Bridge / Abscess dilemma

[Tesla]

Hi.

I had a bridge [upper 12,13,14 I think] fixed about 5 months ago abroad, due to a missing tooth [13]. About 2 or so months later I had terrible pain on the side where my bridge is. The pain lasted a few days and the dentist gave me antibiotics. The pain went away, I finished my antibiotics but I got an abscess on my gum which produces puss when I push it [sometimes blood]. The dentist said it is not a fistula but a sinus infection and that the pain would come back even if it doesn’t hurt now. 12 is infected.

In total he gave me 3 options;

Option 1- He said the following; he recommends root canal treatment to save the tooth. Replace bridge in the future or cut bridge and replace in future. But, RCT won’t be straightforward due to the bridge blocking the view and can’t guarantee it will be successful. With the abscess present, RCT is less likely to be successful.

Option 2- extract tooth with abscess and denture to be fitted immediately, cutting the bridge.

Option 3- like 2 but cut the denture, remove the two teeth [12, 13] so there is less burden 14


I will ask you some questions which might sound very dumb, so bear with me…!

-I’m guessing that the X-ray showed the infection hence his recommendation for RCT?

-Is it true that the abscess/infection will not go away? I am in no pain.

-why can’t he take the bridge off and then do RCT so he has no obstructions…and then put the bridge back?

-the dentist mentioned an endodontist for this type of RC through a bridge, but I am an NHS patient and I doubt treatment by endodontists are on the NHS

-I would prefer to avoid extraction for many reasons. Dentures sound silly as I am 33. I looked at implants online and think mini dental implants are a safer option?

- I am aware that the infection might not be resolved with RCT, so if I extracted, have I sorted the infection out completely? I understand you can still get an infection even after an implant!

Sorry for all the questions but I am very confused and just need some advice please! Thanks a lot.

Lastly….Before I make my decision, I am having 2 fillings on my other side and deep gum cleaning as my gums are inflamed.

I can upload a photo of the abscess if it helps?

 

[svor1988]

Hi.

The dentist said it is not a fistula but a sinus infection and that the pain would come back even if it doesn’t hurt now. 12 is infected.

-Is it true that the abscess/infection will not go away? I am in no pain.

Read about the maxillary sinus. Look at how the teeth roots can sometimes perforate that sinus. Since the dentist said it is a sinus infection I expect the xray will show 12 perforating the maxillary sinus. In my experience you don't need antibiotics to treat that infection... irrigating the sinus with salt water 1-2x daily will do. Search for "saline sinus rinse wikihow" for instructions; all you need is salt, tap water, and a cup/bowl, you don't need to buy anything. Read all about your sinus anatomy so you know how to tilt your head around in order to irrigate the maxillary sinus (e.g. Google Image search for "maxillary sinus teeth" and "maxillary sinus ostia"). Don't use too much salt, it can sting. If it stings rinse with just water (no salt) after doing the salt water. You should feel it when the salt water hits the infected area!

Antibiotics won't treat viral infections. Antibiotics never sufficiently cleared out that area for me either... only saline sinus rinses worked.

I'm not sure why your dentist said the infection would never go away. Perhaps he knows something you didn't state here.

Oh now that I think about it... if 12 became infected in the pulp, that would have probably caused the sinus floor to drop so the root(s) are visibly sticking up into the sinus. I think salt water should treat the infection fine. Not sure if your tooth will ever recover though as it had lost its blood supply.

On that note, oral antibiotics wouldn't be able to get into the tooth if the blood vessels no longer get into the tooth... as antibiotics only spread where capillary flow allows. Your remaining pulp should still be infected after oral antibiotic treatment if what I'm thinking is correct (an xray would help). A nasal antibiotic spray/rinse on the other hand... that would be able to get into the tooth... but salt water will do just fine if not better.

-the dentist mentioned an endodontist for this type of RC through a bridge, but I am an NHS patient and I doubt treatment by endodontists are on the NHS

Endodontists have more schooling and have a larger skill set than general practitioners.

From https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872851/

"A comparison of tooth survival rates after endodontic treatment by endodontic specialists vs. general practitioners, in a [36 month long] multi-center study consisting of 350 teeth that met the inclusion criteria, showed a difference of only 98.1% vs. 89.7% (Alley et al., 2004)."​

-I would prefer to avoid extraction for many reasons. Dentures sound silly as I am 33. I looked at implants online and think mini dental implants are a safer option?

- I am aware that the infection might not be resolved with RCT, so if I extracted, have I sorted the infection out completely? I understand you can still get an infection even after an implant!

Yep. In the above link it will talk a lot about that ("peri-implantitis" is their word for implant infection). 20 year success rate for implants was 75.8%. Getting an implant at age 18 was among the worst decisions in my life. If you can afford it, go with the endodontist is my best guess... your medical professionals would best know what to do.

Though I suppose the saline sinus rinse may help the issue? Did your dentist not mention saline sinus rinses to treat the sinus infection?

I have more thoughts but I shouldn't speculate.