Extraction of maxillary cuspid
 

I have been to the dentist for a second xray and this one showed a dark hazy round shadow around the apex of the tooth. (upper canine)

My options are to extract or do root canal treatment. I have read that root canal involves the use of bleach and this is necessary to disinfect the canal. This is a major deterrent for me and has forced me to consider extraction as the only option. But this has bad consequences too.

Is the extraction of this tooth easily done even though it is the longest tooth in the mouth?

If I leave the space, will my teeth shift and cause biting problems?

is there no alternative to the strong bleach they use during root canal?

Hi Jim,

Is this the same tooth we spoke about previously?

Root canal therapy always includes using a harsh and toxic disinfectant. They are called intracanal medicament's. The idea is to kill the nerves and bacteria that come in contact with the chemical. If it's not bleach then it's formocresol or copious amounts of hydrogen peroxide. All of which are very toxic when used in this way, especially if the irrigation is pushed through the apex and goes beyond the root of the tooth into the bone. I know that sounds awful but you like to be well informed and if I don't tell you and something happens, you will be even more upset.

Removing an upper canine can be a bit complicated because the canines are located in the oval area of the arch and are considered the cornerstone of the arch. They kind of hold the arch in an oval or round shape. Leaving that space empty will cause teeth to shift. So it should be replaced with either a 3 unit bridge, an implant or a partial denture.

If you opt to have it extracted, please see an oral surgeon not a general dentist for that procedure.

Bryanna

yes this is the same tooth which i spoke about previously. But you can see this is a terrible dilemma for me.

I dont want to replace the gap if i extract it because that will involve a fair amount work and will likely be more expensive that the root canal. However as you mention the root canal uses harsh chemicals which is unacceptable to me.

How much of a shift will occur if the gap is left? my teeth are already not perfectly straight so would it matter much?

can the amount of shift be accurately guessed or is it impossible to say?

There is one other question though. There is no question now that the tooth is dead but the mystery is that there were no holes in the tooth and non trauma to it that i can remember. So how did it get infected and die in the first place?

My dentist says it could be due to tooth grinding.

Also can the canine tooth be removed normally or not? is it a surgical procedure or a normal extraction?

Jim,

Okay, I thought so.

Yes, you are in a difficult predicament as there is no easy fix to this problem. I cannot tell you how much or how little your teeth will shift if you do not put something in the place of the canine. This canine is one side of the cornerstone of the upper arch which means when it is not present, the curvature of the arch changes. This causes an unnatural movement with the other teeth. What can happen is the upper teeth will move which will throw off the alignment of the bite to the bottom teeth. This movement could result in damage and eventual loss of other teeth as the bite will not be coming together properly.

The main reason for replacing this tooth is to put something in its place to hold the curvature of the arch. You may be a candidate for what is called a Nesbit. This is a small, one tooth, removable appliance. It is designed to hold the space open, as if the tooth were still there, to prevent shifting of the teeth. But it has to be worn every day or teeth will move and the appliance will not fit. A Nesbit is also worn for esthetic reasons so you do not have a space when you talk or smile. However, this appliance is not meant to leave in when you eat or sleep as it is small and can become dislodged when chewing or sleeping which could be choking hazard. Not all dentists are comfortable suggesting Nesbits because of the choking hazard. But many people have and many people do really well with them. One of our members here, Ginny has a 2 tooth Nesbit and she has remarked many times how happy she is with it.

Regarding the root canal... yes, the medicaments used during the procedure are toxic, but so is a non vital tooth. All teeth require vitality to be healthy. There is nothing healthy about a dead tooth. I know you are a thinker and you delve into all of the details, so that is why I am reaffirming these facts with you as I would assume they would be important to you.

Here is what a nesbit looks like.... http://www.onnikdentallab.com/valplast-nesbit/

Bryanna




QUOTE=jimkh;1116235]yes this is the same tooth which i spoke about previously. But you can see this is a terrible dilemma for me.

I dont want to replace the gap if i extract it because that will involve a fair amount work and will likely be more expensive that the root canal. However as you mention the root canal uses harsh chemicals which is unacceptable to me.

How much of a shift will occur if the gap is left? my teeth are already not perfectly straight so would it matter much?

can the amount of shift be accurately guessed or is it impossible to say?[/QUOTE]

Jim,

Correct, the tooth is infected.

