Tooth #14 concerns, Bryanna can you take a look?
 

Hi Byranna,

I have new concerns since my son has had problems for at least 8-10 years with sinus infections related to dental issues with all of his maxillary molars. He is planning to have a crown (temp) placed on tooth #14 next Mon. However, he also expressed that there is a lot of pain/pressure in that area and that is why he wants to get this taken care of as soon as possible. I think a crown would just make it worse. Since my wife and I already issues over the years with root canals (and I know how you feel about these), this will probably come up as a treatment option in conjunction with a new crown. Can you take a look at a new PA x-ray of this area and of a digital picture about 1 year ago (#15 was already extracted last year) taken just before a sizeable filling was replaced on the distal side of the tooth. There is not much left on that side of the tooth and it almost looks like the distal root may be either cracked or split off from the tooth. There also looks to be infection or a cyst in the sinus. Can you take a look and let me know what you think. Thank you.

Hi Doitashi,

Thanks for posting the xrays.

I will comment on each one:

1) On the pre op dental photograph of tooth #14 just before the filling was placed:

The decay was quite severe extending beyond the gum line, into the pulp and then up into the root surface of the tooth. Extensive drilling was done to attempt to remove the decay but because it went so far below the gum line, there was no clear access to remove it all. The bleeding seen in that photograph is due to two things. One is because a section of the pulp chamber was exposed. Two the dentist drilled away some of the gum tissue attempting to excavate the decay and the gum tissue was inflamed and bleeding. The restoration was a temporary measure to retain this (sick) tooth until infection and further symptoms developed or the ongoing symptoms became too painful. The only treatment options would be to root canal it and attempt to crown it OR extract it. Unfortunately, the rc and/or crown are not going to make this tooth healthy again.

2 and 3)The xrays are taken at slightly different angles which is a good thing because it verifies what is actually present. On the one xray it sort of appears like tooth #14 has an extra root ... which I believe you are making reference to it being a fractured root associated with #14. However, in the other xray it is very clear that the "extra root" is not tooth #14 at all. It is a retained root from tooth #15. Which means the dentist who extracted #15 broke the tooth off at the mesial root and left it in the jaw bone. That root has decay and is infected.

To summarize...

Tooth #14 has pulpal exposure, root decay and infection
Tooth #15 was not completely removed as the decayed and infected mesial root of #15 is still present in the jaw bone.

It would be wise to consult with an oral surgeon to extract tooth #14 and the mesial root of tooth #15. This surgery should be done by an experienced dental surgeon, preferably a maxillofacial oral surgeon. Not a general dentist who has minimum oral surgery experience in comparison to the oral surgeon.

Bryanna

Hi Bryanna,

Thank you for your detailed reply. It is very much appreciated.



UOTE=Bryanna;1227470]Hi Doitashi,Thanks for posting the xrays.

I will comment on each one:

1) On the pre op dental photograph of tooth #14 just before the filling was placed:

The decay was quite severe extending beyond the gum line, into the pulp and then up into the root surface of the tooth. Extensive drilling was done to attempt to remove the decay but because it went so far below the gum line, there was no clear access to remove it all. The bleeding seen in that photograph is due to two things. One is because a section of the pulp chamber was exposed. Two the dentist drilled away some of the gum tissue attempting to excavate the decay and the gum tissue was inflamed and bleeding. The restoration was a temporary measure to retain this (sick) tooth until infection and further symptoms developed or the ongoing symptoms became too painful. The only treatment options would be to root canal it and attempt to crown it OR extract it. Unfortunately, the rc and/or crown are not going to make this tooth healthy again.

2 and 3)The xrays are taken at slightly different angles which is a good thing because it verifies what is actually present. On the one xray it sort of appears like tooth #14 has an extra root ... which I believe you are making reference to it being a fractured root associated with #14. However, in the other xray it is very clear that the "extra root" is not tooth #14 at all. It is a retained root from tooth #15. Which means the dentist who extracted #15 broke the tooth off at the mesial root and left it in the jaw bone. That root has decay and is infected.

To summarize...

Tooth #14 has pulpal exposure, root decay and infection
Tooth #15 was not completely removed as the decayed and infected mesial root of #15 is still present in the jaw bone.

It would be wise to consult with an oral surgeon to extract tooth #14 and the mesial root of tooth #15. This surgery should be done by an experienced dental surgeon, preferably a maxillofacial oral surgeon. Not a general dentist who has minimum oral surgery experience in comparison to the oral surgeon.

Bryanna[/QUOTE]