What is going to be a molar extraction - full extraction.
This molar has been on a 'watch' list since forever?
Well, last week I was sent to see an 'endodontist' to see if the tooth could be saved. Apparently not. The root is being 'resorbed' into the jaw?

From all I gather, it seems as if part of the jaw will have to go as well. Obviously like most of us, my normal reaction is that I am not looking forward to this all.

Experience folks one and all - my question is.....What can/should I expect out of this experience? Aside from a hole and sore gum where a tooth used to be?
Oh, not to mention that eating nuts will probably be a no-no for quite a while... Thanks ahead of time! - j

Hi Dahlek,
I have assisted with countless extractions and also had a few of my own. So I am very familiar with the procedure and the post operative discomfort. But first, it may be helpful to understand some of the reasons why the root may have resorbed in the first place so you can take the steps to help prevent it from occuring again. It may mean having a medical physical to rule out certain systemic possibilities.

Root resorption can result from local and/or systemic issues. Some local contributory causes would be a history of orthodontics (adversely moving the teeth too quickly); internal bleaching/whitening of a root canaled tooth (because root canaled teeth naturally tend to turn gray or black); there could be a growth or cyst depriving adequate blood supply to the tooth; an injury that could have occured many years ago; or just having the tooth root canaled could cause root resorption because the procedure itself cuts off the blood supply to the tooth and also leaves the accessory canals with remnants of necrotic nerve tissue causing the roots to dissolve or resorb over time.

Some systemic contributory causes could be a hormonal or endocrine imbalance (nutritional, metabolic or immue), or disseminated malignancy (cancer that has spread from another area).

One other area that is currently being heavily researched as a possible cause of root resorption and bone deterioration is the use of Bisphosphonate drugs like Alendronate, Fosamax Etidronate, Didronel Ibandronate, Boniva Risedronate, and Actonel Risedronate. These drugs are intended to reduce the thinning of bones, however, they also decrease or eliminate the sufficiency of bone to heal. The chances of a root resorption is elevated in anyone who uses or has used any one of these drugs for any length of time because the skeletal half life (when bone turns over) is on average 10 years. So these drugs stay in the bone for at least that length of time every time they are ingested.

If none of the above seem logical in your situation, then the root resorption may be considered to be "idiopathic" or of unknown origin.

Bisphosphonates are also a concern if someone has an extraction because if the bone cannot heal, then the extraction site will not fill in and the bone can become infected.

If you have not used these medications or any other similar type medications and you don't smoke and are relatively healthy............ this type of extraction is routinely performed without complications. It is imperative that the tooth be completely removed and the socket be debrided thoroughly of all of it's contents. Yes, the infected bone would also need to be removed, but if you are adequately numb, you will not fell any of this. The post operative pain can be minimal if you prepare yourself ahead of time with proper nutrition and follow the postoperatvie instructions carefully. We find that the patients who take a homeopathic formula of Arnica for several days after the procedure do realy well with little to no post op pain and it can be taken in conjunction with pain meds.

As for replacement of that tooth......... that all depends on how infected the bone is; how much bone will be removed; your overall health and if you have taken Bisphosphonates.

I know this is very scary........ but try to look at this as getting rid of something negative in your body that can be causing your immune system to work too hard.

Please let us know if you have any other questions or concerns. Also, let us know how you're doing!

Bryanna

I realize that I've lots going against me - I feared it to be so..
1- have been on Fosamax over ten years
2-crossed the line to serious osteo this year
3- Hypothyroid is recently determined to be Hashi's due to the osteo and other blood works. Thyroid not functioning for over 10 years
4- Am on an estrogen blocker following cancer surgery last year
6- am on anti-seixure meds for auto-immune neuropathy over 4 years
7- Had extensive orthodonture work as a teen [quite a while ago]
8- have worn nite gards for over 20 years -I think the only thing in my favor?
The endodontist had asked me if I had injured my jaw at any time in my life, and other than removal of all wisdom teeth a verylong time ago...That is one part of me that I have no recollection of damaging. Final comment from him was the tooth's gotta go.
What you have stated is refreshing in how straightforward you have put all the things that come into play with any decisions I make about it. Especially about your outlining of 'systemic aspects' -put that way, I can see lots of possible connections. I assume that the work will be done fairly soon, but now I can present all my issues in to the dental surgeon in a more assertive way, one where he/she will know up-front what to expect from me. Maybe it's wishful thinking, but wouldn't it be delightful if THIS was a major contributor to my immune issues?
I count myself lucky to be in a region where top professionals can be found, I've only had a couple of medical duds, but they were doozies. Hopefully once this is done, I won't have to worry about this kind of thing for quite a while - I suppose I'll find out soon enough and I'll report back in.
Again MANY THANKS! - j

Hi dahlek,
I cannot tell you how many patients I have that have been on Fosamax or similar, only to have their osteoporosis progress, not improve!

My personal physician does not recommend the use of bisphosphonates because of the long term negative affects on the bones. Instead, he monitors my vitamin D levels with a serum test called 25(OH)D or 25-dihydroxy vitamin D, every 3-6 months. You may want to do some research on vitamin D and bone health........ you will be surprised with how important this vitamin is to our overall wellbeing. I was very deficient in vitamin D with my serum level being at 12 (optimal is 60-100). I supplement with a product from Biotics Research called Bio-D Mulsion Forte and my serum levels have since stayed in the 60's!!

Another good supplement for the bones is vitamin K2. There is good information on this (and vitamin D) on Dr Mercola's website. Of course calcium, magnesium, boron, and silicia are also helpful and work synergistically with vitamin d3 and k2.

