A Root Too Far

HerrScheisse

Salutations!

I am kerb crawling here for opinions on a matter troubling me for over one month at this stage.

It started with tenderness to the touch in the face, just to the left of the nose. When pressed there would be a tingling toward a specific molar. I inititally thought it mere irritation, but several weeks later it had not improved.

It is a weakness, but I have a bad habit of avoiding medical centres unless one or more of Hippocrate's four humors is seeping from me...it was when the tenderness started spreading further and a large lump developed on my inner gum I eventually sought treatment.

A dentist visit later, it was a nerve infection that necessitated a root canal. A course of antibiotics and filled up the tooth temporarily. Next visit, the filling was opened and more pus came out. The original lump on the gum was also still present. This time more antibiotics and the tooth left open. The lump subsided and the tenderness on my face is gone. The lump is almost gone, there is a section very high on the gum that is hard and if pressed results in a slight tingling sensation.

The dentist says of it were his tooth he would remove it. I understand in principle as he tried everything to save it. He says the infection is latent.
He also says an implant might be tricky because of the seriousness of the infection so rathers I have it removed in hospital than in his surgery.

Do I have any other options? Can I get opinions on what he means by latent? The tooth is not possible to keep and see if the infection returns? Will it always return when filled up? There is no routes to solve this and only removal is possible? Under what circumstances would an implant not be possible?

Just looking for advice and second opinions really. Thanks!

PS Let it be a lesson, do not wait with anything unusual

Oral Surgeon

HerrScheisse wrote: »

Salutations!

I am kerb crawling here for opinions on a matter troubling me for over one month at this stage.

It started with tenderness to the touch in the face, just to the left of the nose. When pressed there would be a tingling toward a specific molar. I inititally thought it mere irritation, but several weeks later it had not improved.

It is a weakness, but I have a bad habit of avoiding medical centres unless one or more of Hippocrate's four humors is seeping from me...it was when the tenderness started spreading further and a large lump developed on my inner gum I eventually sought treatment.

A dentist visit later, it was a nerve infection that necessitated a root canal. A course of antibiotics and filled up the tooth temporarily. Next visit, the filling was opened and more pus came out. The original lump on the gum was also still present. This time more antibiotics and the tooth left open. The lump subsided and the tenderness on my face is gone. The lump is almost gone, there is a section very high on the gum that is hard and if pressed results in a slight tingling sensation.

The dentist says of it were his tooth he would remove it. I understand in principle as he tried everything to save it. He says the infection is latent.
He also says an implant might be tricky because of the seriousness of the infection so rathers I have it removed in hospital than in his surgery.

Do I have any other options? Can I get opinions on what he means by latent? The tooth is not possible to keep and see if the infection returns? Will it always return when filled up? There is no routes to solve this and only removal is possible? Under what circumstances would an implant not be possible?

Just looking for advice and second opinions really. Thanks!

PS Let it be a lesson, do not wait with anything unusual

Incredibly hard to say without seeing you, your tooth and X-ray but....

If the tooth is restorable and a root canal with your general dentist is not working and you want to keep it, then ask for a referral to an endodontist. If it can be saved then that is the best option.

If it can't be saved, then it needs removal. No one needs to go to a hospital for an extraction. See an oral surgeon in his/her clinic if it is difficult but hospital care is unnecessary....

Regarding restorability with an implant... All will depend on how much bone has been destroyed by the infection process and how much will be lost with the extraction. Also how close your sinus is to the site etc.
Immediate implant placement is not a good idea in an infected area, neither is a socket preserving bone graft with the extraction. Best is to carefully remove the tooth surgically, minimal bone removal. Allow healing and infection resolution and then reevaluate regarding implant suitability......

Good luck,
Os

HerrScheisse

Many thanks for taking the time to reply OS - I really appreciate that.

I understand it is tricky without seeing the case yourself. But you have given me some food for thought, I have an appointment for extraction next week so I will try get a second opinion with an endodontist beforehand.

