Aa
advice on a puzzling tooth/root canal/infection problem
Dear dental experts --
reaching out here on behalf of my mom, who has had some trouble with her dentists who can't agree on what is going on. Would really appreciate any ideas on what to do. Given the complexity, I have advised her to talk to the ins co's doctor/patient advocate (?) if there is such a thing.
A few months ago, she had sharp pain in her lower left molar (nearest the front), and the dentist said, you'd better get a root canal, which was done the same afternoon by a local endodontist. At the time, she says, it seemed a little strange that there was pain with no cavity. But it was done and all seemed fine.
Then in the months since, she has had inflammation of the gum around that tooth, and some more dull pain, and the tissue is soft on touching with a toothbrush. Getting more x-rays, it shows that there is bone loss. Unable to explain really what is going on, the first two dentists say that there is an infection, or that maybe the tooth is cracked and causing inflammation -- but cracked in a way that doesn't show up on the x-rays. Those two dentists are not the most courteous to her either, and she gets the feeling they're washing their hands of the matter.
Finally she consulted a family friend in NYC who said, well, that to stop this infection, regardless of whether the tooth is cracked, that tooth will probably need to come out, and maybe in 6 months something can be implanted in its place or a bridge in the meantime.
So she is very upset that all of this is possibly leading her to have to lose a tooth. And she says, it may have to wait until 2010 because of ins caps on the dental spending per year. This gets me angry, because the first 2 dentists should clean up their mess, and an infection should not wait. In the meantime, she is on antibiotics, and a kind of osteoporosis/bone health medication which is taken once a month (from before all this).
do you have any advice on what is going on, or what she should do? thank you!
reaching out here on behalf of my mom, who has had some trouble with her dentists who can't agree on what is going on. Would really appreciate any ideas on what to do. Given the complexity, I have advised her to talk to the ins co's doctor/patient advocate (?) if there is such a thing.
A few months ago, she had sharp pain in her lower left molar (nearest the front), and the dentist said, you'd better get a root canal, which was done the same afternoon by a local endodontist. At the time, she says, it seemed a little strange that there was pain with no cavity. But it was done and all seemed fine.
Then in the months since, she has had inflammation of the gum around that tooth, and some more dull pain, and the tissue is soft on touching with a toothbrush. Getting more x-rays, it shows that there is bone loss. Unable to explain really what is going on, the first two dentists say that there is an infection, or that maybe the tooth is cracked and causing inflammation -- but cracked in a way that doesn't show up on the x-rays. Those two dentists are not the most courteous to her either, and she gets the feeling they're washing their hands of the matter.
Finally she consulted a family friend in NYC who said, well, that to stop this infection, regardless of whether the tooth is cracked, that tooth will probably need to come out, and maybe in 6 months something can be implanted in its place or a bridge in the meantime.
So she is very upset that all of this is possibly leading her to have to lose a tooth. And she says, it may have to wait until 2010 because of ins caps on the dental spending per year. This gets me angry, because the first 2 dentists should clean up their mess, and an infection should not wait. In the meantime, she is on antibiotics, and a kind of osteoporosis/bone health medication which is taken once a month (from before all this).
do you have any advice on what is going on, or what she should do? thank you!
MEDICAL PROFESSIONAL
Sorry to hear about your mom.
Yes, its possible that there's a fracture that can't be seen on an x-ray. Unfortunately x-rays are a two dimensional picture of a three dimensional object and things can be hidden due to the overlap, especially a crack since it can run the wrong way and won't show up. I would have been suspicious of a possible crack due to the lack of a cavity and the symptom of pain on the tooth. There may have been some history of trauma to the area prior to pain. Did the doctors explain the possibility of a fracture or crack prior to treatment?
Since the root canal did not solve the problem, it is probably assumed that the crack is deep and into an area that can't be repaired underneath the gums. At that point, the tooth can't be saved and would need to be removed to prevent further bone loss and a dental implant (which you had mentioned) could be placed after the bone has healed.
She should probably have the tooth removed or she can get a second opinion from another doctor. They can run some more tests to determine if there's a fracture and it sounds most likely that it'll need to come out.
Yes, its possible that there's a fracture that can't be seen on an x-ray. Unfortunately x-rays are a two dimensional picture of a three dimensional object and things can be hidden due to the overlap, especially a crack since it can run the wrong way and won't show up. I would have been suspicious of a possible crack due to the lack of a cavity and the symptom of pain on the tooth. There may have been some history of trauma to the area prior to pain. Did the doctors explain the possibility of a fracture or crack prior to treatment?
Since the root canal did not solve the problem, it is probably assumed that the crack is deep and into an area that can't be repaired underneath the gums. At that point, the tooth can't be saved and would need to be removed to prevent further bone loss and a dental implant (which you had mentioned) could be placed after the bone has healed.
She should probably have the tooth removed or she can get a second opinion from another doctor. They can run some more tests to determine if there's a fracture and it sounds most likely that it'll need to come out.
thank you for this information and advice -- I will pass it along to her!
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