Gum infection

[BuckheadJim]

Went to a new dentist in Sept. 22, had full xrays. #10 tooth had a shadow around the roots. This was pointed out to me without any detail as to a problem. Last week, feeling a sensation in that tooth (not pain) I returned to the dentist. Another xray and I was advised this is a gum infection and the tooth has a crack. The tooth was crowned over 30 years ago and there is a post in the tooth. The dentist gave me the option of an implant or bridge. I asked about watching and waiting and she said that was an option, gave me a weeks Rx of Amoxicillan 875 and left the room. Hygenist said I needed to do something soon or I will lose bone and an implant would not be possible.

My concerns are as follows:
If the drugs do not clear the infection, what is next?
How will I know the drugs have worked since there is no pain?
Will the infection come back (as the hygenist said)? Hard for me to see how a cracked tooth within a full crown is causing infection.
How will pulling the tooth correct the infection if the drugs do not work to clear it?

I prefer to keep the crowned tooth but would accept an implant if necessary. 77 years old I am strongly leaning toward a second opinion in a few weeks to give the drugs ample time to cure the infection.

Any help will be greatly appreciated.

 

[Dr M]

Firstly it is important to note that antibiotics is never a solution to any problem. The solution would be to get rid of the source of infection, which in your case is the cracked tooth. The tooth has been root canal treated in order for a post to be present. This could be why you are not experiencing any pain at this stage. It is important to note, that as the infection enlarges, pressure builds and this eventually leads to pain. Any root canal treated tooth is technically a dead tooth, and it becomes brittle over time, so there is always a risk of fracture.
If the tooth is left in situ, with infection that can recur, there is a risk of bone destruction that can take place.

 

[BuckheadJim]

Thanks Dr M. I appreciate your help. May I ask a follow-up question? Must I seek immediate care or does the antibiotic buy me a little time to plan for an implant?

Thanks again.

 

[Dr M]

It does buy you a little time yes. But not forever. Hope this info proves to be helpful.

 

[BuckheadJim]

Thank you.

 

[hollybrown]

It seems you have a lot of questions and concerns about your current situation, BuckheadJim. If the antibiotics do not clear up the infection, your dentist will likely recommend more aggressive treatments such as root canal therapy or tooth extraction. The only way to know if the drugs have worked is to take another x-ray and see if the infection has cleared. The hygienist is correct that if you wait too long, the infection could spread and cause further damage to surrounding tissues or even lead to bone loss. In terms of watching and waiting, it is essential to keep a close eye on the tooth for any changes in symptoms such as pain, swelling, or sensitivity. If the infection does not clear, your dentist may suggest a root canal or extraction, as these treatments can help prevent further damage and the spread of bacteria. It is also vital that you get a second opinion before making any final treatment decisions. This will give you more insight into other options to help with the infection.

 

[BuckheadJim]

It seems you have a lot of questions and concerns about your current situation, BuckheadJim. If the antibiotics do not clear up the infection, your dentist will likely recommend more aggressive treatments such as root canal therapy or tooth extraction. The only way to know if the drugs have worked is to take another x-ray and see if the infection has cleared. The hygienist is correct that if you wait too long, the infection could spread and cause further damage to surrounding tissues or even lead to bone loss. In terms of watching and waiting, it is essential to keep a close eye on the tooth for any changes in symptoms such as pain, swelling, or sensitivity. If the infection does not clear, your dentist may suggest a root canal or extraction, as these treatments can help prevent further damage and the spread of bacteria. It is also vital that you get a second opinion before making any final treatment decisions. This will give you more insight into other options to help with the infection.

I appreciate your thoughts and will definitely seek a second opinion. The proposed cost of an implant from my dentist in excess of $5300 assures that.

In the meantime, can you suggest how long I should wait for a second xray to determine the effectiveness of the antibiotics? I finished the 7 day routine on January 30, AM.

 

[BuckheadJim]

If anyone is interested, I obtained a second opinion and the verdict is quite the same, the tooth needs removal and an implant or bridge is recommended. However, a possible solution not suggested by the first dentist is a surgical procedure known as an apicoectomy. I have been referred to an endodontist and have an appointment on the 23d. While the first dentist says the tooth is cracked (which would rule out the apicoectomy) the second dentist did not find it to be cracked. So I have some possibility of saving the tooth.

