Wisdom tooth question for Bryanna! Please help
 

Hi Bryanna,

I hope you might be able to advise me as from looking at this site you clearly know your stuff.

I'm 31
Generally good health
Female

Im getting worried - right now it's due to pain in the restored tooth next to wisdom tooth extraction but I'll give you the back history.

Last January I got my first infection around a partially erupted wisdom tooth - it was a doozie. Treated with 400mg metronidazole. I had 3 days worth then it made me violently sick and I was advised to stop taking it any more - I was much better and carried on with life with occasional pain in the area but nothing bad. The tooth was peeking out and tilted back so it was less of a flap as most have and actually a tiny cave - food was apparently getting in all the time. In August it was playing up mildly so I had some doxycycline - apparently that's unusual for teeth but it worked well and I was fully pain free for first time in 2015. All was well - in November it flared up again - gum was mad but infection/pain felt more internal - had amoxicillin which dented the gum infection but I still had pain 'around' wisdom tooth - dentist said it was moving and pressing etc. so arranged to have it out in January. Over christmas I had a squeezing, internal pain seemingly around the wisdom tooth area. It was manageable with pain killers and some days was barely there. But after about 5 weeks of pain and 4 days before that ANOTHER infection occurred - more typical - in the gum which flared up and had pus - this time it was flushed out by emergency dentist and I had 200mg metronidazole which did way more in the 3 days leading up to the extraction than amoxicillin did in 7 days in November - oral surgeon was happy to extract so she removed it - was quite straightforward and came out on one go - she said it was easy because an infection (I don't know which) had dissolved some bone around it (fun) - but she said no sign of infection. Healing has been mostly good (I also had upper on same side out) - pink healthy gums, healing well - been 12 days or so and gums are healing up great. But I have issues with adjacent tooth. It's a root canal tooth and straight after was SUPER sensitive, my bite changed and tapping it with upper tooth was not nice. The sensitivity is gradually improving each day, I wouldn't want to bite hard but it is improving and if you look at the gum around it (and behind it all stitched up post extraction) it is happy. but there is weird pain inside which feels as if it is around the root canal tooth. it can range from feeling like that tooth is being squeezed to shooting pains briefly that shoot downwards. Tenderness, wrenching, not a raw pain and not fully constant, it can come and go - but I am generally aware of something. it doesn't bother me at night, doesn't wake me up and it can feel that if I'm resting my mouth and talking/eating less it's less bothered - if I move my tongue away so it's not resting near the tooth the tooth is mostly happier. Now it could be a latent infection - this scares me I'm terrified I can't be fixed - 2 months of back to back pain of different kinds. Or apparently ligament bruising. Or what? please help me it's got me to breaking point, I'm so terrified this is my life forever. Any advice would be appreciated.

I've just been reading all the info on root canals - do you think best thing is to get this extracted? Sounds like it might be the cause of pain in my mouth since November (of course wisdom tooth and peritonitis too) but now they're gone all pain seems local to around the root canal tooth :(

Hi kgizmo,

Thank you offering the history of the wisdom tooth and describing the pain with the root canaled tooth.

First regarding the wisdom tooth....
Oral infections do not often have symptoms that correlate with the severity of the infection. So basically, you had a long term infection associated with the wisdom tooth that was so severe it caused some of the jaw bone to deteriorate. Although this bone loss may have made the extraction a bit "easier", it only did so because the tooth was now not covered by the bone that it should have been and that area of tooth was sitting in mushy infected tissue. All of the antibiotics that you took prior to the extraction had only served to temporarily lessen the virulence and inflammation of the infection. In actuality the infection was still brewing and spreading. So hopefully the oral surgeon scraped the extraction site and the bone in that area clean after she removed the tooth.

Regarding the root canaled molar... All root canaled teeth harbor infectious bacteria inside of the tiny canals called dentin tubules. There is no access to these canals with any type of instrument, laser, disinfectants or medications. So every root canaled tooth is chronically infected to some degree. The rc procedure is not done to cure the infection, it is done to retain an unhealthy tooth for an uncertain amount of time. Irrelevant of symptoms with this tooth, the infection is still present. Frequently the infection does not show on a dental xray until it has proliferated beyond the dentin tubules and gone further into the tooth and or the jaw bone.

With that said, because of the intricate connection between the adjacent teeth in any quadrant, the infection in the wisdom tooth site has likely caused further inflammation in the adjacent rc molar and the symptoms of the chronic infection in this tooth is now becoming evident. If the wisdom tooth site is no longer infected and you avoid using this rc tooth, the symptoms may (or may not) calm down for awhile but that does not mean the tooth became suddenly healthy. It just means that the dominant inflammation (infected wisdom tooth) has lessened with the extraction. However the bacteria from this rc tooth will continue to progress and eventually it will look for a place to drain into.

In your case, I doubt that your symptoms with the rc tooth are strongly related to ligament bruising. It more likely to be what I have explained above.

The oral surgeon has an xray of this rc molar.... it would a good idea to take a new one to compare it. Although nothing different may show unless the bacteria has spread from the dentin tubules.

The only way to cure an infected tooth is to have it extracted. I know that sounds awful but the anatomy of our teeth does not allow for anything to get into those tiny canals to remove the necrotic nerve tissue.

Bryanna

Hi Bryanna,

Thanks for replying - it's calmed a lot today so I'm hopefully the immediate issue is lessening - I went to my dentist and he took an x ray - it's looking ok in there - not like I was expecting - great dark masses of dying bone - and the area where wisdom tooth was looks like it's beginning to fill in slightly. I'm with you - I think ultimately the root canal will have to go soon as if this is the case that they are toxic there's no point keeping it. Comparing the new x ray to the old one I can see the teeth (the 2nd molar and Rc) have already spaced out a bit. I'll try attach today's x - ray and I'm seeing oral surgeon tomorrow. Hopefully things will improve - the gum on top is looking pink and happy. I hope I can be ok - this stuff is scary

Hi kgizmo,

Thanks for posting the xray. It does not show the extraction site in it's entirety and that area is a bit blurry. But that site seems to be okay.

The root canaled molar clearly shows a widened periodontal ligament on the mesial root (the left root looking straight at the xray). This can be caused by the unhealthy and non vital status of this tooth and/or due to the extraction of the adjacent tooth allowing this tooth to move back out of it's original position. It also looks like you may have deterioration starting in the tooth in the area called the furcation. The furcation is located at the center of the tooth where the top of the root system joins together. It appears as a black dot or mark on the xray at that junction. This area is prone to deterioration as it is a very weak area of root canaled molars.

I am glad that your symptoms have calmed down. But I agree that the rc tooth is on borrowed time.

Bryanna