#30 Tooth Abscess? (with 3D scan) Bryanna can you please take a look?
 

Hi Bryanna,

Can you please take a look at a recent 3D scan of the LR jawbone (for my wife)? Planning to get #30 extracted very soon, long time chronic but worsening symptoms of what appears to be a bad tooth abscess along with severe bone loss across the bottom right at least 30-32 area? PA and digital x-rays over the past 1-2 years included. #29 and #31 extracted last July. Major MODFL amalgam filling (second filling at the time) with buildup and 5 pins on #30 back in 1995 (mentioned this tooth probably needed RCT then!). On top of this, first crown of #30 in 2005 then again in 2008, and 2015. The digital picture just before the last crown placed in Aug 2015 appears to show a significant crack across the top surface of what remains of the tooth?. Can you take a look at these images and let me know what you see and think. Thanks.

Hi Doitashi,

Thanks for attaching the xrays, photo and scan of her right side.

The scan shows extensive bone loss in her lower right quadrant from #29 site all the way back beyond #32 site as well as other areas on her right upper and lower anterior. This view is only of her right but based on what is seen there, her left side may be in similar condition.

Tooth #30 has been in poor condition since at least 1995 based on the fact that she had an MODFL amalgam placed there at that time. That size filling indicates that there was likley massive decay and very little actual tooth structure left to that tooth at that time. Each time the dentist treated that tooth thereafter ... 3 times with 3 new crowns ... more tooth structure was removed. The photo clearly shows that the crown portion of the tooth, the part of a natural tooth that is seen above the gum line, is completely gone. The xray from Oct 2014 shows bone changes and bone loss in the furcation area of tooth #30. This is the area in between the roots. The xray from June 2015 shows progression in the bone changes and bone loss in that same area.

The crack line that you are referring to in the photo of tooth #30 is actually in an area of the division of her root system. That is how much protective tooth structure above the gum line is actually missing. The dentist could most likely and easily poke an explorer instrument right through that crack.

This extraction should be done by an oral surgeon, not a general dentist. This tooth is going to be a bit tricky to remove and will likely require an incision to gain access to the root system.

Is or has your wife been on any type of bone building drugs? For example Bisphosphonate type drugs? Here's a little blib on current information about those drugs which you can explore further if you chose to:

Pharmacology of bisphosphonates

The reason I ask about the drugs is because your wife, based on your posts here, has a lot of dental problems as well as substantial loss of jaw bone in areas of her extractions as seen on the scan. Those drugs contribute to dental problems and loss of jaw bone especially in people who have oral infections and/or tooth extractions.

Let me reiterate that tooth #30 when removed should be by an oral surgeon, not a general dentist. She may also opt to have some twilight sedation for that surgery as it may be a bit difficult to be awake for it. Please discuss the sedation with the oral surgeon at the surgical consultation.

I hope this information was helpful. Let us know how things go.

Thank you for the detailed reply Bryanna.