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tooth extraction when root is in sinus cavity

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Unread 06-23-2011, 12:01 PM   #81
Sr_goodman
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Confused tooth root in sinus cavity

i hada tooth pulled about a month ago and the rooh wa in my sinus city. whe they pulled it it was absessed and my sinus membrane ruptured. i was wondering if it is normal for them to pull an absessed tooth? also i he had alot of swelling in the area and in cheek, with a burning sensasion all over my face. is that normal as well?
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Unread 06-24-2011, 05:10 PM   #82
Bryanna
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Abcessed teeth should always be extracted. So that is good that you had that done. The sinus membrane was probably perforated from the infection and upon removing the tooth, the perforation became larger. Did your dentist give you specific instructions after he removed the tooth? Things like rinse with warm salt water several times a day for a couple of weeks.... do not blow your nose for several days... do not use any mouthwash until the hole is completely closed...no smoking or drinking alcohol as both of these things will prevent the area from healing closed... no drinking through a straw for several weeks....

Swelling would be normal after the removal of an abcessed tooth. The burning sensation could be unrelated or it could have been a sensitivity to the anesthetic that was used. Is there still swelling and/or burning in your face?

Bryanna



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Originally Posted by Sr_goodman View Post
i hada tooth pulled about a month ago and the rooh wa in my sinus city. whe they pulled it it was absessed and my sinus membrane ruptured. i was wondering if it is normal for them to pull an absessed tooth? also i he had alot of swelling in the area and in cheek, with a burning sensasion all over my face. is that normal as well?
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Unread 07-10-2011, 02:07 PM   #83
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Bryanna
I am a 41 year old male with a bridge over 1 extracted tooth from 2 years ago. The bridge came off about 6 months ago while flossing under it. It was reattached by my dentist. Been experiencing pain in my front support tooth area for several months, about 2 weeks ago the pain got out of hand. Went to my dentist and was referred me to an Endodontic who performed a root canal on my tooth. He spoke in a manner in which I understood what was going to happen and I am very pleased with his professional mannerism along with his staff.

The pain and facial swelling went away and yet I still had some tender issues in my upper gum area. I was prescribed Pen VK as well as an 800mg ibuprofen and 1000mg Tylenol rotating every 3 hours. The last two days is I have noticed some discomfort while biting on my back support tooth. Today while washing my face I noticed some more pain in my sinus area down to the tooth. This is what had led me to find this thread while searching for an answer on sinus/teeth since I have had two sinus surgeries in the past.

Here is what was sent to my dentist:

Today we had the pleasure of meeting and evaluating XXXX for endodontic concerns associated with his upper right bridge in the #3-#5 position. After taking several angled PA’s, a BW, and performing all tests #5 renders of DX of necrotic/SAP. #3 IS tender to percuss and bite on but responds to cold testing within normal. We opted to treat only #5 today.

Under 2 carts of lido w/1:100000epi we opened through a porcelain abutment to discover a two canalled necrotic system. We shaped the P to 18mms w/F3 and the B to 19mms w/F3. The two join as one near the apical 4 mms. We used copious irrigation with endoactivation dried and placed CaOH2 into the system in order to disinfect over the next 30 days.

My question is now that the swelling and tenderness is increasing would the right course be to look at extracting and if so what does that leave for my back support tooth once the bridge is removed. I have spent over $2000 on this one area since my baby tooth extraction. Your response based on what I have laid out for you would be appreciated.
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Unread 07-11-2011, 12:37 PM   #84
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Hi netdude,

According to your post, the root canal is incomplete on tooth #5. The dentist has debrided and widened the visible canals and placed calcium hydroxide inside these spaces. The next visit would be to remove the CaOH2 and melt a rubberized material containing barium into these spaces. This material is called gutta percha ........and just for your information it is highly toxic and has a whole list of other negative issues. I'm giving you that information as a start to help you become better informed when making your decision.

It is not unusual for you to have continued pain in a non vital tooth simply because the bacteria from the tooth has proliferated into the bone which causes a referred pain that can feel like it's coming from the tooth and/or surrounding area... including the sinuses. The fact that the root canal is only partially done, is irrelevant. The bacteria will still be present inside of the tiny canals that are unaccessible and will continue to proliferate into the bone. Again, offering information to help you become better informed.