I had hoped to keep it, as the infection has gone away, but indeed if I press on the upper inner gum (approx where the root of the tooth is) I get a tangy sensation. So it can be the damage from the infection is just too much in this area

HerrScheisse

A last query, if worse case scenario occurs and an implant cannot be placed, do I have any options?

Problem is it is a molar, a very functional tooth for me and not a visual "pretty" tooth. :pac:
I need it for chewing!

What is an average timescale for healing after a removal? And approx how long before an implant could possibly be placed?

Thanks again

Oral Surgeon

HerrScheisse wrote: »

I have an appointment for extraction next week so I will try.....(

Make sure that this is a careful surgical extraction. The aim is to cut the tooth and roots into pieces to remove carefully and not expand and destroy the bone like what happens in a non surgical removal....

HerrScheisse wrote: »

A last query, if worse case scenario occurs and an implant cannot be placed, do I have any options?

Problem is it is a molar, a very functional tooth for me and not a visual "pretty" tooth. :pac:
I need it for chewing!

What is an average timescale for healing after a removal? And approx how long before an implant could possibly be placed?

Thanks again

The options are
Nothing
A denture
A bridge
An implant

A implant is most likely possible but may require bone grafting in advance of that... All depends on how much time and money you want to spend on one tooth really....

HerrScheisse

Oral Surgeon wrote: »

Make sure that this is a careful surgical extraction. The aim is to cut the tooth and roots into pieces to remove carefully and not expand and destroy the bone like what happens in a non surgical removal....
QUOTE]


Ye Gods! I had imagined it would be a local anaesthetic and a few hefty tugs with a pliers but :eek:

I have an appointment with an endodontist monday, I'll post back up after the visit with their feedback for the benefit of anyone else in a similar situation.

HerrScheisse

Salutations again!

I have been to the endodontist today and learned quite a lot. Firstly it is like a normal dentist visit except they look at the mirror in your mouth with some kind of high powered binocular apparatus

A new X-ray was also taken and the history of the problem reviewed. When I stated that the tooth should be removed because of a latent infection from the root canal she frowned visibly.

Post examination, she said that the tooth has to be removed. She said that the reason is not the infection, but that too much damage has been done drilling for the root canals and that does not make it viable to keep it. She could fill it but said that I would be back soon enough...

I was quite upset to hear that it was not the infection but the drilling for nerves that is the reason for the loss. She said it can be tricky to find them sometimes, I do know the dentist did have trouble finding them and was rooting around quite a bit with the drill. Is that quite common OS, or should I be looking for a more skillful dentist? If I had known this, I would have gone to the endodontist for the original root canal but that is easy to say in hindsight.

She also said that the dentist that places the implant should be the one to do the removal, as he will have a better insight on the strategy for placement and can adjust the removal to suit.

A bridge was ruled out as the teeth on both sides of the molar are in great condition so it makes no sense to crown them for anchoring. The only options are do nothing or an implant, and I really need that molar for comfortable chewing so i am looking at a 2k+ procedure :eek: (1k implant and 1 k crown placement).

A friend did tell me to look at Eastern Europe for this but I have no experience of that, nor of the quality of treatment.

Thanks for any more feedback! I suppose it is just a tooth in the end.

Oral Surgeon

HerrScheisse wrote: »

Post examination, she said that the tooth has to be removed. She said that the reason is not the infection, but that too much damage has been done drilling for the root canals and that does not make it viable to keep it. She could fill it but said that I would be back soon enough...

I was quite upset to hear that it was not the infection but the drilling for nerves that is the reason for the loss. She said it can be tricky to find them sometimes, I do know the dentist did have trouble finding them and was rooting around quite a bit with the drill. Is that quite common OS, or should I be looking for a more skillful dentist? If I had known this, I would have gone to the endodontist for the original root canal but that is easy to say in hindsight.

