CT Results- question for Bryanna
 

Hi Bryanna,
I started a new thread cause the other one was getting too confusing. I have the results of my Maxillofacial CT/with contrast.
It looks as though everything is normal (which I can't believe) but one question I have for you. It says:

"status post removal of left maxillary tooth crowns with remnants of the molar roots within the maxillary alveolus. No adjacent cortical irregularity or erosion"

Is that normal? I think it means that tooth roots are still in my sinus? Could that be causing my problems?

There is something definitely not right and I am starting to look like a crazy person because every ct comes out normal! The only other thing I can think of is it is the Pseudomonas and maybe it doesn't show up on the ct?

Thank you

Angels,

The maxillary alveolus is the bony socket that holds the roots of the tooth. It is not the sinus. The description of the report is not clear the way it is written here. Could you re-post it with the exact wording and punctuation?

Thanks,
Bryanna

That is exactly how it is written in the conclusion. In the findings, it says "no bony defect of the left maxillary alveolus. Status post removal of left maxillary molar crowns with remnant of the roots within the maxillary alveolus."

Is it normal to have roots left like that? The oral surgeon told me the roots were infected and in my sinus. He is at a dental conference all next week. Ugh!
Thanks

Angels,

This statement the way you say it is written appears to be an incomplete statement. However, it could be just the way the radiologist wrote the report in response to what was written on the prescription for the scan... "Status post removal of left maxillary molar crowns with remnant of the roots within the maxillary alveolus."

One) If the script read something like..... Scan area of the upper left quadrant post removal of teeth and root remnants. It could mean the "current" status post removal of such and such was found to be normal.

Two) If the script read something like .... Scan area of upper left quadrant post removal of teeth for retained root remnants, etc. It could mean the current status shows root remnants were found in the maxillary alveolus.

At least that is my interpretation of it. Do you see what I mean?
Bryanna

Yes, I do. I think it was a finding? Is that normal to have roots left after an extraction?

Angels,

When a tooth is extracted, it is imperative to remove the tooth in its entirety.... this includes every bit of tooth structure including the roots. It is also imperative to remove the periodontal ligament that surrounds the root structure as this ligament is a chronic source of infection if it is left in the bone. And it is also imperative to remove all other diseased tissue and diseased bone as they too will be a chronic source of infection if they are left behind.

Ninety nine+ percent of the time, there is no reason not to perform a complete and thorough tooth extraction.

Bryanna

Aha, maybe that is my problem! This sinus problem is not going away. If the roots were infected and they are still there couldn't that be it? There is no reason for this to hang on. Also, if there are roots left in there, how do you get them out? Is this an involved procedure? Is it performed by an oral surgeon?
Thank you for your help, I am very unsettled right now and I really appreciate your posts! Also, this makes sense with the roots because when I move my head certain ways I get a nerve twinge in the area where the teeth were removed. Also, when I do my sinus wash it happens also, in fact after I do the sinus wash that area will hurt and bother me for a while. I still feel like I did before the teeth were taken out.like I have an infection.

Angels,

If the roots of the extracted teeth are still in the bone and/or they moved or were pushed up into the sinus during the extraction, then that could explain a chronic infection that antibiotics are not able to cure.

Retained roots from extracted teeth need to be surgically removed. The type of the surgery depends on their location but they are generally retrieved from an entry of the oral cavity. Most often an oral surgeon will perform this surgery. However, if there is extensive damage, infection or other sinus complications have arose, then the os and an ENT will frequently collaborate on the surgery.

Your oral surgeon needs to inform you if the roots are still retained and if so, where are they exactly.

Root canaled teeth have so many things wrong with them and so many possible complications can arise when these teeth are not extracted before they become badly infected. Sometimes the rc tooth is so ridden with bacteria that the roots separate from the rest of the tooth due to deterioration or decay. When that occurs, it may nor may not be clearly evident on the dental xray. In those cases, the dentist only becomes aware of the problem when he goes in to extract the tooth and there's no root or roots attached to the tooth. Sometimes in attempting to retrieve the infected roots, they end up getting pushed up further into the bone or the sinus. It's hard to retrieve roots from the jaw bone that are mushy and decayed as they just keep breaking apart.

