this is a scary journey to go on. It is much easier if you understand the treatment plan in it's entirety including both the oral surgery and the restorative options. Also, it is very helpful to plan your meals before the surgery date so that you can keep up with nutrition, etc without having to give it much thought afterwards. I can help you with that if you want me to.

Bryanna