Hard for me to say.... If that's what the endodontist thinks and she has seen your tooth then so be it...
What I explain to people is that the tooth needed a root canal for a very good reason- it was compromised already.... so it's not like it was a virgin tooth and perfect in every way before seeing your dentist. It can be hard to locate canals (even for endodontists) but yes sometimes extra tooth is removed and maybe with the benefit of hind sight or with more experienced eyes it should not have happened..... Don't try to compare your dentist's root canal skills with an endodontist, your dentist will come off worse every time.....

HerrScheisse wrote: »

She also said that the dentist that places the implant should be the one to do the removal, as he will have a better insight on the strategy for placement and can adjust the removal to suit.

I couldn't agree more

HerrScheisse wrote: »

A friend did tell me to look at Eastern Europe for this but I have no experience of that, nor of the quality of treatment.

please don't, there are many threads here to explain why...

All the best,
OS

HerrScheisse

Just to follow up, I have made an appointment for next week in the hospital.

The one doing the removal is a face, mouth and jaw surgeon...not a dentist! I assume this is because theya re the one that do the implants?

Might i assume a surgical removal will be local anesthetic injected straight into the gum, or is laughing gas used also? Will I be able to drive home after it?

Oral Surgeon

HerrScheisse wrote: »

Just to follow up, I have made an appointment for next week in the hospital.

The one doing the removal is a face, mouth and jaw surgeon...not a dentist! I assume this is because theya re the one that do the implants?

Don't assume, lots of max fax guys have little or no experience of dental implants. As well as that, implant treatment should be restorative planned and driven, ie, the guy placing the crown on the implant should be the guy to ask the implant surgeon to place the implant with his/her restoration in mind.
You don't want to head off to get an implant only to find that the type of implant placed is rubbish and the restorative dentists can't/won't restore it.... or it has been placed without the restorative dentists final crown in mind and so is not ideal....

Also, as mentioned before, the ideal situation is that the guy removing the tooth is the guy who will eventually place the implant. There's an easy, quick and destructive way to remove a tooth and there's the slow, difficult and conservative way. Only the guy placing the implant will bother saving your bone and do it right, bottom line....

HerrScheisse wrote: »

Might i assume a surgical removal will be local anesthetic injected straight into the gum, or is laughing gas used also? Will I be able to drive home after it?

This is usually the case but if you are going to a private hospital and have insurance etc, you may find yourself having an unnecessary general anaesthetic, I hear all the stories..... Best to ring them to find out....

HerrScheisse

Thanks again OS, this treatment is proving to be a veritable minefield.

The surgeon doing the removal will also place the implants, I have asked a nurse I know working in the hospital and they have quite a good reputation. I was taken aback when I first heard that it was a specialised surgeon (mouth, cheek, face) doing the removal rather than a dentist but this is a first time experience for me.

However, it is a dentist that will place the crown.

I asked a guy with implants about his personal experience and he had to have a bone graft, and they took it from his skull :eek:

Admittedly he has a very large head so it was no problem for him, but I would rather it taken from somewhere else, rather the hip or an extremtity, certainly not from my skull. Can they take from the hip? Does it hurt much, require much healing?

I did know an American guy that partook in medical experiments to pay his way through college, and he said that it hurt a lot having bone samples removed from his hip...:pac:

HerrScheisse

Salutations!

I am posting the following to relay my experience of an extraction for anyone in a similar pickle.

This morning I checked into the hospital, the usual administrative procedure, name, address, referral details etc.

I was then brought to the department where I was having the extraction, a nurse took me into a room for an x-ray and clamped my head in a device and I had to bite on a small protrusion. She left the room and a small panel done a complete rotation around my head, very futuristic :pac:

Next was into the operating room, I had a small discussion with the surgeon that I wished an implant so the extraction should be done in accordance.
A nurse wrapped me up in a medical blanket lovingly, like she was tucking her child into bed. No goodnight kiss though :pac:

The surgeon had a good manner in that he talked me through every single detail of the procedure, this made it much more relaxing for me. First there were two injections, one on the outer gum, and then a slightly more uncomfortable one on the inner. A small wait of five minutes for it to take effect.