I don't know what is going on in your particular case but it is imperative that the oral surgeon explain in detail what is going on and offer you some options as to what to do about it.

I'm sorry you are going through this. I hope you can see the os on monday and get some answers.

Bryanna

The bad news is the oral surgeon is out of town until Feb 2nd. I have already gone back twice and he said nothing is wrong. He did an X-ray but I can't remember if he did the CT scan around my head. I know he did it after he removed both teeth though. How come he couldn't see the roots? I am trying to get a hold of the Endodontist that has so desperately tried to help me through this whole thing. He seems to be the only one who cares. He also referred me to the oral surgeon. I am wondering if I should go to a different oral surgeon? What do you think? I am suffering terribly with this sinus thing and to think of going another week with it is killing me. Also, I was just reading that leaving root remnants can cause heart problems. Also, what happens if the reason he left the roots are because it is too close to sinus or a nerve? Will someone be able to successfully get them out without damaging my sinus or nerve? This whole thing makes me nervous!

Angels,

Ironically, the endodontist is a strong promoter of root canal therapy which is the very thing that has contributed to the severity of your infection. Is this the same endodontist that did both root canals on 14 and 15? Did he also do the root canals on the other two upper teeth that resulted in a sinus infection? How long ago was the problem with the other side and what transpired during that situation? Was that sinus infection ever completely resolved?

By any chance has this endodontist and the oral surgeon that he referred you to communicated with each other about your case?

I think it would be wise to insist and expect the oral surgeon, the endodontist and the ENT doctor to confer on your case. If they are reluctant to do that, then something is weird because these discussions are done routinely especially in cases such as yours. It would be difficult to try and find another oral surgeon, etc to take on your case at this stage because it's complicated and no one really wants to end up being wrongly blamed for what someone else did or didn't do. So you have to try to get these guys to collaborate with each other.

I know you are suffering with this infection and I know the stress of all of this is becoming unbearable. However, before you jump out the window, you have to be truthfully informed of the status of the situation. Are there retained roots of #14 and/or #15, is so why and where are they?.... Is there still an apical lesion in the sinus from prior to the extraction of #14, if so why wasn't it removed?.... Is the bone graft causing further problems, if so should it be removed immediately and how involved will that be? These are the pertinent things you need to be informed about so that you know what is worrisome and what isn't. Those 3 doctors need to collaborate on your case, figure out what is going on and then truthfully inform you of whatever that is. Otherwise, you will keep stressing about possibilities and making assumptions that may or may not have any relevance.

I really cannot stress enough that before you try to get other dentists involved, those 3 practitioners need to collaborate. In most cases, it is the oral surgeon who ends up being the one who presents the outcome of that collaboration and treatment options to you.

Bryanna

Hi Bryanna,
I had similar problems in 2010 and this endodontist did that root canal on #14. I had 5 good years until I had another bout with bronchitis and a sinus infection. That is just how it started in 2010. I am guessing that all of this started in #15 because when the oral surgeon took that one out he said that it was a very bad and old infection that apparently had gone way up. He said that was from a bad root canal where the roots were severed, infected and in my sinus. This endodontist did not do that root canal. In fact, it was a fancy dentist in the wealthy part of town who did it. He was all about the money. I also remember being in a lot of pain after that procedure. It was in the early 2000's. So tomorrow I will talk to the endodontist and hopefully the ENT will call me back. The oral surgeon is out of town. I do feel like nobody cares and they just write me off. This is my life and it has been ruined. I can't go to work until this is better, I am a flight attendant and can't fly like this. I very much feel like I still have infection in that area. I am normally a healthy person and there is no other reason why I can't get rid of this.
Thank you for helping me, I so appreciate it.

Angels,

The infection is the result of both root canaled teeth. One tooth could easily have infected the other and the infection continued to spread from there.