Teeth become infected for a number of reasons. Here are some them:

1) Decay which can occur on the exterior or interior of the tooth.

2) Recession along the gum line exposing the sensitive root area to hot and cold temperatures over a period of time can cause enough trauma to the tooth to render it infected.

3) Recurrent decay underneath a previous filling.

4) Grinding or clenching your teeth on a habitual basis. The force put on the teeth during bruxism causes trauma to the live, nutrient rich periodontal ligament that cradles and attaches the tooth to the bone. From the chronic trauma, the ligament becomes inflamed, bacteria moves in and infection develops.

5) A misaligned bite can cause repetitive trauma to those teeth that are being over worked while chewing. This can cause the nerves to die inside of those overworked teeth and infection moves in.

6) Unresolved gum disease can allow enough bacteria to get in underneath the gum line eventually infecting the tooth.

7) If an adjacent tooth is non vital, has a root canal or has a periodontal problem, the bacteria from that tooth will travel to the surrounding teeth which can result in infection of the other teeth.

All tooth extractions are surgical. Some require an incision while others don't. Some require the tooth to be sectioned in pieces while others don't. But all extractions are a surgical procedure. Removing the canine is a bit tricky because the surgeon has to take great care during the removal so as to not disturb too much of the surrounding bone. The idea is to remove the tooth and all diseased tissue while leaving as much bone intact as possible. That is why I recommend an oral surgeon do the extraction.

Bryanna

you say that you cannot tell me how much or little the teeth will move. (I expect there will be be some movement.) But then you go onto talk about the worse case scenario of further tooth loss which may or may not happen. Even if it does, we all lose our teeth in the end. Often with age, other illnesses affect us and eventually we all die. The loss of a tooth is horrible but if you look at the whole picture it is actually not the end of the world.

And what about the positive side which you didnt mention? Perhaps tooth movement is a good thing? People pay a heck of a lot of money to move their teeth into alignment. If my teeth move into the right position, it would be an advantage which i get for free.
As I mentioned, my teeth are already not exactly straight. They are crowded and the tooth next to the dead tooth is already under the adjacent tooth. Chances are this tooth will move towards the gap (should i get the extraction) rather than away from it. This would be a good thing would it not...

i thought you held the belief that the bone also has to be scraped clean after the extraction? and now you say the bone shouldnt be disturbed. Biological dentists recommend scraping the bone but it is not something usually done.

how much is a partial single tooth denture anyway?

Jim,

I have been in dentistry as a dental technician since 1979 and have seen no more than 1 handful of root canals be problematic...some involved trauma such as accidents.

I had one done on #30 in 1982 and it is still there with never any complications.

Bud

Hi Bud,

Welcome to the dental forum!

Like you, I too have been in the dental field since the late 70's as a restorative and surgical chair-side assistant. What field of dentistry do you work in? I'm curious how it is that you have only seen a handful of problematic root canaled teeth when I see infected root canaled teeth all the time? As a matter of fact, most of the people who post on this forum talk about the repetitive infections they have with their root canaled teeth. Care to share with us how you know of only a handful of these problems? Thanks!

Bryanna

Jim,

I answered your questions as logically and informatively as possible. I do not have a crystal ball to tell me how much or what direction your teeth will move in. Just because your teeth are not straight now does not mean that extracting some of them will straighten the rest of them out or improve your bite. Missing teeth, with few exceptions, can lead to negative changes in the alignment of the bite. Those changes can put too much force on some of the teeth when chewing which could result in inflammation of those teeth and eventual tooth loss. This can usually be prevented if the missing teeth are replaced after they are extracted.

You are mistaken about all people losing there teeth when they age. That is absolutely not everyone's automatic fate. People lose their teeth most often due to neglect, not age.

Bryanna

Jim,

I never said the bone should not be thoroughly debrided. I said the surgeon needs to take great care in removing the tooth as well as the diseased tissue so as to preserve as much bone as possible as the canine is the cornerstone of the arch. That is what I said.

Every dental school on the face of this earth teaches the dental students to debride the bony socket after the tooth is extracted. The problem is that this important step is frequently neglected to some degree. FYI... Biological dentists attend the same schools that conventional dentists attend.

