redo root canal or pull tooth

[ljd]

Hi,

I had a root canal on #14 in March of 06 and an apico in May of 07.   I have been dealing on and off with a fistula since then.  After many consultations without much information, I finally went to an endodontist who have me a 60-70% chance of success to redo the root canal.  My question is with this infection happening for the last 21/2 years, how safe is it for a root canal?  I am worried about the bacteria traveling in my body.  The doctor did say he would start me on penicillan for 3 days before the root canal. Is it better to just pull the tooth?  Is there less chance of the infection traveling?  Thanks for any advice.

[Jerome Tsang, DDS]

Good question.  The reason why the fistula probably isn't bothering right now is because as the infection grows and produces pus, it drains out of your fistula into your mouth.  If the fistula ever closes though or gets plugged, then there is no escape for the pus and it'll swell inside your jaw and can cause a severe abscess or swelling, or it may attempt to leave through another space in your head which can be very dangerous.  

The reason why antibiotics don't work well with the jaw bone or any bone is that the blood flow is poor to the area and hence the antbiotics are not as effective in fighting off an infection.  If you had a better blood supply, you body might even be able to fight it off without antibiotics.

[DaniRoss]

I just found out yesterday that I have a fistula from a root canal that was done over a year ago.  It doesn't bother me except for a little swelling of the gum around that tooth, but it comes and goes.  The x-rays taken yesterday did show the infected area around the root.  My question is, why can't a fistula be treated with antibiotics?  We treat other infections in our body with antibiotics so why not a fistula?  Thanks.

[Jerome Tsang, DDS]

Well, if you follow the endodontist's recommendation of re-treating the root canal, then the infection should be resolved.  If that is your main concern, there shouldn't be an issue with that.  The only thing I worry about is that if you had a root canal and an apicoectomy in that area and now are getting a retreatment, there must be something extensive going on in the area to require that much treatment.  

I would agree with the endodontist that there's a 60-70% chance of success of a retreatment.  Generally the success rate of a re-treatment can vary in research but I would say 60-70% is a good estimation.  Some say as low as 40%, some say as high as 80%.  But 60-70% seems about the average.

[ljd]

Thank you for your answer.  I would eventually need a new crown and post.
  I have discussed implant, but it is close to the sinus  and one doctor did not think it would be a good idea. I was trying to save my tooth, but now I am not sure it is the best idea.I am worried about the spread of infection since it has been in there for so long.  I have read about dental infections causing serious problems in the body and that is what I am worried about going in and digging around making it spread versus pulling the tooth.

[Jerome Tsang, DDS]

Well, after your consultation with the endodontist, it sounds like there's a 60-70% chance of success in a root canal retreatment.  By definition, if it is successful, the infection should be resolved.  By cleaning the canals and removing the source of bacteria, the body will be able to fight off the infection.  Unfortunately the blood supply/flow to a tooth is poor, hence why the body isn't as effective in healing or removing the infection.  A root canal (or a retreat) will clean the canals again of the bacteria and allow the body to resolve any issues in the bone.  

You may also want to weigh the cost of treatment.  Do you need a new crown, a possible post or core buildup?  These are additional costs that you may want to consider versus getting the tooth removed and placing an implant or bridge or possibly denture if you're missing other teeth.