Endodontists are the highest earning dentists on the planet. In the dental profession, they are regarded as the money makers for not just themselves but for the profession as their endodontic treatments provide additional and expensive work for the referring dentists. Especially when you consider that a tooth can be root canaled and re crowned numerous times before it is finally extracted. For this reason, many dentists are reluctant about speaking up about the systemic health risks associated with dead infected teeth. It would be like shooting themselves in the foot.

I hope you can get these doctors on board to figure out exactly what is keeping the infection active and be given options how to take care of it once and for all.

Bryanna

Me too! Just one more question. I have had these bone grafts in since October and November. How hard would it be to take them out?

Angels,

Generally in that time frame, 3-4 months, some integration has taken place but it really depends on the infection. If the grafts are just swimming in mushy infection, then they can be scraped out along with the infection. If the grafts have moved or migrated due to the infection, then a more exploratory surgery is needed to remove as much as possible.

Any oral surgery that you have from this point on in that quadrant of your mouth has got to be done under very sterile conditions and by a highly skilled oral surgeon. However, before any surgery takes place, the sinus involvement needs to be determined first.

Bryanna

Thank you Bryanna! I will keep you posted. I just want healthy teeth! It is weird cause I do take really good care of them. I can't go to sleep with out thoroughly flossing! I always get my cleanings every 6 months too!

I took the CD to the Endodontist and he told me that sometimes a new bone graft can look like roots. The ENT still won't call me back. Something is very wrong and nobody cares. I really don't know where to turn next. This is devastating me both emotionally and financially. It has ruined my life and I am ready to just give up.

Angels,

I am not surprised by what you were told by the Endodontist. He may be "nice" to you and compassionate towards you, but he is very mindful not to risk throwing any of his colleagues under the bus. I know that sounds really terrible but unfortunately it is how things are done.

The endodontist should be able to distinguish the radio graphic difference between retained roots of the tooth and bone graft material. What was his interpretation of the written radiology report? Does he acknowledge the severity of your infection? What did he suggest that you do?

Your ENT doctor is not going to be comfortable dealing with the problem (solely) if he feels it is related to the oral surgery. Again, he is also going to be mindful not to throw anyone under the bus.

This is why they all need to collaborate so that no one is apt to (accidentally) step on anyone elses toes. Have you asked them to collaborate?

Bryanna

The Endodontist told me that I can come in for an X-ray and he will be able to tell from that. He said the pictures are not real clear. I have a copy of them if you want to see them. I am thinking that maybe I should go back to the lab and get a new 3d x ray of those two teeth and then I will have a copy on my own and can bring it to another oral surgeon who isn't worried about throwing anyone under the bus. I don't think anyone realizes how bad the infection really is. At least what I am feeling in my head. I just spent 28 days on Levaquin and today was the last day, I don't feel like the infection is completely gone and I really hope it doesn't get bad again. The ENT still won't call me back so I can't even discuss this with him. I am feeling very lost and unimportant right now. I am in a severe depression which is not my personality at all.

UPDATE since I wrote this earlier
The Endodontist called me and told me that he called the oral surgeons office this morning and got the X-ray that he took on Christmas Eve and also the 3D panoramic image from right after he removed the last tooth. He said there is absolutely not a root there and everything looks great. He could see no infection. I am baffled. I really don't know where to turn next. I think it would be better if they just found something. The not knowing is what is killing me. Do you think it is just healing and going to take a very long time?

Angels,

What is their, endodontist and os, interpretation of the written radiology report?

A 2 dimensional dental xray taken by the endodontist will only show a 2 dimensional view. That is why you had the 3 D done in the first place. Who did the 3D scan.... the oral surgeon? If it is blurry, as the endodontist told you it was, then they need to do it again and do it right this time.

In order for you to proceed with a new oral surgeon you will need to have all of your radiographs and scans both pre and post op the removal of these teeth. You will also need to have copies of all of the chart and surgical notes. Anyone taking on your case will need to see that history of this quadrant of your mouth in order to proceed properly. I think you may have to that if you feel that you are not getting better. You cannot keep going on antibiotics as that puts your systemic health in jeopardy.