Bryanna

Jim,

It depends on the location of the dental office and what dental lab is used.

Call your dentist and ask him.

Bryanna

There is no way to tell if the root canal has been successful anyway. I currently have a dead tooth which is infected all throughout it. Yet the only symptoms I have are

A) a slight ache and slight pain when pressed
B) a hazy area on the tip of the root on the xray

These are fairly minor symptoms and could easily be missed. In fact the first time I saw a dentist, he never suspected any problem and told me the pain was normal. Even the xray was 'inconclusive'.

Now imagine if I had a root canal. As long as you removed the dead tissue inside the canal, my symptoms would likely disappear. But that doesnt mean the infection is gone.

Sorry but this is all non scientific. I have heard some people say root canal is great and others say its terrible. The first dentist I saw said there is no problem with removing my tooth except cosmetics. Everybody says something different. We need more objective data to support these highly variable opinions.

Jim,

Root canal therapy is done in an attempt to "retain" a tooth. It is not done to cure an infected tooth or to make an unhealthy tooth, healthy again. Once the nerves die in the tooth from decay or trauma or once a tooth is root canaled the tooth becomes non vital..... dead.... no longer able to receive nourishment from the blood vessel that was supplying it life before it died. Bacteria and inflammation set in and infection follows. This same process would occur with every other body part or organ of the body.... teeth are no exception, they require vitality to be healthy. This is not my opinion, this is basic biology. Every dentist and every doctor has learned this... but not every dentist or doctor is going to recommend extraction of the tooth unless the patient decides that is what they want to do.

As with any other part of the body, teeth do not have to show symptoms of a problem until the problem is severe and/or has spread beyond the original site. This is why people will often, but I had no "problem" with that root canaled tooth until all of a sudden it swelled up. Just like people will say.. I had no idea I had heart disease until I had a heart attack. Or I had no idea I had diabetes until I passed out. It is often the progression of disease or an illness that will eventually show itself.

The early onset of infection in a tooth does not usually appear on an xray. It appears when the infection has spread beyond the tooth. Just like in your case of this "other tooth" that you say is dead and infected.

You wrote: <<Now imagine if I had a root canal. As long as you removed the dead tissue inside the canal, my symptoms would likely disappear. But that doesnt mean the infection is gone.>>

I don't have to imagine what takes place during a root canal.... I've assisted on them countless times. It is not possible to remove all of the dead nerve tissue from the interior of the tooth, especially the hundreds of microscopic canals called dentin tubules. The reason some people have relief of their symptoms is due to the removal of the most inflamed nerves but that does not render the tooth healthy just because the symptoms subside. Other times the inflammation is increased after the procedure and the pain is worse. Either way, the end result of any rc procedure is a dead, diseased tooth. Again, this is not my opinion, it is basic biology.

The anatomy of tooth is what it is and there is no changing that. Any tooth that is non vital is not healthy simply because all body parts require vitality to be healthy .... and there is no changing that. Whether you believe it is systemically healthy to keep a dead tooth in your head or not... that is your opinion and your decision.

I have answered your questions and explained everything in great detail. I am not here to convince you of anything, I just provide the facts along with information that may not be disclosed to you by your dentist. I suggest that you decide what your priorities are and let those be the direction you go in.

Bryanna

there is no other tooth which is infected. Thee is only one that i am referring to. here is another clearer xray. What is your opinion of this?

Jim,

I'm sorry if I misunderstood your post about having a another problem tooth. I did not realize you were speaking of the same tooth as it did not come across that way. My bad :/

Thanks for posting the new xray.
Yes, there is clearly an infection covering about 1/3rd of the root of this canine. From the angle that this xray was taken, it is possible that 3/4th's of large canal is calcified. This would mean that there is no access to the majority of the large canal if you were to do a root canal. Canals calcify for different reasons. Sometimes people have odd anomalies with their teeth and calcification is one of them. Other times the canal calcifies from trauma or chronic irritation from clenching or grinding the teeth.

To rule out calcification of the canal, you would need another xray taken at a different angle, perhaps a bisecting angle, as dental xrays are only 2 dimensional.

Bryanna

can you tell from this image if it is a digital xray or not? Over exposure to radiation is another one of my concerns..

