Question regarding dental infection in bone

[Marcy Dorfman]

Hi there. I've recently had two failed root canals. An abcess has resulted and the dentist (in corroboration with an endodontist in the practice) has said they think the infection has gone into the bone. They are now recommending that I see an oral surgeon as the problem is beyond the scope of their practice. Just wondering what the prognosis is for this? Is it a good idea to lose the tooth (ie, to have the tooth extracted?). Any other advice on what to expect? Thanks for any help!

[Bryanna]

Hi Marcy,

FYI... I am a dental chair-side assistant with 30+ yrs experience and I can answer your question.

All root canaled teeth are infected to some degree because the bacteria that remains in the microscopic canals before, during and after the root canal procedure can never be removed. The infection eventually overwhelms the tooth and moves into the bone causing an abscess. This scenario is commonly seen every day in dental offices. The only way to cure the problem is to remove the tooth/teeth because that is the chronic source of the infection.

Bone infection can be a serious health concern and should be taken care of promptly after the diagnosis. Also, the longer the infection is present, the more the bone will deteriorate which could limit the replacement options for these teeth.

The sooner the infected teeth are removed, the better the long term prognosis. Losing our teeth is never easy but it's really a matter of health and it's definitely healthier to remove them when they are infected rather than retain them.

Review your replacement options with your dentist prior to having the teeth extracted so that you and he can decide on a mutually agreeable treatment plan.

I hope this information is helpful and I wish you well... let us know how you're doing

Bryanna

Originally Posted by Marcy Dorfman

Hi there. I've recently had two failed root canals. An abcess has resulted and the dentist (in corroboration with an endodontist in the practice) has said they think the infection has gone into the bone. They are now recommending that I see an oral surgeon as the problem is beyond the scope of their practice. Just wondering what the prognosis is for this? Is it a good idea to lose the tooth (ie, to have the tooth extracted?). Any other advice on what to expect? Thanks for any help!

[Marcy Dorfman]

Hi Bryanna, Many thanks for your reply - I'm grateful for the information. I realise that everyone's anatomy is different, but would you know anything about how best to treat the infection once the infected tooth is extracted?
Also - as this is quite an important tooth (a molar, lower right) - I'm assuming I should be looking into having an implant - is this correct? But, obviously, I will need to get clear of the infection first. Sorry about all these questions, but I respect your knowledge on the subject, Bryanna. Many thanks!

[Bryanna]

Hi Marcy,

It is important that the oral surgery be informed that this tooth has been root canaled twice..... also informing him of when the first one was done. This gives him an idea of how long the infection has been present.

The oral surgeon will remove the tooth along with the periodontal ligament as well as any unhealthy bone that he can see or scrape away easily. He may or may not place some bone graft material inside the socket at that time depending on the health of the bone. Antibiotics may be prescribed and it is up to your immune system to deal with the residual bacteria. Just be sure to follow the post operative instructions to the "T" and eat as healthy as possible.

Dental implants are a great tooth replacement providing they are placed in healthy bone. Otherwise, they can be a chronic problem with the risk of failure fairly high. So yes, the area would have to be clear of infection prior to placing the implant. This would be done with periodic xrays to monitor the health of the bone.

Your questions are always welcome..... that's why I'm here

Bryanna

Originally Posted by Marcy Dorfman

Hi Bryanna, Many thanks for your reply - I'm grateful for the information. I realise that everyone's anatomy is different, but would you know anything about how best to treat the infection once the infected tooth is extracted?
Also - as this is quite an important tooth (a molar, lower right) - I'm assuming I should be looking into having an implant - is this correct? But, obviously, I will need to get clear of the infection first. Sorry about all these questions, but I respect your knowledge on the subject, Bryanna. Many thanks!

[Marcy Dorfman]

Hi Bryanna, Hope you are well. Well, I have seen my dentist again, Bryanna, and he is recommending that I have an apisectomy. Based on what you have written previously, I'm assuming that all of the difficulties you have already identified would apply? (i.e., that the infection remains unless one loses the tooth). In any case, the appointment has not been scheduled yet, and I am taking a few days to do some research. From what I've seen online, the success rate looks to be about 50% at best. Just wondering what your opinion would be, Bryanna. Many thanks!