Bryanna

Hi Bryanna,
The endo thought that the CT was not clear so he ordered the 3D xray that the Oral Surgeon did after my tooth removal and he told me it was very clear and there is no root. Now I am back to square one. The weird thing is I still feel like there is an infection somewhere. I am thinking maybe on my right side? I am having pain over there and my right cheek is swollen . Is there a panoramic xray that would look at my whole mouth? It is really weird, the last time I had this type of thing I had issues with teeth on both sides. I am starting to feel like a freak. I am so desperate to feel good again.

Hi Bryanna,
I am getting close to 3 months since the last bone graft. My ENT finally called me back and said there is no infection anywhere but where I had the teeth removed is still inflamed, swollen and it is inflaming my sinus area. So I still feel like I have a sinus infection . I actually still feel like I have aninfection like I did before they even took the teeth out. I feel so sick all the time. Is that normal after all this time? Should I go and see if they can do another panoramic 3D image of the area? I am afraid he is just going to say everything is ok when I feel like there is still something wrong. Should I get a second opinion? I am so tired of this, I cry every day all day and I really can't live like this anymore. I really don't know where to turn.

Angels,

The endodontist is clearing his conscience and telling you he sees nothing. The oral surgeon and ENT are both doing the same thing. But are they discussing your situation as a group or are they each coming up with their own opinions?

Given your ongoing physical symptoms and now the right side is inflamed as well .... whether or not there is infection is still unclear. If all was healing well... then why is the right side acting up and why is there still so much inflammation present that you feel like you have a sinus infection? If all is healthy, then why do you feel so ill?

A couple of things come to mind....

1) Sometimes the infection ends up being kept alive by species and strains of bacteria that are resistant to the antibiotic taken.

2) The healing from the extraction of an infected root canaled tooth can be lengthy due to the proliferation of the infection into areas beyond the tooth. Dentists (surgeons) who suspect a systemic infection did or could occur will generally put the patient on IV antibiotics like Levaquin and others. The IV antibiotics bypass the absorption of the tissues or stomach going directly into the blood stream. This route of administration is immediately effective. The oral route first goes through the stomach or small intestine where it is then absorbed into the blood stream. This generally results in a lesser or diluted overall dosage than when given intravenously. However, the prescribed antibiotic irrelevant of the administration route may not be effective in killing off all of the species/strains of bacteria. Even though there was a culture taken, new bacteria could have been forming that did not show up on that particular specimen.

3) Root canaled teeth can cause or contribute to a host of bacterial infections that spread way beyond the offending tooth. It is possible that you have a systemic infection that is not being diagnosed.

These are the issues that need to be taken into consideration by the 3 doctors who have taken a role in your care. There may be no current radio graphic areas visible of infection but that does not rule out a systemic infection. If they cannot give you any reasons why you feel ill and miserable, then they have to put their heads together and figure out a plan to help you. It may behoove you to be referred to an infectious disease specialist.

I know I am repeating myself and I'm sorry about that. But the help has to come from them and their willingness to see this through. If they are not willing to collaborate, then you should consider gathering all of the records and see a new oral surgeon.

I don't doubt that you feel miserable and I feel horrible knowing you are going through this ordeal .... I wish there was something I could do for you.

Bryanna

Hi Bryanna,

Thank you for trying to help me. I don't think any doctors are talking to each other. I keep getting written off like nothing is wrong. Nobody will listen. I still very much feel like there is an infection. It feels like I still have my infected teeth. I am so tired of going to the doctors and have them tell me nothing is wrong. I am not a baby or a hypochondriac, I just want to feel better. It has been 3 months since #14 was taken out and 2 and a half since #15. The site where they were taken out is still red. My sister had the same thing last week and hers is not red like mine is. She went to a different doctor. Should the site still be red? It is also sore.

Angels,

Why aren't the doctors communicating with each other? Have you asked them to do that? Each one of them has treated you regarding this problem... they are obligated to see this through or dismiss you as a patient.

No the sight should not be red... no it should not be sore if it is healing fine.