But just to be clear, can you tell me which tooth is the canine in the image? counting from right to the left, I think it is the 3rd one along, which is faulty. The dentist pointed out that there is a hazy shadow near the tip. is that right?

what do you mean by 3/4 is calcified? can you explain what this means.

does it definitely need extraction or root canal then?
why not? dont they just drill through it?
but whats the point? doesnt the tooth need to come out anyway?

I am still stuck with the same dilemma. Extraction alone, is the quickest fix, but 5 to 10 years down the line, I could be looking at jaw problems which would be a nightmare.

Jim,

If this xray can appear on the dentist computer screen then it is a digital xray. If he can only view the xray on an xray box viewer then it is not digital. Did he view it on a computer screen? If you are contemplating having the root canal, I would suggest that you have an xray taken at a different angle to determine if the canal is calcified or not.

The canine is the 3rd tooth from your front tooth. You have a central, a lateral, and a canine. I cannot tell you how many it is from the back because this xray does not show all of your molars and so I don't know how many of them you still have.

There is an infection hovering over about 1/3rd of the tooth from the root down. Yes, he may have referred to this as a hazy shadow. He should have been more specific.

A calcified canal means that the nerve that is suppose to be there is not visible on this xray as that portion of the interior of the tooth has fused together. There may be a microscopic canal where there was once a large canal but microscopic canals are not picked up on the xrays. Or this tooth could have an anomaly meaning the large canal maybe never formed properly in the first place. No, I cannot tell you if it fused or if it never formed.

If the canal is calcified, then there is no access to the large canal which means the root canal cannot be done. So the tooth would need to be removed.

Drill a hole in what? The only hole that gets drilled into the tooth for a root canal is the opening hole into the pulp chamber in the center of the tooth. Instruments are then pushed into the opening and up into the large canal scraping out the nerve tissue. It's not like you drill a hole into the tooth and the contents miraculously fall out.

Root canaled teeth are chronically inflamed and infected. The rc procedure does not cure the infection. If that causes you concern then there is no point in doing the root canal. If you are not concerned about the ill health of the tooth, then if the canal is not calcified, do the root canal.

If you extract the tooth and do not replace it with something, then you are most likely going to have issues occur with the shifting of your teeth which can result in other dental problems as I have explained to you. If you do the root canal, it could be a week, a month... 6 months... 5 years.... before that tooth is removed. Why? Because you will most likely keep the tooth irrelevant of how infected it becomes until it becomes painful.

You need to read all of this information over again and see that I have repetitively given you the same information again and again. You are in a dilemma because you are uneasy about the information that I have given you because you have your own version of things and on top of that your dentist does not offer much information at all. Sort through it and make a decision that you feel is best for you.

Bryanna

so what are you suggesting instead of the root canal if you disagree with it so much? an extraction followed by a partial denture?

If so, that has its drawbacks too. I am concerned that the extraction itself may not be a simply job. What if it tears the bone and makes a hole through my nose? The apex of that tooth is painful when i press right next to my nose on my face. How do I know whether the extraction will not cause such kinds of problems?

also I wanted you to tell me which tooth you are referring to on the image i uploaded. I know which tooth is the canine, in my mouth. I wanted to know which one it is on the image.

why cant they simply drill through the tooth if its calcified? The main thing is to drill until you get to the tip of the root.Then you can clean out that area and seal it. Also you can seal off any remaining bacteria so its not necessary to remove all of the bacteria. I agree it is not a perfect procedure but you make it sound like it is no better than leaving the tooth alone. Which is better? If you had a choice between leaving the tooth as it is and chronically infected, OR removing upto 99% of the bacteria with a root canal, which is better?

Where is the evidence that root canal, if done properly does not cure the infection?
Just because it fails after 20 years does not mean it was not effective up to that point does it?

I have heard some people say root canals have lasted them over 20 years or more. There are also some which fail very quickly. But you are dismissing the whole procedure. Why would they do it all over the US and the whole world, if it didnt fix the infection? That is the purpose of a root canal. If it didnt work, people would not pay hundreds of dollars to have it done. If it was no better than leaving it alone, then they would leave the tooth as it is.
Root canal treatment has been known to instantly provide relief from the unmistakeable pain of an abscess.