BRYANNA - I really need your professional advice. I have suffered with facial pain and eye pain for over 20 years on my left side prior to a root canal and afterwards. The tooth then had an apicoectomy about 18 years ago which left me with constant sinus pressure.
Two years ago the tooth then had another root canal by a very experienced Endodontists after a small infection showed at my six monthly check up. This made everything worse I kept returning complaining of pain but was told to leave the tooth to settle down I was put on amitriptyline and pregabalin by the dental school until eventually a fistula formed. (this story is the short version)
Two years after root canal and an Xray at the dental hospital which showed infection the tooth was removed. I payed privately for a very experienced oral surgeon which was 8 weeks ago. I am in worse pain now then before and again I was told to let it settle down. It hasn't. The oral surgeon has referred me to a neurologist for pain medication. However I took it upon myself to seek another opinion of an oral surgeon, he did another X-ray, which I have attached (there is a small piece of amalgam in the socket from the apicoectomy) and also a 3D scan which showed a very small sinus communication which he said should heal on its own as there is no nasal discharge. His advice was to leave alone and see if the area heals or to go back in and clean the socket. Please advice Bryanna. this is completely ruining my life being in constant pain.

Did you have silver filling in the crown of that root canaled tooth?

No, the amalgam is from an apicoectomy many years earlier and the amalgam actually sat on top of the tooth root but it has not been removed when the tooth was extracted.

Hi Jamm,

Thanks for the xray.

Here's what I see on the xray..

1) A root canaled pre molar with radio graphic pathology. Did that tooth have an apicoectomy? It looks like it may have due to the blunting of the root tip..... OR the gutta percha perforated the apex. Either way, there is a cyst at the apex.

2) There is a moderate size piece of mercury lodged in the extraction site. This was likely the mercury blob that was placed at the apex of that extracted molar when the apico was done. Ideally the oral surgeon should have removed that mercury when he extracted the tooth. Really there is no excuse for leaving it there.

3) There are other small fragments of mercury scattered about which would be difficult to remove as they become embedded in the tissue.

4) There is a moderate area above the mercury blob that is suspicious. May be an infection and that may be where the sinus is involved.

5) Not sure of the health of the last molar. That tooth needs another xray taken at a bisecting angle.

6) All of these problems are likely apparent on the 3D scan.

You have a long history of dental infection in that quadrant of your mouth because root canal therapy and apicoectomies do not cure an infected tooth. The dentin tubules will remain infected with trapped nerve tissue irrelevant of how perfect either of those procedures are done.

This is not going to settle down on it's own because .....

1) There is a blob of toxic mercury stuck in the surgical site that will prevent healing.
2) There is pathology and infection with the pre molar as well as in the surgical site of the extracted molar.

The oral surgeon should have informed you of the problems with the pre molar and he should have been MUCH more thorough with the extraction and debridement of the molar. The problems you have are not going to heal in time. They require intervention.

Medicating you to kill the pain, is only a band aid at the very least.
I am really sorry your dentist has not informed you of these things. Your choices are to go back to the oral surgeon that botched up the molar extraction or see a different one and explain you want a thorough debridement of the surgical socket.

I know this is depressing news...... but I hope it is helpful to you.

Bryanna

Bryanna, thankyou so much for your reply and taking the time to advice me I have been reading the advice you give to people on this site for over two years, Just wish this kind of information was available may years ago as unfortunately you do not question what the dentist advices especially when you are younger.
I paid privately to have the tooth with the apioceptamy removed by a very respected and experienced oral and maxillofacial surgeon because I was fully aware about complications removing these kind of teeth from information provided by yourself.
Here is the problem I am now facing, when the tooth was removed it took all of two minutes and there was no X-ray present at the time, the surgeon informed me there was a granuloma on the extracted tooth. I returned to him two more times one which he charged me for! I complained of continued pain in the area I asked him specifically if there could be remaining root fragments in the socket as it was uncomfortable and he assured me there wasn't as he had a good look in the socket and he advised me to let it settle and he would send me to a neurologist for pain management. He did not take a post extraction xray.
I have emailed him a copy of the X-ray and I am awaiting his reply.
The second oral surgeon said we could monitor the site or go back in remove the amalgam and clear out the area which looks like scar tissue and maybe risidual infection but the risks are maybe damaging the back tooth or opening the sinus communication more so that it becomes permanent. He also spoke a drilling the bone to make a blood clot.
My trust in dentistry here in the UK has completely gone!!
Do I go back to the original surgeon and ask him to complete the surgery? or stick with second oral surgeon who I no nothing about. Do I present myself at the local dental school? I want the best possible outcome as this is having a massive impact on my daily life.

By the way the pre molar was a perfectly healthy tooth but due to continued pain around that area over the years a previous dentist decided to fill and eventually root canal it.

Thankyou again for responding to my post it means so much to me.

