What should I do with this tooth?


Joined
Jul 17, 2022
Messages
7
Almost two years ago, a rather large piece of my upper left second premolar broke off. There had been RCT done on it in the past, but no crown was placed afterward. The RCT had to be redone, and the tooth also got a post and core treatment. Sometime before the permanent crown was placed, I had throbbing tooth pain and a periapical infection. My endodontist prescribed me antibiotics, and shortly afterward, the crown was placed on the tooth. I didn't do anything about it for the last one and a half years because an oral surgeon told me to just leave it be, and if it got worse, get it extracted and replaced with an implant. My endodontist, though, believed it needed an endodontic surgery.
Three weeks ago, I got my teeth checked by a dentist, and according to the x-rays, the periapical abscess seems to be still there.
IMG_4536.jpg

My endodontist compared the new x-ray with the old ones he had and told me to leave it be for as long as it works. This tooth had been mostly asymptomatic for the past one and half years but suddenly started having some sort of pain/pressure two weeks ago. The pain almost completely subsided within a few days, but then I got this pimple on my gums. It seemed to be more on the inside of my lips than on my gums.
IMG_6098.HEIC.jpg

I went to a gum surgeon, and she recommended extraction and implant. She also prescribed me some antibiotics for the abscess, but unfortunately, she based her diagnosis only on the x-ray and didn't examine the pimple. After a week, the pimple is no longer there, and the tooth is mainly asymptomatic again.
I seriously don't want to lose this tooth. I'm only 24 and already lost the tooth next to it when I was younger (my first molar), and I also paid a lot of money for the crown, so I really prefer to keep this tooth for as long as possible!:(
What should I do with this tooth?
 
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Joined
Jul 17, 2022
Messages
7
For those interested, I now provide a very long, detailed history of the procedures done on this tooth and the recommended procedures:
  1. Had a root canal treatment by a general dentist sometime in the past with no crown.
  2. A rather large chunk of it broke on October 1, 2020
  3. Went to an endodontist to redo the RCT on October 12, 2020
  4. Went to a restorative dentistry specialist and had a post and core treatment on October 15, 2020
  5. On October 29, 2020, the tooth started having throbbing pain and the x-rays showed there seemed to be a periapical abscess there.
  6. So I went back to my endodontist, and he said I needed an endodontic surgery for my second premolar and might need an RCT done on my first premolar next to it (had a filling due to a deep cavity on September 2, 2020, by a general dentist (not the one in point 1)) after some thermal vitality tests. So he recommended two dentists, a general dentist (not the one in point 1 or the one who did the filling for my first premolar) and a gum surgery specialist, for the surgery. He also prescribed me some antibiotics and told me it should be okay to get the permanent crown placed.
  7. The crown got placed on November 26, 2020, even though I informed the restorative dentist of the abscess.
  8. I went to the general dentist and got an OPG (I still have the OPG, and I can upload it if anyone wants to take a look at it), and he said it needed an apicoectomy. I was afraid of surgery, so I went to the other general dentist mentioned in point 6, and he said the surgery must be done even though it's not worth it and the tooth probably will get extracted anyways. He recommended going to an oral surgery specialist.
  9. On December 14, 2020, I went to the oral surgeon, and he said just leave it be and if it got worse, go down the route of extraction and implant.
Sometime between then and now, it just stopped hurting, and everything was good. So I went to another general dentist (not the one in any of the points before) three weeks ago for a checkup. I told him about my second premolar to ensure everything was fine. He got an x-ray (which I already uploaded in the last post). So he recommended going back to my endodontist or another one to see what can be done about it.
  • I went to another endodontist. The lady at the register showed him the x-ray and told me nothing could be done about it.
  • I went back to the general dentist and told him what he had told me. He said okay, let's extract it then.
  • I panicked and went back to my old general dentist (the one in point 6 who did the filling) to consult with. He said if there's no sign of pain or any fistulization, then just leave it be, but take PA graphs of the tooth every six months to compare it with the old ones.
  • Just to be sure, I went back to my old endodontist (who redid the RCT). He compared the new x-ray with the old ones he had and said if I don't have any pain, then just leave the tooth be.
The problem started when I was obsessing over this tooth that night, and I started pushing around my gums there to see if I really don't have pain anymore. I kept obsessing and "checking" for some time, and that's when I started feeling some kind of pain/pressure. I paid it no mind and thought it was nothing, and the pain actually started subsiding, but then four days later, I had that pimple in my mouth.
  • I went to the gum surgeon (mentioned in point 6), and she said she could do the surgery, but it's not worth it because the abscess is too big, so she recommended extraction and implant. She also prescribed me some antibiotics. The problem is, for whatever reason, she didn't check that pimple on my gums and just looked at the x-ray.
 

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Dr M

Verified Dentist
Joined
May 31, 2019
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Good day

The pimple you are referring to is called a draining sinus. It usually forms after an abscess formation. Before the pimple appears, there is a pressure pain feeling. After the pimple appears, it provides an outlet for the pressure and therefore the pain disappears. The pimple can then disappear and re-appear several times, different in size and sometimes it can actually be very painful. The fact that you have a draining sinus forming is a clear indication that the root canal is failing on the tooth, either to a missed canal, or a crack that is present, which is sometimes only visible on an 3D scan.
You can leave it and monitor the size of the dark area around the root tip, by comparing x-rays, to determine any changes in size of the lesion, which is indication of the abscess enlarging. If it enlarges a lot, it might have an effect on the adjacent teeth. Keep in mind that 1) It is never a good idea to have active infection in your system when looking at your body holistically, and 2) The peri-apical radio-graph provides a 2D image of the area only. The abscess might be enlarging in dimensions not visible on the x-ray.
In the end there is a high likelihood that the tooth needs to be extracted. Sooner or later .
 

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Joined
Jul 17, 2022
Messages
7
Good day

The pimple you are referring to is called a draining sinus. It usually forms after an abscess formation. Before the pimple appears, there is a pressure pain feeling. After the pimple appears, it provides an outlet for the pressure and therefore the pain disappears. The pimple can then disappear and re-appear several times, different in size and sometimes it can actually be very painful. The fact that you have a draining sinus forming is a clear indication that the root canal is failing on the tooth, either to a missed canal, or a crack that is present, which is sometimes only visible on an 3D scan.
You can leave it and monitor the size of the dark area around the root tip, by comparing x-rays, to determine any changes in size of the lesion, which is indication of the abscess enlarging. If it enlarges a lot, it might have an effect on the adjacent teeth. Keep in mind that 1) It is never a good idea to have active infection in your system when looking at your body holistically, and 2) The peri-apical radio-graph provides a 2D image of the area only. The abscess might be enlarging in dimensions not visible on the x-ray.
In the end there is a high likelihood that the tooth needs to be extracted. Sooner or later .
Thank you so much for taking the time to answer my question. I deeply appreciate it.
 

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