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Advice before extraction and jaw bone debridement

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Unread 06-11-2013, 06:36 AM   #1
dbpei
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Unhappy Advice before extraction and jaw bone debridement

I had a dental implant of tooth #15 in 2008 that never felt right to me. The tooth had a failed root canal followed by a difficult extraction. When I would bend down, it was as though I could feel the metal in my bone and I would feel sinus pressure. My gum above that tooth has been dark gray ever since the implant. (Could this be necrotic bone beneath the gum tissue?) I have addressed this with both my dentist and oral surgeon but they said the implant looked fine.

It turns out that I have developed a fistula in the roof of my mouth above #14 and #15. The dentist thinks that the tooth next to the implant is infected and it is going to be extracted tomorrow. This tooth had a root canal done in 2011. Sadly, the infection has spread to my jaw bone above the tooth. The oral surgeon is prepared to clean out the infected bone as best he can.

I have some questions:

1. If tooth #15 is infected, is it likely that the jaw bone above the implant on #14 could be infected as well?

2. Is there any way that the oral surgeon can determine if the adjacent bone is infected when he is extracting the tooth and cleaning out the necrotic bone tissue?

3. If it looks like the jaw bone is infected above the dental implant, should the oral surgeon try to remove the implant while he is extracting the tooth next to it?

I am concerned that this infection has spread throughout my jaw and even into my skull. I feel strange sensations in my face and the side of my head as well as my mastoid bones. I am hoping this can all be taken care of with the extraction and antibiotics, but I am so afraid of the damage already done.

I want the oral surgeon to take a culture or biopsy of the bacteria so we know what type of bacteria we are fighting. Is there anything else you would recommend for me to communicate with my oral surgeon tomorrow before he does the surgery? I am going to have conscious sedation for this as I don't think I could tolerate the anxiety!

Last edited by dbpei; 06-11-2013 at 07:20 AM.
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Unread 06-11-2013, 10:33 AM   #2
Bryanna
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Hi dbpei,

I will re post your questions and answer them in bold

<<<I had a dental implant of tooth #15 in 2008 that never felt right to me. The tooth had a failed root canal followed by a difficult extraction. When I would bend down, it was as though I could feel the metal in my bone and I would feel sinus pressure. My gum above that tooth has been dark gray ever since the implant. (Could this be necrotic bone beneath the gum tissue?) >>>

YOUR DESCRIPTION INDICATES A PROBLEM IN THE AREA OF THE IMPLANT. THE ACTUAL IMPLANT ITSELF MAY APPEAR TO LOOK OKAY (NOT TO BE CONFUSED WITH "HEALTHY") BUT THERE IS SOMETHING BREWING BECAUSE YOU SHOULD NEVER HAVE SINUS PRESSURE FROM THE IMPLANT. CHANCES ARE THE BONE WAS INADEQUATE AND NOT HEALTHY WHEN THE IMPLANT WAS PLACED AND THERE MAY HAVE BEEN A SINUS EXPOSURE AS WELL. THE DISCOLORATION OF THE GUM INDICATES THAT THE BUCCAL BONE (THE BONE THAT FACES THE CHEEK SIDE) IS EITHER EXTREMELY THIN OR NON EXISTENT DUE TO THE BACTERIA THAT SPREAD FROM THE INFECTED ROOT CANALED TOOTH CAUSING THE BONE TO DETERIORATE. DURING THE DIFFICULT EXTRACTION, WHATEVER BONE WAS PRESENT IN THIS AREA WAS MOST LIKELY REMOVED BECAUSE IT JUST CRUMBLED FROM DISEASE.

UNFORTUNATELY, MANY DENTISTS WILL PLACE IMPLANTS IN DISEASED BONE AND TAKE A LET'S SEE WHAT HAPPENS ATTITUDE. USUALLY PATIENTS ARE NOT INFORMED OF ANY OF THIS AND WHEN PROBLEMS ARISE THEY ARE EVENTUALLY TOLD THAT THE BODY REJECTED THE IMPLANT OR THE IMPLANT FAILED. I CANNOT SAY FOR CERTAIN THIS IS YOUR CASE.... BUT IT DOES OCCUR VERY FREQUENTLY.

<<<1. If tooth #15 is infected, is it likely that the jaw bone above the implant on #14 could be infected as well?>>>

IT IS VERY LIKELY THAT THE BONE "SURROUNDING" 14 AND 15 IS NECROTIC AND DISEASED RATHER THAN JUST ABOVE EITHER TOOTH. IT IS NEVER WISE TO PLACE AN IMPLANT IN UNHEALTHY BONE AND/OR NEXT TO A ROOT CANALED TOOTH. AGAIN, THIS IS DONE FREQUENTLY AND THE END RESULT IS NOT FAVORABLE DUE TO THE DISEASED BONE FROM THE INFECTED TEETH.