From your post, it sounds like tooth #3 may be in jeopardy also but it may just be tender from the inflammation from #5. IF the abutment crown on #3 fits well and #3 is healthy radiographically, perhaps the healthiest long term treatment option would be to have the dentist cut the bridge at the junction between tooth #3 and 4, leaving the abutment crown on tooth #3. Extract tooth #5 and allow the site to heal for several months, then re-evaluate the health and fit of the existing crown on tooth #3 at that time. IF #3 is ok, no infection, no swelling, crown fits well... then place an implant in #4 and 5 site
providing there is ample healthy bone and no sinus interference to functionally hold 2 implants. You may also have to put a new crown on #3.... all dependent on the DX at the re evaluation.

If you are missing teeth on the other side of your upper arch... then you may be a candidate for a removable partial denture to replace all of your missing upper teeth.

I know you have spent a lot of money on this area of your mouth. But be aware that you will continue to spend a lot more in trying to retain this tooth because the infection cannot be eradicated by completing the root canal or by taking antibiotics simply because of the bacteria is forever present in the microscopic canals.

Since the root canal was just recently performed... perhaps the endodontist would be willing to reimburse you a portion of his fee if you were to decide to have tooth #5 removed.

Please let us know how things are going......

Bryanna


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Originally Posted by netdude View Post
Bryanna
I am a 41 year old male with a bridge over 1 extracted tooth from 2 years ago. The bridge came off about 6 months ago while flossing under it. It was reattached by my dentist. Been experiencing pain in my front support tooth area for several months, about 2 weeks ago the pain got out of hand. Went to my dentist and was referred me to an Endodontic who performed a root canal on my tooth. He spoke in a manner in which I understood what was going to happen and I am very pleased with his professional mannerism along with his staff.

The pain and facial swelling went away and yet I still had some tender issues in my upper gum area. I was prescribed Pen VK as well as an 800mg ibuprofen and 1000mg Tylenol rotating every 3 hours. The last two days is I have noticed some discomfort while biting on my back support tooth. Today while washing my face I noticed some more pain in my sinus area down to the tooth. This is what had led me to find this thread while searching for an answer on sinus/teeth since I have had two sinus surgeries in the past.

Here is what was sent to my dentist:

Today we had the pleasure of meeting and evaluating XXXX for endodontic concerns associated with his upper right bridge in the #3-#5 position. After taking several angled PA’s, a BW, and performing all tests #5 renders of DX of necrotic/SAP. #3 IS tender to percuss and bite on but responds to cold testing within normal. We opted to treat only #5 today.

Under 2 carts of lido w/1:100000epi we opened through a porcelain abutment to discover a two canalled necrotic system. We shaped the P to 18mms w/F3 and the B to 19mms w/F3. The two join as one near the apical 4 mms. We used copious irrigation with endoactivation dried and placed CaOH2 into the system in order to disinfect over the next 30 days.

My question is now that the swelling and tenderness is increasing would the right course be to look at extracting and if so what does that leave for my back support tooth once the bridge is removed. I have spent over $2000 on this one area since my baby tooth extraction. Your response based on what I have laid out for you would be appreciated.
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Unread 07-11-2011, 05:36 PM   #85
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Bryanna

Thank you for your prompt reply. The Dr. assist called today (third follow up call)to see how I was doing. I had mentioned the increase in tenderness in my sinus cavity down to the tooth as well as the issue with the back supporting tooth. As you had mentioned since the root canal is only partially done they had planned on sealing it on my next appt on July 27th.

After taking my information she called back to say that they will start another round of Pen VK as well as refill # 5 with another medicine. In addition since #3 was suspect they are planning on doing a root canal on it at the same time on my next appt.

In doing some research I found some information on a Apicoectomy procedure but not sure if I am playing arm chair dentist or not. But since I am writing the checks I want to find out all my options. I will ask him his thoughts if this is would be a viable solution to this problem.

