Hi Ive been looking over this site for a few days now and was hoping maybe bryanna could answer some of the questions I have.

First of all I have MS I dont know if that has any risks were dental work is concerned Ive never had a dentist say it did.
Basically the left teeth on the top and bottom all need to be fixed with crowns on all root canals on some and crown lengthining on 2. They werent hurting until I had a tooth pulled 1 week ago now the left side of my mouth is constantly uncomfortable so I dont know if some damage was done when the tooth was taken (far back bottom left difficult extraction) or if their just all starting to act up now.

From what Ive been reading about root canals Im now concerned about getting one since it seem not to be the fix I thought it would be and am now concidering pulling the teeth that need the root canals and crown lengthining because the crown lengthining procedure seems scary too.

I feel so confused and dont know what to do but Im afraid to let these teeth sit and not do anything ( I dont want them to get abscessed and kill me as I have read about) I have an apt. for the root canal scheduled but would it just be a waste of money to do that since root canal from the sounds of it only delay the problems and the tooth eventually needs to come out anyway. or am I just not understanding correctly

And any insite on crown lengthining would be grately appriciated is it more painfull than extraction?

thanks
Davida

Hi David,

I hope I can offer you some insight about your concerns about root canal therapy and crown lengthening surgery. Keep in mind that I am personally without waiver on my opinion about root canals. However, everyone needs to be their own advocate and make decisions that are in their own best interest. My personal opinion is based on 30 years in the dental field and thousands of patients of whom I have worked with. Biopsy reports of extracted root canal teeth <some teeth were symptomatic and others weren't> don't lie and I have never read one that indicated the tooth was in any way healthy.

MS can most definitely affect the recovery process of some dental procedures. Dentists need to be very aware of the potential risks associated with the meds that MS patients are on particularly if the patient needs oral surgery. Here is a site that goes into a bit of explanation about these things. The dental treatment planning is at the bottom of the page:
http://www.cda-adc.ca/jcda/vol-66/issue-11/600.html

Sometimes there is residual pain or discomfort in the jaw or near the site of a recent extraction. This pain should be temporary and never feel like it is spreading. I'm wondering if your MS is affecting the left side of your face either from the traumatic extraction or if the MS was already there but in remission prior to the oral surgery? Have you had an MRI recently that would have shown the oro-facial region of your head? If not, it may be wise to have one prior to undergoing any further dental work.

The root canal issue is a controversial one amongst the dental population because so many dentists work their whole career and never once order a biopsy of an infected tooth. These dentists have no clue what these reports are stating because they have never seen one. Root canals are done to "retain" a tooth that has an infection, not "cure" the infection. Some of the infectious bacteria is removed, but the rest of it is harboring in the lateral canals that cannot be seen on an xray and in the microscopic canals that are unaccessible. I often refer people to this informational site where ironically the dentist writing the lengthy article, Dr Meinig, was for many years the grand pubah of Endodontics until he did some research about them.:
http://www.rheumatic.org/teeth.htm

You are correct in that you cannot just take the wait and see attitude and do nothing. In your particular situation having MS, it may be wise to ask what all of your treatment options are for all the teeth in question. Then approach your choices by eliminating those that are questionable with regard to #1 your overall health and well being and #2 will you have to revisit or retreat these teeth sometime down the road which means that they may have become a chronic burden to your immune system.

The answers are not easy and can be life altering in more ways than you can imagine. If you choose to remove the offending teeth, then it would behoove you to seek a dentist who understands the connection about MS and dental treatment. Perhaps this site will be helpful in locating someone like that:
www.IAOMT.org

Crown lengthening surgery is generally performed for one of two reasons:

One is because there is a deep pocket of gum tissue that is trapping bacteria and infection is present. The open gum tissue is removed, eliminating the deep pocket. In these cases, a portion of the root may be exposed after the surgery site has healed which may or may not be sensitive to temperature and prone to cavities and plaque accumulation due to the softness of the root structure. If the tooth is root canaled, the temperature sensitivity will not be present but the other issues are the same. It is imperative to keep these areas very clean once they are healed.

Two is because the tooth/teeth may be broken down near the gumline which would make placing a crown on them impossible. So the gum tissue is elevated by surgically removing some of it. This will allow more acutal tooth structure to be exposed so the new crown/cap will have something to be cemented onto. But again, these areas can be sensitive <in non root canaled teeth> if there is any open margin along the gumline on the crown/cap.

Crown lengthening procedures are very different than extractions. The surgerized area will be tender for a few days but there is no bone pain like there may be with a traumatic extraction.

David, I know I have poured out more information than you probably wanted to hear! Don't let it overwhelm you, just let it give you the empowerment to ask questions and seek the best treatment for you!!

Please keep us posted on what's going on ~'.'~

Bryanna

Bryanna, thank you so much for the info you gave me. Basically for the last 3 weeks I have been trying to reserch everything they said I needed to have done, and get as much info as possible.

The only med Im on for my MS is betaseron and Ibuprofen occasionally as needed but lately it has been a lot. I havent had an MRI since I was dx 2 years ago. Seems like so far has taken a mild course at this point anyhow.

The dentist when he extracted the tooth was saying to his assistant helping him that the moler by the tooth he was extracting was moving more then the tooth he was extracting, I think thats when he decided to stop trying to wiggle it out and use some drills and get it in pieces. But yeah Im still really sore I keep thinking do I have dry socket, but that should be excruciating right its not something that would be controlled by Ibuprofen right?

I had to teeth pulled on the other side months back same tooth oposite side, differant dentist. And I was sore for a few days but nothing like this. But then all the teeth around that tooth that was just pulled are in sad shape.

I have an appt. for the root canal to be done on the 19th but I still dont know what Im going to do. Its one of those teeth were if I loose it by extracting it I will not be able to chew on that side it is also one that needs the crown lengthing too.

But thank you so much for your response
Davida

Hi Davida,

It sounds like your dentist had a tough time removing this tooth and may have traumatized the tooth or teeth next to it during the surgery. Sometimes during an extraction it is necessary to use the adjacent teeth as an anchor for the dental instruments <called an elevator> to lean against. However, this can cause the adjacent teeth to be very achey for several days afterwards. It is definitely something to keep an eye on and watch for signs of infection...... like swelling, pus, sharp pain and a bad odor.

A dry socket can occur because the blood clot was disturbed either during the surgery or immediately afterwards. The socket should always be debrided and irrigated thoroughly when the tooth is removed. This prevents any bacteria from creeping in there and disturbing the healing. It is imperative to have a good size blood clot in the socket to keep the bone moist for the first few days post op. The symptoms of a dry socket usually occur within the first 3-4 days after the extraction. It is painful, feels hot, bad odor, sometimes limited opening of the mouth, ill feeling in general and gets progressively worse until it is treated. If you think you may have a dry socket, please don't hesitate to call your dentist asap. Extraction sites that don't heal properly can end up with a chronic bone infection.

I completely understand your concerns about having teeth to chew on! I also appreciate your uncertainty about having a tooth removed that you need to chew with. Since you already have missing teeth on both sides of your lower jaw, if you were to remove the bad ones, is there a way to replace them with a removable partial denture? Was that option offered to you?

Bryanna