<<<2. Is there any way that the oral surgeon can determine if the adjacent bone is infected when he is extracting the tooth and cleaning out the necrotic bone tissue?>>>

FIRST OF ALL, THE RADIOGRAPHS COULD BE USEFUL IN SHOWING SOME OF THE ISSUES WITH THE IMPLANT. SECONDLY, IN THIS CASE HE MAY FLAP THE TISSUE OVER BOTH TEETH TO GIVE HIM A VISUAL OF THE BONE AND ENABLE HIM TO ADEQUATELY REMOVE THE DISEASED BONE.

<<<3. If it looks like the jaw bone is infected above the dental implant, should the oral surgeon try to remove the implant while he is extracting the tooth next to it?>>>

YES, HE SHOULD REMOVE THE IMPLANT IF THE BONE IS DISEASED. IT MAKES NO SENSE TO RETAIN AN IMPLANT IN INFECTED BONE.

<<<I am concerned that this infection has spread throughout my jaw and even into my skull. I feel strange sensations in my face and the side of my head as well as my mastoid bones. I am hoping this can all be taken care of with the extraction and antibiotics, but I am so afraid of the damage already done.>>>>

NOT TO FRIGHTEN YOU BUT TO INFORM YOU THAT ...... THE INFECTION CAN SPREAD TO VARIOUS AREAS OF YOUR JAW BONE AND BEYOND. IT IS NEVER OKAY TO RETAIN AN INFECTED TOOTH OR AN IMPLANT IN INFECTED BONE. IT IS IMPERATIVE FOR YOU TO EXPLAIN IN DETAIL TO THE OS ALL OF YOUR PHYSICAL SYMPTOMS. IT IS ALSO IMPERATIVE FOR YOU TO SHOW SINCERE CONCERN ABOUT YOUR "SYSTEMIC HEALTH" REGARDING THIS DENTAL PROBLEM. IT IS UP TO YOU TO INFORM THE OS THAT YOU ARE WILLING TO REMOVE THE IMPLANT IF IT IS NOT SITTING IN HEALTHY BONE. OTHERWISE, HE MAY JUST LEAVE IT THERE... AS STUPID AS THAT SOUNDS :/

<<<I want the oral surgeon to take a culture or biopsy of the bacteria so we know what type of bacteria we are fighting. Is there anything else you would recommend for me to communicate with my oral surgeon tomorrow before he does the surgery? I am going to have conscious sedation for this as I don't think I could tolerate the anxiety!>>>

HE CAN SEND THE ROOT CANALED TOOTH ALONG WITH SOME FRAGMENTS OF BONE TO BE CULTURED AND BIOPSIED. HE MAY TELL YOU THIS IS NOT NECESSARY OR ROUTINELY DONE...... HOWEVER, IT CAN AND SHOULD BE DONE ROUTINELY TO DETERMINE WHAT SPECIES OF BACTERIA YOU ARE DEALING WITH SO THE PROPER ANTIBIOTIC CAN BE PRESCRIBED. YOU MAY HAVE TO STAND REALLY FIRM WITH THIS AND HE MAY BECOME ANNOYED... BUT WHO CARES??!! IT'S YOUR BODY AND IT'S HIS OBLIGATION TO PERFORM THE PROCEDURE PROPERLY AND THOROUGHLY WHICH INCLUDES KNOWING WHAT YOU'RE DEALING WITH. IT WOULD BE WISE TO CALL THE OS OFFICE AHEAD OF TIME, LIKE TODAY, TO INFORM THEM THAT YOU WANT THE PATHOLOGY DONE SO THEY CAN HAVE IT SET UP AHEAD OF TIME.

I wish this did not have to be so difficult. It is bad enough that you have not been properly informed regarding root canals.... and that you have been living with the discomfort of the implant... and that you have this serious infection going on.... geez, you shouldn't have to now deal with telling the OS what to do! I can tell you this.... the informed patient gets different and more thorough dental care.... without a doubt. I always tell patients to be their own advocate and let the dentist be annoyed at your questions or your insistence to be thorough..... he'll get over it

You will be okay... just follow your instinct with this and be assertive with your concerns. Believe me.... when dentists are surgical patients themselves ... they are scared sh**tless and they have plenty to say about everything!