If this does not solve the issue based on what you have indicated with the bacteria in the bone I will opt for the extraction and partial denture. According to what the Dr said and what I saw I have great bone support. So extraction will be the final straw. Hoping with combo of meds, refill of 5 and root on 3 solves this.

Again I appreciate your time and insight, will keep you up to date should anything change for the good or bad.
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Unread 07-11-2011, 08:02 PM   #86
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Hi netdude,

I figured this was what your dentist was going to recommend but I was hoping he wouldn't have. Your situation is not at all unusual in that you are getting repeated doses of antibiotics which can only temporarily reduce the inflammation; retreatment of the same tooth with a "special" (bogus) medication that does nothing to permanently kill off any of the bacteria and they might as well root canal tooth #3 because then they can sell you a new three unit bridge that will be anchored by two chronically infected teeth. The integrity of your existing bridge has already been compromised by drilling through it to do the root canal on #5... drilling through it again to do #3 will only compromise it further. The lifespan of these teeth and the new bridge is minimal if that. I will take this further by telling you that when you continue to have pain, swelling, and develop sinus issues.... etc.... you will be told that you need to have both teeth retreated and another new bridge. Your dentist will put this additional treatment off as long as he and you can.......

An apicoectomy is a a surgical procedure in which they flap back a large portion of the gum tissue above the tooth; cut or drill a <window> into the jawbone; cut off the apex (tip of the root) all in an effort to gain access from the root of the tooth down. Small files are used to debride the visible portions of the inside of the tooth leaving the microscopic canals loaded with bacteria just as in the traditional root canal procedure. The large canals and root opening are somewhat sealed with a rubberized material containing barium and the hole in the jawbone is plugged with a chunk of mercury filling material. This procedure does absolutely nothing to eliminate the infection that is lodged inside the tiny canals. Because of the injury to the jawbone, the irritation from the mercury and the proliferating bacteria from the tooth, this procedure will cause extensive bone deterioration jeopardizing the likelihood of placing a successful implant in the future. It would also compromise the fit of a removable partial denture due to the loss of the bony ridge that is needed to hold the appliance in comfortably. I'm pretty sure your dentist will not openly inform you of any of these things. So... ask him about all of these things and hopefully he will be truthful with you and not diminish or misconstrue the reality of this procedure.

If this were me, I would be very concerned about the systemic consequences associated with infected teeth and the sinus issues that can easily occur from proliferated infection from upper teeth.

I hope you are able to become well informed, not just by me, but by your dentist so that you can make a knowledgeable decision that you feel is in your best interest.

Please do keep us posted...
Bryanna









Quote:
Originally Posted by netdude View Post
Bryanna

Thank you for your prompt reply. The Dr. assist called today (third follow up call)to see how I was doing. I had mentioned the increase in tenderness in my sinus cavity down to the tooth as well as the issue with the back supporting tooth. As you had mentioned since the root canal is only partially done they had planned on sealing it on my next appt on July 27th.

After taking my information she called back to say that they will start another round of Pen VK as well as refill # 5 with another medicine. In addition since #3 was suspect they are planning on doing a root canal on it at the same time on my next appt.

In doing some research I found some information on a Apicoectomy procedure but not sure if I am playing arm chair dentist or not. But since I am writing the checks I want to find out all my options. I will ask him his thoughts if this is would be a viable solution to this problem.

If this does not solve the issue based on what you have indicated with the bacteria in the bone I will opt for the extraction and partial denture. According to what the Dr said and what I saw I have great bone support. So extraction will be the final straw. Hoping with combo of meds, refill of 5 and root on 3 solves this.

Again I appreciate your time and insight, will keep you up to date should anything change for the good or bad.
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Unread 07-31-2011, 03:02 PM   #87
netdude
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Bryanna

Here is a update on my condition. Went to the doctor on the 22nd to discuss my treatment options before my 27th appt. It was determined that my #3 tooth was in no danger and that a root canal would not be necessary. It responded very well to a cold test and the xrays did not show any issues. My main issue was in my bite. it would cause me very much discomfort and it was determined that it needed to be tweaked. It was causing pressure on #3 and #5 at the same time which was causing discomfort in the gum area.