Hi Jamm,

I understand that you paid privately.... I often suggest that people take that route because the care is often higher quality and more individualized. I still feel that is usually the best way to go over a dental school or insurance based practitioner.

However, in the case of your first oral surgeon..... to extract a tooth without an xray is a huge NO NO as you cannot possibly know what you are getting into without that xray. That is why the surgery was so quick because he did not debride the area... because he didn't know the full extent of what was there. Secondly, ALL tooth extractions REQUIRE a thorough surgical debridement, there are no exceptions to that rule. Unfortunately, this step is not routinely done as it is suppose to be. The granuloma he referred to was a clear indication that there was more happening in that site which needed further investigation (an xray) and debridement.

What the second oral surgeon is referring to as scar tissue is most likely infection and granulation tissue. Scar tissue does not have the exact appearance as infection, which is pretty obvious on your xray. He may be making that reference to avoid further questions from you about why the first OS didn't do a more thorough debridement.

The concern about having permanent damage is two fold:

1) Without question it is never healthy to have an infection in your jawbone and especially one that has traveled to the sinus cavity. In your case you have at least 4 issues that are contributing to the bacterial problem. One is the root canaled pre molar, the second is the dirty extraction site, the third is the toxic mercury sitting in the surgical site and the fourth is the sinus perforation which is not likely to heal unless the other issues are taken care of.

2) Permanent damage can occur from long term infection (ie root canaled teeth, non debrided extraction sites and chronic sinus involvement). It can also occur from deterioration of the jaw bone due to the proliferation of infectious bacteria. All of which can make the person very ill beyond the original source of the infection.

3) At some point this quadrant of your mouth.... the rc tooth/the infected extraction site/the blob of mercury/ the sinuses.... will have to be addressed. The more deterioration that occurs, the more prolific the infection will become and the more likely it will become a systemic health concern.

Based on all of those things going on and in addition to the length of time that there has been infection in that quadrant (20 years), if the surgery is done now there is a possibility of some damage occurring with the surgical intervention, but no one can tell you if it would be temporary or permanent.
There are also no guarantees that the surgical intervention would be able to cure the infection in it's entirety because the bacteria may be hidden and not yet visible clinically or radio graphically.

The options are....

1) Wait and let it proliferate and be medicated for the pain.
2) Do not wait. Debride and remove the visible sources of the infection and the mercury giving you a better chance of a healthier, more complete recovery.

I know people think they have to just trust their dentist to always do the right or best thing. However, as much as you have no choice but to trust the skills and knowledge of the dentist, it is imperative to remain your own advocate and use your voice to make your concerns and expectations clear.

Again, I hope this info is helpful to you.
Bryanna

Bryanna,

Thank you once again for your quick response and expert advice.
I will definitely be having a thorough surgical debridement of the area and will keep you updated on the outcome.

Have a fantastic day

Jamm,

I just want to mention, or reiterate, that the root canaled pre molar in that quadrant is a source of chronic infection and it does have radio graphic pathology at the apex.... which you may be inaccurately told is scar tissue. Infection, such as this tooth, can prevent healing from any type of surgical intervention you have in that molar area and sinus. This risk includes a less than successful healthy integration of a dental implant if you were to consider that in that molar area sometime in the future.

I just wanted you to be aware of that.
Bryanna

Hi Bryanna,

I was doing a search on healing after amalgam removal & this thread came up. Not sure if replies are monitored as this thread is from some years back tho I thought I would write.

I had a root canals in 1 molar, lower right. It got reinfected a few yrs later & infection appeared in molar next to it, which had a previous silver filling. I decided to have both teeth pulled in 2012 & 2014. First surgeon found infection in gum & bone & debrided with ozone. I’m not sure the 2nd surgeon in 2014 checked for osteomyelitis. I felt extremely ill on an off from 2015-2020. Finally, I found a naturopath who directed me to a holistic oral surgeon. He did a 3D cat scan saw 2 big pieces of silver amalgam in the gum above infected jaw bone, left by a previous surgeon for over 5 yrs! Gum had turned gray. He removed, debrided the bone & flushed the area & my body with ozone & vit c & packed the area with my prp. I also had all old amalgam fillings removed expertly & cleansed the body of heavy metals with colonics etc. 3 months later, April 2021, right side of my face swole up & I took clindamycin which worked. Repeat scan in May showed no infection in jaw bone & my health has been improving dramatically. Tho, I still have swelling in the debrided jaw area. I’ve been having acupuncture done regularly to lower the swelling. Ever since 2015, I sometimes feel a nerve pain up side of face like a towel is being wrung. It has lessened since the debridement in Jan 2021, but still present. I’m wondering if the body is still healing & it just takes more time, or do I need to re-address the swelling & nerve pain. Thank you very much for possibly reading & replying to my (long) post.

Welcome Bhav.