Try to calm your nerves... do some slow, deep breathing to help calm down. It is also best if you have a food menu planned ahead of time. You will be on soft foods for several days. So make the menu as healthy as possible

Keep us posted!
Bryanna
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Unread 06-11-2013, 11:32 AM   #3
dbpei
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Bryana, I can't thank you enough for all of this advice and information! I just left a long detailed message with the OS' secretary asking her to please let him listen to my message and I have decided that I will bring my concerns tomorrow in writing so he can have it before he begins the surgery. I

I am leaving for an acupuncture visit to de-stress and prepare me for tomorrow. I will write when the surgery is behind me. Thank you again!

Quote:
Originally Posted by Bryanna View Post
Hi dbpei,

I will re post your questions and answer them in bold

<<<I had a dental implant of tooth #15 in 2008 that never felt right to me. The tooth had a failed root canal followed by a difficult extraction. When I would bend down, it was as though I could feel the metal in my bone and I would feel sinus pressure. My gum above that tooth has been dark gray ever since the implant. (Could this be necrotic bone beneath the gum tissue?) >>>

YOUR DESCRIPTION INDICATES A PROBLEM IN THE AREA OF THE IMPLANT. THE ACTUAL IMPLANT ITSELF MAY APPEAR TO LOOK OKAY (NOT TO BE CONFUSED WITH "HEALTHY") BUT THERE IS SOMETHING BREWING BECAUSE YOU SHOULD NEVER HAVE SINUS PRESSURE FROM THE IMPLANT. CHANCES ARE THE BONE WAS INADEQUATE AND NOT HEALTHY WHEN THE IMPLANT WAS PLACED AND THERE MAY HAVE BEEN A SINUS EXPOSURE AS WELL. THE DISCOLORATION OF THE GUM INDICATES THAT THE BUCCAL BONE (THE BONE THAT FACES THE CHEEK SIDE) IS EITHER EXTREMELY THIN OR NON EXISTENT DUE TO THE BACTERIA THAT SPREAD FROM THE INFECTED ROOT CANALED TOOTH CAUSING THE BONE TO DETERIORATE. DURING THE DIFFICULT EXTRACTION, WHATEVER BONE WAS PRESENT IN THIS AREA WAS MOST LIKELY REMOVED BECAUSE IT JUST CRUMBLED FROM DISEASE.

UNFORTUNATELY, MANY DENTISTS WILL PLACE IMPLANTS IN DISEASED BONE AND TAKE A LET'S SEE WHAT HAPPENS ATTITUDE. USUALLY PATIENTS ARE NOT INFORMED OF ANY OF THIS AND WHEN PROBLEMS ARISE THEY ARE EVENTUALLY TOLD THAT THE BODY REJECTED THE IMPLANT OR THE IMPLANT FAILED. I CANNOT SAY FOR CERTAIN THIS IS YOUR CASE.... BUT IT DOES OCCUR VERY FREQUENTLY.

<<<1. If tooth #15 is infected, is it likely that the jaw bone above the implant on #14 could be infected as well?>>>

IT IS VERY LIKELY THAT THE BONE "SURROUNDING" 14 AND 15 IS NECROTIC AND DISEASED RATHER THAN JUST ABOVE EITHER TOOTH. IT IS NEVER WISE TO PLACE AN IMPLANT IN UNHEALTHY BONE AND/OR NEXT TO A ROOT CANALED TOOTH. AGAIN, THIS IS DONE FREQUENTLY AND THE END RESULT IS NOT FAVORABLE DUE TO THE DISEASED BONE FROM THE INFECTED TEETH.

<<<2. Is there any way that the oral surgeon can determine if the adjacent bone is infected when he is extracting the tooth and cleaning out the necrotic bone tissue?>>>

FIRST OF ALL, THE RADIOGRAPHS COULD BE USEFUL IN SHOWING SOME OF THE ISSUES WITH THE IMPLANT. SECONDLY, IN THIS CASE HE MAY FLAP THE TISSUE OVER BOTH TEETH TO GIVE HIM A VISUAL OF THE BONE AND ENABLE HIM TO ADEQUATELY REMOVE THE DISEASED BONE.

<<<3. If it looks like the jaw bone is infected above the dental implant, should the oral surgeon try to remove the implant while he is extracting the tooth next to it?>>>

YES, HE SHOULD REMOVE THE IMPLANT IF THE BONE IS DISEASED. IT MAKES NO SENSE TO RETAIN AN IMPLANT IN INFECTED BONE.

