Root canal complication
 

I'm hoping someone here can answer my questions.

Six months ago, my jaw was fractured pretty badly (I was kicked in the head and jaw by a horse...), and in order to fix it, the oral surgeon put in two titanium plates, which are now there to stay, and arch bars so it could heal. The mental nerve was damaged as well, so I lost all feeling in my lower lip, chin and gums on my lower jaw.

When the arch bars were taken off, my teeth were re-x rayed, and it was determined that two of the screws in the titanium plates were going right through the roots of my teeth (28 and 29). This was something the oral surgeon suspected when he did an X-ray of my teeth a week after surgery, but he told me he wanted to leave it alone for the time being and that we would readdress the issue in a six months to a year, allowing the mental nerve time to heal.

I went to my dentist about a week after the arch bars came off, and he also told me it was in my best interest to leave my mouth alone for as long as possible so it could heal. I had already been told by the oral surgeon that those two teeth would probably need root canals or possibly need to be pulled in the future, and my dentist confirmed that possibility as well.

Thankfully (and unfortunately), I've been slowly getting the feeling back in my lower jaw, but about three weeks ago, those two teeth started throbbing. Chewing is painful, as is brushing my teeth, and flossing is like sticking a fork in my gums. I went back to my dentist, and he and my oral surgeon decided it was time for me to get a consult from an endodontist.

My dentist told me a root canal on my teeth would probably be done in two parts; one from the top and another from the side to get the root underneath the screw. What does that entail exactly? What questions should I ask the endodontist?

I'm starting to think it might be better to just have both teeth pulled, but I also know it's better to keep my teeth for as long as possible. I honestly never thought I'd need a root canal at 29 years old, so I have no idea what to expect. Any feedback would be very appreciated.

Hi Casey,

That was a horrible accident that you had. Was it your own horse? You are lucky to be alive!

To explain what is meant by doing the root canal from the top and then doing it from the side to get to the bottom portion of the tooth......
A typical root canal procedure would be done from the biting surface of each tooth. This done by making an entry hole in the top of each tooth then going into the tooth with various files to remove nerve tissue. Then a surgery called an apicoectomy would be done from the side or bottom of each root. This is done by making an access window through the gum, into the bone and then using similar files to remove nerve tissue from inside of that portion of the tooth. The tip of the root gets cut off and plugged up with a filling material, sometimes a mercury filling material. Then the access window is sutured closed. That's the short version but you can get the idea from that.

I am going to be very honest with you here in case your dentists forgo some of this information because this is a very sticky situation. I'm going to assume that the surgeon did not deliberately drill into those teeth meaning that was done unintentionally. I think he was trying to stay above the mandibular canal to avoid causing permanent nerve damage. However, if he went in blindly that's truly risky or if he was unsure about the placement then he should have evaluated other options. What those options would have been depends on your exact situation.

Here's my feedback on your dental situation:

I think the dentist and oral surgeon do not know what to do at this point because there is no real good answer. This is a true catch 22 situation. They want to prolong doing anything until the bone has healed more but that could result in a major infection. Retaining those teeth with root canals and apicoectomies is at most a very temporary measure and there is no doubt that it will result in chronic inflammation and infection because neither of those procedures can make those teeth healthy again. In fact the bacteria that will be brewing in those teeth and surrounding bone could compromise the integrity of the invasive surgery that you have already had. At the same time extracting those teeth would be complicated and may cause too much trauma to the newly surgerized bone.

It's important for you to understand that "keeping those teeth" for any extended period of time is highly unlikely. The dentists are truly concerned about what the lesser of the evils are at this point of time.

You will need to convey your utmost concerns to these dentists so they plan treatment according to what is most important to you. If you are concerned about the integrity and longevity of the invasive jaw surgery that you have had done as well as the health of your jaw bone... make those things very clear to each dentist above all else. Do not go along with any treatment until you have all 3 dentists on board and in agreement. Dentists tend to take temporary measures if their patients tell them they are most concerned about "retaining" their teeth. They tend to look beyond the temporary when the patient talks about longevity and overall health.

I hope I have given you some helpful information. Please keep in touch here.

Thanks for responding Bryanna:)

It's been a while since I've been on here.

You are correct in the fact that the oral surgeon didn't intend to put screws through my teeth (and it turns out 3 of them have screws in them.). My jaw was fractured in several different ways, and the plates and screws needed to be placed where they were. And there is the fact that I have extraordinarily long roots (which is probably why none of my teeth were knocked out.). I was told that just because it looked like the screws were in the tooth on an X-ray it didn't necessarily mean they were and that a CBCT would determine if they actually were. I definitely have damage to the nerve and still have no feeling in the gums on the lower right side of my jaw.

Since I wrote the last post, I went and saw the endodontist. He did a CT and discovered I had external root resorption on 25 and 26 and had screws in 3 different teeth. He also discovered my jaw did not heal back together in that area either. He started root canals on 25 and 26 and put in 'disinfectant' (which my dentist later told me was a nice way of putting it. I'm still not quite sure what it is other than it kills healthy and unhealthy cells). He then did a root canal on 28, which had a screw in it partially that he was able to root canal around.

I came back a month later and another CT was done that showed I had internal root resorption in #24. He started the root canal on that tooth and 'disinfectant' was put in it as well. I'm supposed to return in a month to determine if that has improved.

I'm having pain in # 29 (it has a screw directly in it), but the endodontist, oral surgeon and my dentist are all hesitant to do anything with it at the present time. Thankfully they are all working together and communicating. The oral surgeon thinks it might be necessary to take the screws out, but doesn't want to touch me at the moment. The endodontist is leaning towards that as well, and also agrees waiting is a good decision.

At this point I'm ready for this all to be over, but I have a feeling this is just the beginning of my dental problems. Do you think it likely I will keep any of these teeth? I think you're right about the trauma to the bone and especially now that we know my jaw hasn't healed. I told all three of them straight up to do what they needed to do. I'm alive; that's all that matters, so I really don't mind if those teeth all need to come out.

Thank you for all of your help.