My eyes were covered up to protect them from the surgical lamps. He proceded to pull on the tooth to see if there was movement and told me I would feel pressure in my face. There was a cracking sensation, then he told me he would remove the nerves. There was some drilling which was quite loud. The three roots then had to be removed, one was easy, the other two slightly more difficult.

He then stitched up the gum, and I could bite on a small cotton for five minutes. He pinched my nose and I had to blow, this was to check if the air could escape as this could cause problems.

And that was it - all done in less time than it takes to change a car tyre.

It was not painful, merely uncomfortable, particularly the pressure sensation toward my nose. But certainly not unbearable, I had imagined much worse.

While driving home, I could feel the pain starting to increase, I had the weird sensation that I wanted to bite something really hard.

A precription for Ibuprofen and I feel ok, there is a weird sensation in my mouth as my tongue is not yet used to the gap, it was an upper molar on the back left.

I have an appointment for end August to follow up and examine the potential to place an implant.

All in all, not a pleasant experience, but there are worse things you could undergo. In my minds eye, what I imagined was way worse than the reality.

He also told me an implant is not so bad either, that it is placed in 25 minutes under local anaesthetic.

Ill update this thread as I go along, maybe it helps somebody.

Oral Surgeon

HerrScheisse wrote: »

He pinched my nose and I had to blow, this was to check if the air could escape as this could cause problems.

HerrScheisse

OS, this is a first time procedure to me, but why the facepalm??

Maybe I explained the reason wrong but he did pinch my nose and ask me to blow. What would be the purpose of doing this?

And it was of course prior to stitching up.

Also I forgot to add, at the start, he pushed the gum back prior to beginning the extraction.

Kind of worried now, as I did my best to inform beforehand...and it is a dentist / surgical specialist that did the procedure, he must (re should) know what he is doing. At least I hope so :eek:

Oral Surgeon

HerrScheisse wrote: »

OS, this is a first time procedure to me, but why the facepalm??

Maybe I explained the reason wrong but he did pinch my nose and ask me to blow. What would be the purpose of doing this?

And it was of course prior to stitching up.

Also I forgot to add, at the start, he pushed the gum back prior to beginning the extraction.

Kind of worried now, as I did my best to inform beforehand...and it is a dentist / surgical specialist that did the procedure, he must (re should) know what he is doing. At least I hope so :eek:

This move is used to check if there is an oro antral communication/ fistula (OAF). The issue I have is that in many cases where an upper molar is removed and is close to the sinus or has a very small perforation into the sinus- simply allowing it to heal with or without stitches and advice such as no nose bloing etc is enough to allow the area to heal uneventfully.

If, however, you get the patient to attempt to force air through the area if it is a small perforation- this often blows a bigger hole in the area and helps establish the fistula....!!

So;
If there is no fistula and there is good bone between the extraction socket and antrum- it makes no difference
If there was a tiny perforation or crack in the socket/ antrum floor, doing this noseblowing move will likely help establish this OAF in an area that would otherwise heal.....!!
If there is a large hole into the antrum, then a blunt probe into the socket will easily diagnose this and the nose blowing is unnecessary and again likely to help worsen a bad situation......

The only time I dothis noseblowing thing is 6-8 weeks following an extraction if an OAF is queried....

So... facepalm...

HerrScheisse

Right that makes perfect sense!

Lucky his test proved that there was no hole, or should I say, that he created no hole! :pac:

HerrScheisse

I would like to extend my thanks to Oral Surgeon for all the advice the last couple of weeks, it was be very useful to me and certainly made the process much easier! Thank you sir!

Luckily there has not been much if any pain, just a slight funky taste and a bit of rubbing from the stitches against my tongue, like having some fishing line in your mouth!

I have an appointment to evaluate the healing in August with a view to setting an implant. I was thinking, a crown is attached to the implant, but how is the gum handled? For example, the gum was shoved back during the extration, and now it is stitched and will change shape, how is the crown fit such that it blends nicely with the gum?