<<<I am concerned that this infection has spread throughout my jaw and even into my skull. I feel strange sensations in my face and the side of my head as well as my mastoid bones. I am hoping this can all be taken care of with the extraction and antibiotics, but I am so afraid of the damage already done.>>>>

NOT TO FRIGHTEN YOU BUT TO INFORM YOU THAT ...... THE INFECTION CAN SPREAD TO VARIOUS AREAS OF YOUR JAW BONE AND BEYOND. IT IS NEVER OKAY TO RETAIN AN INFECTED TOOTH OR AN IMPLANT IN INFECTED BONE. IT IS IMPERATIVE FOR YOU TO EXPLAIN IN DETAIL TO THE OS ALL OF YOUR PHYSICAL SYMPTOMS. IT IS ALSO IMPERATIVE FOR YOU TO SHOW SINCERE CONCERN ABOUT YOUR "SYSTEMIC HEALTH" REGARDING THIS DENTAL PROBLEM. IT IS UP TO YOU TO INFORM THE OS THAT YOU ARE WILLING TO REMOVE THE IMPLANT IF IT IS NOT SITTING IN HEALTHY BONE. OTHERWISE, HE MAY JUST LEAVE IT THERE... AS STUPID AS THAT SOUNDS :/

<<<I want the oral surgeon to take a culture or biopsy of the bacteria so we know what type of bacteria we are fighting. Is there anything else you would recommend for me to communicate with my oral surgeon tomorrow before he does the surgery? I am going to have conscious sedation for this as I don't think I could tolerate the anxiety!>>>

HE CAN SEND THE ROOT CANALED TOOTH ALONG WITH SOME FRAGMENTS OF BONE TO BE CULTURED AND BIOPSIED. HE MAY TELL YOU THIS IS NOT NECESSARY OR ROUTINELY DONE...... HOWEVER, IT CAN AND SHOULD BE DONE ROUTINELY TO DETERMINE WHAT SPECIES OF BACTERIA YOU ARE DEALING WITH SO THE PROPER ANTIBIOTIC CAN BE PRESCRIBED. YOU MAY HAVE TO STAND REALLY FIRM WITH THIS AND HE MAY BECOME ANNOYED... BUT WHO CARES??!! IT'S YOUR BODY AND IT'S HIS OBLIGATION TO PERFORM THE PROCEDURE PROPERLY AND THOROUGHLY WHICH INCLUDES KNOWING WHAT YOU'RE DEALING WITH. IT WOULD BE WISE TO CALL THE OS OFFICE AHEAD OF TIME, LIKE TODAY, TO INFORM THEM THAT YOU WANT THE PATHOLOGY DONE SO THEY CAN HAVE IT SET UP AHEAD OF TIME.

I wish this did not have to be so difficult. It is bad enough that you have not been properly informed regarding root canals.... and that you have been living with the discomfort of the implant... and that you have this serious infection going on.... geez, you shouldn't have to now deal with telling the OS what to do! I can tell you this.... the informed patient gets different and more thorough dental care.... without a doubt. I always tell patients to be their own advocate and let the dentist be annoyed at your questions or your insistence to be thorough..... he'll get over it

You will be okay... just follow your instinct with this and be assertive with your concerns. Believe me.... when dentists are surgical patients themselves ... they are scared sh**tless and they have plenty to say about everything!

Try to calm your nerves... do some slow, deep breathing to help calm down. It is also best if you have a food menu planned ahead of time. You will be on soft foods for several days. So make the menu as healthy as possible

Keep us posted!
Bryanna
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Unread 06-11-2013, 03:02 PM   #4
Bryanna
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dpei,

You are very welcome

Writing things down is a great idea and it shows that you are serious about your concerns.

Great idea to do some acupuncture today!! Also would be helpful to have it done post operative as well!

My husband and I are huge believers in acupuncture and have been for many years )

Will keep you in our thoughts as you venture into this dental journey! You will be okay

Bryanna


Quote:
Originally Posted by dbpei View Post
Bryana, I can't thank you enough for all of this advice and information! I just left a long detailed message with the OS' secretary asking her to please let him listen to my message and I have decided that I will bring my concerns tomorrow in writing so he can have it before he begins the surgery. I

I am leaving for an acupuncture visit to de-stress and prepare me for tomorrow. I will write when the surgery is behind me. Thank you again!
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Unread 06-13-2013, 07:47 AM   #5
dbpei
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Default Surgery went well!

Hi Bryanna,
The surgery went well yesterday! I am so glad I used IV sedation - as I didn't feel a thing until after the Novocain wore off and it seemed like the surgery was over in a heartbeat. The oral surgeon said that he found a large abscess at the tip of the tooth and the roots had penetrated into my sinus cavity like he suspected. He said that it should heal on its own as long as I follow the instructions to not blow my nose and if I sneeze, to open my mouth, ... I am continuing with the augmentin he prescribed as there was a lot of infection in there.