On my 27th appt the root canal was completed and when he viewed the upper part of the canal it was dry indicating that there was no bacterial infection. He mentioned before the procedure if it was wet that that would be a cause of concern. So he finished the root canal and adjusted my bit on the bridge. After the adjustment I can say that the discomfort I was feeling is much better and I am not hitting that bridge every time I eat. I need to follow up with my normal dentist for him to seal the area of number 3. Plan to do that in the next week.

I am thankful for your feedback and your honest answers. It allowed me to go into the appt on the 22nd with what are my options and to discuss what we need to do to take care of this. I will continue to watch this area and if anything develops will consult again.

Thank you again,
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Unread 10-29-2011, 09:58 AM   #88
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This thread has been very helpful to me, i wish i had uncov ered it years ago.

I have constant tooth pain, have been implored for YEARS to "save the tooth". Perhaps I am a bit cynical, but 25 years of constant pain (teeth and sinus) in an expensive and ultimately futile effort to save brittle damaged teeth... well... dentists do their patients a huge disservice when they refuse to listen to them.

Every tooth i have had crowned, "had to have" a root canal. The root canal helped relieve pain for maybe 30 days. Ultimately, all of these teeth were removed, but only after a lot of arguing with the periodontist, who did not want to remove them. After each one was removed, the degree of the problem was apparent, and I was told "you made the right decision" post-removal.

The maxillary teeth were grown into my sinuses. After my procedure, my periodontist told me, unsolicited, that people with my problem typically have sinus pain relieved once the infected tooth is out. I feel 100% better having that tooth out, even with the post-procedural pain, it feels BETTER.

My periodontist is almost pain free! a very good technician, but I wish she would have removed the tooth when I asked her to do it 3 years ago, instead of costing me a fortune in root canal and restoration. On the plus side, I refused to have it permanently crowned until I knew it was going to be a good solution, so I saved myself another $1,000 right there.

"Save the tooth" is NOT always in a patients best interest, healthwise or financially.
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Unread 10-29-2011, 12:17 PM   #89
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I am terrified of monday. I have three loose teeth. All will have to come out as there is no exta money with medicare/medicaid for any dental work. I already have a fear of the dentist and I feel sick right now with worry. I am not sure how to handle this. I have known about the problem for years on this side of my mouth, but I had so many other medical problems and 8 surgeries, that there was no opportunity to even get checked out. Now I am in trouble, and face this issue. What can I say to the dentist so he will be gentle with me? I am afraid I will loose my stomach. Any advise would be welcome. I am so afraid. ginnie
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Unread 10-29-2011, 01:59 PM   #90
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Hi ktag.

Thank you so much for posting your experience!!! It is unfortunately true that patients concerns often go unheard or they are ignorantly dismissed. So many people go through so much unnecessary and expensive dentistry on infected teeth only to end up removing them all.

Thank you for speaking up and sharing your personal dental history here!! I hope others are reading it and identifying with you!

Bryanna


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Originally Posted by ktag View Post
This thread has been very helpful to me, i wish i had uncov ered it years ago.

I have constant tooth pain, have been implored for YEARS to "save the tooth". Perhaps I am a bit cynical, but 25 years of constant pain (teeth and sinus) in an expensive and ultimately futile effort to save brittle damaged teeth... well... dentists do their patients a huge disservice when they refuse to listen to them.

Every tooth i have had crowned, "had to have" a root canal. The root canal helped relieve pain for maybe 30 days. Ultimately, all of these teeth were removed, but only after a lot of arguing with the periodontist, who did not want to remove them. After each one was removed, the degree of the problem was apparent, and I was told "you made the right decision" post-removal.

The maxillary teeth were grown into my sinuses. After my procedure, my periodontist told me, unsolicited, that people with my problem typically have sinus pain relieved once the infected tooth is out. I feel 100% better having that tooth out, even with the post-procedural pain, it feels BETTER.

My periodontist is almost pain free! a very good technician, but I wish she would have removed the tooth when I asked her to do it 3 years ago, instead of costing me a fortune in root canal and restoration. On the plus side, I refused to have it permanently crowned until I knew it was going to be a good solution, so I saved myself another $1,000 right there.

"Save the tooth" is NOT always in a patients best interest, healthwise or financially.
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