I will be seeking further information on the costs of a bridge in the event the surgical procedure is not possible. I have been surprised to find the cost of a bridge to be about the same as an implant (about $5000) as everything I have read suggests the bridge would be much less expensive.

 

[MattKW]

A bridge will usually cost a bit less than an implant, but the pros and cons are different.
Doing a bridge will involve drilling back the adjacent teeth for the crowns (of the bridge), and this carries a 5-10% chance of damaging the "nerve" (pulp) to the extent that you need to do an RCT! You would need a very good reason to do a bridge on teeth that have never been filled and damaged in the past.
Plus, you need the 2 teeth supporting the bridge to be fairly upright because the drilling has to be fairly parallel-sided. This is not always possible.
So, bridges nowadays are much less frequent since implants were developed. I did bridges quite often 40ya when implants were only just becoming useful; I haven't done one for the past 10 years because implants are usually a better choice.
P.S. antibiotics only buy you a little bit of time. It would be like taking antibiotics to "cure" a splinter in your hand. No, you take out the splinter. Maybe an apico is possible, but most RCTs that fail after 30 yrs (esp with a post) are going to be due to a vertical root fracture.

 

[BuckheadJim]

Thank you MattKW. In this case the adjacent teeth already have full metal based crowns. While I dread the thought of having them removed/destroyed for the purpose of a bridge I would think further removal of tooth would be either minimal or unnecessay. I am hoping the endodontist can handle the problem with the infection but if not I will need to make a decision soon. My second dentist recommended the bridge due to the ability to finish the job in short order rather than a multi-month process with the implant. My number 10 tooth is the problem and numbers 8, 9, 10 and 11 currently have full porcelin covered metal crowns. Numbers 8 and 9 are over 30 years old and matching the bridge color to the remaining #8 may be a problem with a bridge.So many things to consider.

 

[MattKW]

Actually, that's quite good. Tooth 10 are always weak teeth, so to have survived 30 years WITH a post is outstanding. Nowadays I often don't crown root-filled 10s, and suggest an extraction and implant instead.
So, yes, I'd do a bridge here; very simple. Just cut off old crowns carefully, tidy up the preparations, and get a bridge. Paralleling will not be a problem. So, something good has come out of your senior age and bashed-up old teeth!
The procedure would be: Take a temporary impression (model) of the 3 crowns still in place, cut off the crowns on 9 and 11, extract the 10, then make temporary bridge from 9-11. You then should wait at least 10 weeks for the wound to heal, and the bone to shrink. Then you take off temp bridge, tidy up preps, take master impn for bridge, make new temp bridge if necessary. 2 weeks later, cement new permanent bridge.
Colour-matching is easier nowadays, too. Many dentists have digital cameras of some sort which makes it easier to communicate to the lab. If the colours are very hard to match, I send the patient to the lab.

 

[BuckheadJim]

Thanks for the additional information. I am not of the belief my dentist plans to use a multi week process to finalize the bridge. I do like the idea of the gum and bone stabilizing before the final work is done and I will surely ask about that.

 

[MattKW]

1. Yes, it is essential to wait. After an extraction, the wound will achieve initial gum healing within 2 weeks. But the bone will collapse slowly (remodel) over 10 weeks until it stabilises. If a permanent bridge is made too quickly after the extraction, then as the bone remodels, you will get an unattractive and annoying gap under the bridge. This would be very unsightly for a front tooth. And that's assuming the tooth comes out easily.
2. Worst case scenario is that your tooth is fragile, and you are not young, so root-filled teeth often fracture, which might necessitate a surgical extraction and loss of even more bone. It may even need a bone graft to rebuild the correct shape before making the permanent bridge.
3. There is no real problem leaving a temporary bridge for this length of time. The only thing is that rather using a soft temporary glue which is only designed to last 2 weeks (for the temp bridge), I suggest the dentist use a semi-permanent glue (zinc phosphate is nice) or a permanent glue. Yes it'll be a bit more fiddly for him in 10 weeks time, but at least it won't fall out until things are ready.

 

[BuckheadJim]

My wife had an appointment with our dentist today and I had her inquire about the time span between temporary and permanent bridge placement. Answer: 8-10 weeks. Makes me feel better about the plan. I still have hopes that I may qualify for the apiocoectomy
and save the tooth. Thanks again for all your information.