[Bryanna]

Hi Marcy,

The procedure you are referring to is called an Apicoectomy which is a surgical root canal procedure. It is the removal of the apical area of the tooth.... meaning the tip of the root is cut off and instruments are driven down into the tooth as opposed to being driven up into the tooth from the biting surface during a non surgical root canal. The visual cyst and diseased tissue and bone are scraped out (as they would be during an extraction) ... the interior of the tooth is filled with a rubberized material just like you already have.... and the open root is filled with a mercury or some other toxic material which becomes embedded in the bone and the covering gum tissue.

This invasive procedure serves the same purpose as the other 2 root canals that you have had on this tooth. There is still no access to the millions of microscopic canals that harbor infectious tissue which is what renders this tooth chronically infected. So unfortunately there is nothing to be gained by having this procedure done. Your dentist is well aware that there is also a high probability of irreversible bone damage associated with an apicoectomy because the procedure is very traumatic to the bone...... the root filling material is a constant irritant to the bone and covering gum tissue.....there is extensive inflammation ....and the infection will still be brewing making it impossible for the area to heal properly. The longer this tooth is present the more extensive the damage. So when this tooth is finally extracted, replacement of it will be limited because the bone will be unhealthy and inadequate for a dental implant.

One important thing to keep in mind is.... how is this chronically infected tooth affecting your systemic health? The mouth and the body are intricately connected.... it is very risky to hold onto an infected tooth and your dentists should be informing you of this information.

I hope I have be clear in my response to you. My intention is to inform you from a health perspective and not just a dental one.

Keep in touch.......
Bryanna

Originally Posted by Marcy Dorfman

Hi Bryanna, Hope you are well. Well, I have seen my dentist again, Bryanna, and he is recommending that I have an apisectomy. Based on what you have written previously, I'm assuming that all of the difficulties you have already identified would apply? (i.e., that the infection remains unless one loses the tooth). In any case, the appointment has not been scheduled yet, and I am taking a few days to do some research. From what I've seen online, the success rate looks to be about 50% at best. Just wondering what your opinion would be, Bryanna. Many thanks!

[Marcy Dorfman]

Hi Bryanna, Thank you for your previous reply. I am back again, having seen the oral surgeon now. The oral surgeon took a very in-depth x-ray (camera went all around my head), and has concluded that an Apicoectomy would be ineffective in my case (too much bone loss!), so we are going ahead with the extraction. Unfortunately, when this tooth is gone, I will no longer have any molars on my lower right! I understand that my options are either: (1) an implant (...and only if bone loss is not too great...I need to get the opinion of an implant specialist for this), or a small metal denture which will be fitted to the gap. Wondering if you had any opinion on these, Bryanna...? Also, is there any way I can boost my immune system in preparation for the extraction, and/or the recovery period after? I'm a bit worried about the whole thing...! Many thanks...your advice has been invaluable! (By the way, I don't know if I mentioned...I am American, but live in the UK...I don't know if they do things entirely different here compared to the US!)

Kind regards,

Marcy

Originally Posted by Bryanna

Hi Marcy,

The procedure you are referring to is called an Apicoectomy which is a surgical root canal procedure. It is the removal of the apical area of the tooth.... meaning the tip of the root is cut off and instruments are driven down into the tooth as opposed to being driven up into the tooth from the biting surface during a non surgical root canal. The visual cyst and diseased tissue and bone are scraped out (as they would be during an extraction) ... the interior of the tooth is filled with a rubberized material just like you already have.... and the open root is filled with a mercury or some other toxic material which becomes embedded in the bone and the covering gum tissue.

This invasive procedure serves the same purpose as the other 2 root canals that you have had on this tooth. There is still no access to the millions of microscopic canals that harbor infectious tissue which is what renders this tooth chronically infected. So unfortunately there is nothing to be gained by having this procedure done. Your dentist is well aware that there is also a high probability of irreversible bone damage associated with an apicoectomy because the procedure is very traumatic to the bone...... the root filling material is a constant irritant to the bone and covering gum tissue.....there is extensive inflammation ....and the infection will still be brewing making it impossible for the area to heal properly. The longer this tooth is present the more extensive the damage. So when this tooth is finally extracted, replacement of it will be limited because the bone will be unhealthy and inadequate for a dental implant.

One important thing to keep in mind is.... how is this chronically infected tooth affecting your systemic health? The mouth and the body are intricately connected.... it is very risky to hold onto an infected tooth and your dentists should be informing you of this information.

I hope I have be clear in my response to you. My intention is to inform you from a health perspective and not just a dental one.