Is your sister on Levaquin for a severe sinus infection related to severely infected root canaled teeth? Or did she just have a tooth extracted that is not as involved as yours?

You have a severe case that needs to be followed through by your doctors.

Bryanna

Hi Byanna,
No I have not asked the doctors to talk to each other. The problem is they don't think anything is wrong. My sister had a very complicated case. She had surgery from many years ago from a bad root canal from same dentist as the one who did mine. The tooth was infected and also in her sinus and she has substantial bone loss. So hers seemed more complicated, I think. But I am not sure cause she one up's me all the time. She also doesn't work in an airplane so sinus issues are not as much of a problem for her.
The site is definitely red but I am not sure it is swollen. My neck is swollen and my ear is ringing. I feel like I have an infection. I have an appointment with the oral surgeon tomorrow morning. I am sure he will say I am fine. I will leave in tears. I don't know what to do after that.

Angels,

It is up to you to get these doctors to talk to each other. Each one of them has been involved in your case. To keep seeing them as separate entities means to keep going in circles. They need to talk about your case with each other as they all have a different perspective of the situation based on the symptoms you presented with and the complaints you have made. They each have their own findings and opinions to discuss with each other. If they don't want to collaborate with each other, than you know that you have to seek new doctors.

Based on your description, it sounds like your sister had an apicoectomy done years ago that resulted in further infection causing bone loss. Which is pretty typical of maxillary apicoectomies. Did you have apicoectomies with either of your rc teeth? Is your sister seeing an ENT doctor? No doubt you both have serious dental infections. Which one of you has the worst .... who knows. Did the dentist put her on Levaquin too?

It is important to tell the OS about the swollen neck and ringing in the ear. It is up to you to convince him that you are not feeling well and that you do not just want to be pacified with more antibiotics. It's a shame that you have to take all of this initiative, but if your don't, then nothing is going to change.

Bryanna

The only thing I had on those two root canal teeth were root canals. Yes, my sister is seeing an ENT and she is taking amoxicillin . I am not sure how I can get these doctors to talk to,each other because the ENT does not think anything is wrong except a tooth problem. My sinuses are fine. He said I have a little fluid in them but I was doing a sinus wash at the time and that is what he thinks it was caused from. What do I do if I go in the morning and he says nothing is wrong? I won't know where to turn. I am living In a complete nightmare right now.

Angels,


You brought 3 different doctors in to deal with ONE problem that involves teeth, sinus and infection. Irrelevant of what their opinion is... they need to discuss your case with each other to come up with a solution. How do you get them to do that... you say to whomever you want to make the initial call... I have seen an ENT, OS and Endodontist about this area of my mouth. Please contact so and so and so and so as I feel it would behoove me to have a collaborated opinion as to what could be going on and what can be done.

Bryanna

Hi Bryanna,
Just what I thought would happen. He did a 3D, CT xray and everything is fine. I am not sure where to turn now. It must be the Pseudomonas in my nose that is causing all the discomfort.

Angels,

Get a copy of that scan sent to the ENT and also the Endodontist. That's how you get the ball rolling.

What was his reason for .... you feeling so unwell ..... for the swelling in your neck .... for the red and sore area in your mouth? Did he tell you it was from the Pseudomonas in your nose? If so, what was his suggestion on how to deal with that?

Bryanna

No, everyone just throws their hands in the air and says I'm sorry. I am giving up...

Hi Bryanna,
I really can't give up because I feel so awful and can not live like this. Today the site where the teeth were removed has been hurting all day. My left ear is ringing quite loudly, the left side of my neck is swollen and I am still having the sinus/nose issues and my eyes are burning. I feel so sick, like I have an infection. Just like I did before the infected teeth were removed. I went to the oral surgeon and he was so confident that nothing is wrong that he made a copy of the scan on the cd and said take it wherever you want but nothing is there. I am beyond frustrated as something is terribly wrong. I don't just do this for fun. I live in San Diego, CA. I need to find the very best oral surgeon I can find for a second opinion. Do you know how I can find one?

Angels,

I am going to send you a personal message about a dentist in San Diego. Please check your PM.

Bryanna