I agree with you that you have several possible contributing factors to your root resorption. Is this the only area in your mouth that has this condition? It is imperative for the oral surgeon to know that you have been taking Fosamax along with your entire health history and other meds. He will need to take certain precautions when debriding the bone and your healing may be monitored closely for a long time.

Please keep in touch and let us know how you are doing ~'.'~

Bryanna

Right now about the Bionophosphates....I re-re-re-read the 'latest' Prescribing Info [as all know I am a strident advocate about this!] and found a teeny tiny print footnote about taking a 'break' from it for a few months ...never stating why. Not one doc has EVER mentioned this teeny fact to me. I find it appalling and yet, I do HAPPEN to be the the 'bone-wise' between rock and hard place regarding the osteoporosis.
Before the cancer was 'found' 18 mos +/- ago, my teeth were losing enamel as if losing quarters to the slots...My feet -the bones were suddenly turning transparent...I upped my calcium and all to no avail. Chomping down 6 different calciums combos to get the right amount of Mag has been an adventure...getting all that extra stuff without the 'bonus' of unwanted B-6...which aggravates my neuropathy well has also been fun? I DO know theres lots of K in there tho...
I wish that the endocrinologist appt were sooner than Oct tho...Maybe the ocon that I see next week or the Neuro next month will order the metabolic tests to see how I'm faring? Sure hope so as the the general/standard test has only been the chem panels.. I've a suspicion more 'things' need to be watched...sigh.
As far as resorption - this is a whole new world to me [aside from horses who have bone spurs[splints] on their legs suddenly having them go away...no people tho] I guess I have to go 'look it up' now I know how to spell it right?
I had suspected a bunch of big UH-OH's with all this, when it started 'sort of ' small, but I suspect more that we are talking BIG TIME U-O's now. I suppose I should be grateful that the U-O's aren't in a bigger size type?
Onward, will most likely get the surgeon's name on Wed...more fillings with more after that...I'm in a holding pattern about long-term repair or pull actions given all the 'contingencies'...For a year I can deal with the holding pattern...after that, I believe some long term issues regarding teeth are going to have to be VERY realistically dealt with.. That is probably worth another thread tho isn't it? Honestly about resorption...I've only HEARD of it in this last week? YIKES! I know I've a couple of other 'gray areas' being 'watched'...Who knows?
Another bone [pardon pun?] for me to gnaw on tho..would be: is my 'chomp factor' a possible cause for an infection that, in spite of a nite gard, got the old auto-i ball rolling down hill? So many tests, I realize NOW, that could have been done, when done at the rite time, COULD answer soo, many, many questions NOW. It positively confuses the few functioning brain cells left [after meds, of course]!
OH well! Life goes on, with or without pain! I will trudge on some how, tho not necessarily gracefully?
Super thanks again. I will be 'armed' with knowledge and ask the proper questions to [as Garrison Kellior says:] Do what needs to be DONE!
Are we having fun yet? - j

Endodontist said can't do a root canal, referred to dental surgeon....who felt that w/all my 'issues' patching what's there is better than taking that small % risk of not healing and infection-that could occur. He did not feel that the Fosamax in tablet form was the big issue more that the auto-immune issues and possible infections or calcium issues from the cancer & seizure meds were the big problems. The surgeon is holding his cards so to speak that I might be in the .06% who might encounter healing problems....long term ones.
Soo, everything's on HOLD...I'll see my dentist to discuss where we go from here, if anywhere.
Sooo, Monday an update on the current state of confusion will be added to this state of confusion.
I do believe I will be even more confused then. Isn't life wonderful?
At least I met one dentist to whom I did NOT have to explain all my medical issues. He looked at my summary sheet and went: HUMMM!
I suppose that part was refreshing compared to visits with many MD's, on the other hand, I have to ask: Why aren't MD's as up-to-date as the dentists? - j

hi dahlek,
I've been away for awhile, but I did get your private email...... thanks for the kind words :-))

I understand what the dentist is saying about patching this tooth. You have a very compromised immune system and the meds you are on cause their own set of problems. So there is no way to know how the extraction site would heal if this tooth were removed. The real concern with this or any other tooth, is infection. It really needs to be monitored closely, as do all of your teeth.

You ask the question about MD's not being as up to date as dentists....... actually, both professions know little about the other one. The only DR'S that know both medicine and dentistry are those that have sought a combined degree and/or have spent alot of time learning on their own. I always say that all MD and DDS/DMD degrees should be dual degrees making it mandatory for all physicians and dentists to learn about both. Doesn't that sound like a good idea??

I know this is very confusing, but try to remain positive and just keep asking these dentists questions until you are comfortable about making a final decision.

Please keep us posted!
Bryanna

a matter of deciding what options [if any] are the lesser of the potential evils. Probably maintaining status-quo for a while and patching as best possible will be the safest route.

Well, I was impressed by both the endodontist and the oral surgeons as they seemed more versed in autoimmune issues than most docs I meet. Thing is, I suspect they see folks who haven't gotten their teeth cleaned 3-4 times a year as I regularly had in an effort to always try to keep my teeth . I've been diligent about these things for decades and I'm no better off than if I'd just neglected them totally.

Needless to say, I believe I am more than a bit peeved rite now. It's good to have a knowledgeable touchstone such as yourself to help preserve one's sanity!

As for dentists and docs talking to each other - I guess it's equally difficult to get docs in different fields to become a bit more 'interdisciplinary'. Just a teeny bit of knowledges about other fields and the conditions they treat and where fields meet and intersect would be ultimately OUR lifesavers, or at least knowledge of the meds we take and how they affect our other medical conditions could save us all a lot of problems down the road. Sigh!

Onward now to muddle onward! - j