Keep in touch.......
Bryanna

[Bryanna]

Hi Marcy,

The xray that the oral surgeon took is called a panoramic film or panorex for short. Most surgeons, some general dentists, take this type of xray routinely because it shows a variety of areas at one time .... the upper and lower teeth, jaw bone, jaw joints, a portion of the nasal cavity, and more.

I'm glad he opted to not do the apicoectomy. That procedure is barbaric and it does not cure the problem. The extraction is the only way to remove the infection as it removes the source of the infection... the tooth!

With regard to having an implant in that area.... dental implants require healthy, substantial bone to be successful. Anything less than that is very risky for failure. In your case, the real complication is not just the loss of bone but the long term infection in the bone. This means that the remaining bone may not be healthy enough to handle an implant.

The replacement alternative is a partial denture. If you are missing any other teeth on the lower arch that have not already been replaced, the partial will have teeth on it to fill in those gaps. If you are just missing teeth only on the lower right, then you could have a unilateral partial denture...which looks like this....
http://en.wikipedia.org/wiki/Removable_partial_denture

My opinion of replacement of this tooth since you asked......
I am not a proponent of dental implants replacing teeth that have had a long standing infection because the health of the bone is questionable even after the extraction. The removable partial denture can be made to fit precisely so that it is comfortable making it a reasonable replacement option.

There definitely are ways to build your immune system both pre and post op surgery. Keep in mind that processed foods, those covered in pesticides and chemicals will slow down the immune response.

#1... Eat nutritiously, all organic if possible. Variety of fruits and veggies. Limit processed foods as the nutritional value is not up to par in most cases.

#2... Consume little to no sugar. Avoid "diet" labeled foods or drinks. Use stevia or xylitol as a sweetener.

#3... Drink several glasses of filtered water throughout the day to keep hydrated and continuously remove toxins. Drink green or white tea... kombucha tea is awesome for the immune system in many ways and it tastes great!

#4... Take a probiotic supplement daily to encourage the growth of healthy intestinal bacteria.

#5... Make healthy soups with organic, free range chicken/vegetable broth and add a variety of vegetables... chicken, beef... to your liking. These are great post op oral surgery.

#6... Supplementing with vitamin C also a good immune booster and great for healing from surgery. Just avoid vitamin C for 24 hours prior to surgery as it could interfere with the anesthetic. But definitely resume taking it right after the surgery.

#7... The B complex also helpful....

Those are just a few things that would be recommended for most people. If you have certain diet restrictions or take medications, you'll have to be mindful of consuming anything that would be contraindicated.

I know this is a bit scary but you will feel so much better when this tooth is removed ...and your body.... will thank you :>

Keep in touch....feel free to ask questions or just vent if you want to!!
Bryanna

Originally Posted by Marcy Dorfman

Hi Bryanna, Thank you for your previous reply. I am back again, having seen the oral surgeon now. The oral surgeon took a very in-depth x-ray (camera went all around my head), and has concluded that an Apicoectomy would be ineffective in my case (too much bone loss!), so we are going ahead with the extraction. Unfortunately, when this tooth is gone, I will no longer have any molars on my lower right! I understand that my options are either: (1) an implant (...and only if bone loss is not too great...I need to get the opinion of an implant specialist for this), or a small metal denture which will be fitted to the gap. Wondering if you had any opinion on these, Bryanna...? Also, is there any way I can boost my immune system in preparation for the extraction, and/or the recovery period after? I'm a bit worried about the whole thing...! Many thanks...your advice has been invaluable! (By the way, I don't know if I mentioned...I am American, but live in the UK...I don't know if they do things entirely different here compared to the US!)

Kind regards,

Marcy

[Marcy Dorfman]

Hi Bryanna

First of all, many thanks for all of the excellent advice you have given me... as my situation has developed, I can't tell you how comforting it's been to refer to this forum!

Well, Bryanna, I am now scheduled to have the extraction on Monday! My normal dentist said he was confident he could do the extraction, but I have been reading the forum tonight, and noticed you have said that - if there is infection (i.e., an abcess) - than an oral surgeon should really do the extraction. Does this matter significantly? (I ask this because to see an oral sugeon on the NHS may take 3-4 months, whereas my private dentist can do it next week - after all I've read, I'm keen to get the thing out!)

Also, Bryanna, following on from discussions with my dentist, the oral sugeon and what I have read here, it looks like I would be a better candidate for a small denture as opposed to an implant. I'm just wondering how long it usually takes following the extraction before the partial can be fitted?

Thanks again, Bryanna! Will be in touch soon...