I continue to have tinnitus and a feeling of fluid and mild tingling/burning in my face, skull and ears, but hopefully, once the inflammation dies down, some of that will go away. I am just so glad to have that infected tooth out of my body. I forgot to ask the oral surgeon about how much necrotic bone tissue he found, but will ask him about this when I see him in a week. On my first visit to him, I asked him if he would scrape away all the dead bone and he said he would. He took a culture of the tooth and bone as I asked.

I presented him with my written concerns before the surgery. He was very supportive and not threatened at all by this. He did say that my implant looked good (before the surgery) and he did not think it was affected by all of this. I pray he is right. I am trying to take really good care right now by eating softer foods and rinsing with salt water very gently. I am not doing my usual routine and trying to rest more.

Is there any blood testing or are there any symptoms to look for to know whether this infection could have become systemic? That is my biggest fear, given the length of time I have had the odd symptoms (burning, tingling and feeling of fluid/pressure) in my ears and skull.

Thank you again for all of your guidance and support. Hopefully, things will continue to improve and all of these symptoms will be history in a few months.
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Unread 06-13-2013, 09:41 AM   #6
Bryanna
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Hi dpei,

Very glad to hear the surgery went well and the os was thorough with the surgery. Also good to hear that he was so open to your concerns and did the culture! That's great!!

It is important to take very good care of yourself during the next few weeks even when it starts to feel better because there is a lot going on in that area that is going to take time to heal. Keep in mind that the bacteria that caused the abscess had been residing inside of the tooth and it proliferated through the tooth into the bone. He hopefully removed all of the diseased bone and tissue. There is no way to know that for certain. You just have to do your part in being cautious and healthy and see what happens.

The typical signs of a problem would be any of these things .... an increase of pain near the surgical sites by the 3rd to 4th day... an unusual drainage coming from your sinuses .... an air sensation or bubbles coming from the socket when you drink water .... if another fistula forms on the palate or gum .... a fever ..... unusual swelling.

The other physical symptoms you are feeling will hopefully subside and go away completely very soon. Hard to predict whether they are caused by the infected tooth and/or the dental implant. Especially since you said you've had some issues ever since the implant was put in. So that is a wait and see situation at this point. I think it is wise to have that implant xrayed every few months to see if there are any changes. What did the oral surgeon say about the gray/dark area on the buccal side (cheek side) of the gum at the implant site? You may want to ask him at your post op appt if that part of the implant is covered by bone or was that bone destroyed by the infection from tooth #15??

Regarding blood work... because you are on the antibiotic, the bloodwork could be inconclusive. About 2-4 weeks after the last dosage, you could have a CBC test done and also speak to your physician about other tests to check for systemic infection.

Wishing you an easy and complete recovery!!
Keep us posted...
Bryanna



Quote:
Originally Posted by dbpei View Post
Hi Bryanna,
The surgery went well yesterday! I am so glad I used IV sedation - as I didn't feel a thing until after the Novocain wore off and it seemed like the surgery was over in a heartbeat. The oral surgeon said that he found a large abscess at the tip of the tooth and the roots had penetrated into my sinus cavity like he suspected. He said that it should heal on its own as long as I follow the instructions to not blow my nose and if I sneeze, to open my mouth, ... I am continuing with the augmentin he prescribed as there was a lot of infection in there.

I continue to have tinnitus and a feeling of fluid and mild tingling/burning in my face, skull and ears, but hopefully, once the inflammation dies down, some of that will go away. I am just so glad to have that infected tooth out of my body. I forgot to ask the oral surgeon about how much necrotic bone tissue he found, but will ask him about this when I see him in a week. On my first visit to him, I asked him if he would scrape away all the dead bone and he said he would. He took a culture of the tooth and bone as I asked.

I presented him with my written concerns before the surgery. He was very supportive and not threatened at all by this. He did say that my implant looked good (before the surgery) and he did not think it was affected by all of this. I pray he is right. I am trying to take really good care right now by eating softer foods and rinsing with salt water very gently. I am not doing my usual routine and trying to rest more.

Is there any blood testing or are there any symptoms to look for to know whether this infection could have become systemic? That is my biggest fear, given the length of time I have had the odd symptoms (burning, tingling and feeling of fluid/pressure) in my ears and skull.

Thank you again for all of your guidance and support. Hopefully, things will continue to improve and all of these symptoms will be history in a few months.
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Unread 06-13-2013, 10:24 AM   #7
dbpei
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Default Thank you for your great advice

Thank you again, Bryanna. You seem to give such good advice. I will do all you suggest. I am so glad I discovered this forum a couple of weeks ago. I wish I had discovered it years ago!
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