Marcy

Originally Posted by Bryanna

Hi Marcy,

The xray that the oral surgeon took is called a panoramic film or panorex for short. Most surgeons, some general dentists, take this type of xray routinely because it shows a variety of areas at one time .... the upper and lower teeth, jaw bone, jaw joints, a portion of the nasal cavity, and more.

I'm glad he opted to not do the apicoectomy. That procedure is barbaric and it does not cure the problem. The extraction is the only way to remove the infection as it removes the source of the infection... the tooth!

With regard to having an implant in that area.... dental implants require healthy, substantial bone to be successful. Anything less than that is very risky for failure. In your case, the real complication is not just the loss of bone but the long term infection in the bone. This means that the remaining bone may not be healthy enough to handle an implant.

The replacement alternative is a partial denture. If you are missing any other teeth on the lower arch that have not already been replaced, the partial will have teeth on it to fill in those gaps. If you are just missing teeth only on the lower right, then you could have a unilateral partial denture...which looks like this....

My opinion of replacement of this tooth since you asked......
I am not a proponent of dental implants replacing teeth that have had a long standing infection because the health of the bone is questionable even after the extraction. The removable partial denture can be made to fit precisely so that it is comfortable making it a reasonable replacement option.

There definitely are ways to build your immune system both pre and post op surgery. Keep in mind that processed foods, those covered in pesticides and chemicals will slow down the immune response.

#1... Eat nutritiously, all organic if possible. Variety of fruits and veggies. Limit processed foods as the nutritional value is not up to par in most cases.

#2... Consume little to no sugar. Avoid "diet" labeled foods or drinks. Use stevia or xylitol as a sweetener.

#3... Drink several glasses of filtered water throughout the day to keep hydrated and continuously remove toxins. Drink green or white tea... kombucha tea is awesome for the immune system in many ways and it tastes great!

#4... Take a probiotic supplement daily to encourage the growth of healthy intestinal bacteria.

#5... Make healthy soups with organic, free range chicken/vegetable broth and add a variety of vegetables... chicken, beef... to your liking. These are great post op oral surgery.

#6... Supplementing with vitamin C also a good immune booster and great for healing from surgery. Just avoid vitamin C for 24 hours prior to surgery as it could interfere with the anesthetic. But definitely resume taking it right after the surgery.

#7... The B complex also helpful....

Those are just a few things that would be recommended for most people. If you have certain diet restrictions or take medications, you'll have to be mindful of consuming anything that would be contraindicated.

I know this is a bit scary but you will feel so much better when this tooth is removed ...and your body.... will thank you :>

Keep in touch....feel free to ask questions or just vent if you want to!!
Bryanna

[Bryanna]

Marcy,

I would only trust a general dentist to remove an abscessed tooth if he was very experienced at doing this and if he routinely debrides the surgical site thoroughly. Most general dentists do not clean the socket out very well and residual bacteria can lead to further infection. He may not be open to your questioning him about this.... but the bottom line is this... it's all about you and your well being. So if he takes offense, so what! Tell him you do not want any further problems with this. Believe me, when dentists are patients themselves, they settle for nothing but what they want/

Did you speak to the dentist about the removal partial? Everyone heals a bit differently. Depending on how long it takes for the site to heal determines when the impressions for the partial can be made. Sometimes it's a matter of weeks, other times it's a couple of months.

Glad to hear that you are moving forward with this. Hopefully you can communicate your concerns and wishes to this dentist and he will be open to all of it.

Keep in touch here....
Bryanna



QUOTE=Marcy Dorfman;915571]Hi Bryanna

First of all, many thanks for all of the excellent advice you have given me... as my situation has developed, I can't tell you how comforting it's been to refer to this forum!

Well, Bryanna, I am now scheduled to have the extraction on Monday! My normal dentist said he was confident he could do the extraction, but I have been reading the forum tonight, and noticed you have said that - if there is infection (i.e., an abcess) - than an oral surgeon should really do the extraction. Does this matter significantly? (I ask this because to see an oral sugeon on the NHS may take 3-4 months, whereas my private dentist can do it next week - after all I've read, I'm keen to get the thing out!)

Also, Bryanna, following on from discussions with my dentist, the oral sugeon and what I have read here, it looks like I would be a better candidate for a small denture as opposed to an implant. I'm just wondering how long it usually takes following the extraction before the partial can be fitted?

Thanks again, Bryanna! Will be in touch soon...

Marcy[/quote]