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Medical Forum / General / Dentistry / July 2006Tooth infection
I had swollen gums on the lower left side and pain while chewing. The periodontist suspected fracture and took x-rays which did not reveal any fractures but he said that fractures may not necessarily show up. He then numbed the area and cleaned it. While cleaning, he said he noticed some bone loss near the root of lower left second molar and that food was probably getting stuck in the pockets. He prescribed antibiotics for abscess and will check again in a week. Most of the gum swelling has already gone and chewing pain has decreased. If the tooth is infected, does that mean that a root canal or extraction is always necessary or is it possible for tooth infection to heal on its own without surgery? And does bone loss always require surgery? > I had swollen gums on the lower left side and pain while chewing. > [quoted text clipped - 15 lines] > > And does bone loss always require surgery? You can certainly get a periodontal abscess, which doesn't involve the pulp (and therefore doesn't require a root canal) until very late, at which time the tooth is probably a goner. Bone loss does not always require surgery. Surgery is usually aimed at reducing the depth of periodontal pockets, improve the shape and conformation of the underlying bone, and sometimes to increase the level at which the gum attaches to the tooth and occasionally to graft to increase bone support. You say you are going to a periodontist--he should be able and willing to go into detail on this. Good luck, Steve  SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Yes, I will ask on my next visit. My confusion is on the diagnosis of "abscess". If I understand correctly, "abcess" can refer to a gum infection as well as to an infection of the tooth and both can exhibit the same symptoms. I will ask the periodontist if the infection involves the tooth or just the gums. I am not sure how the tooth infection diagnosis is made (do x-rays reveal that?) > > I had swollen gums on the lower left side and pain while chewing. > > [quoted text clipped - 35 lines] > Brooklyn, NY > 718-258-5001 > Yes, I will ask on my next visit. > [quoted text clipped - 6 lines] > I am not sure how the tooth infection diagnosis is made (do x-rays > reveal that?) Frequently. The diagnosis is usually made by a combination of clinical and x-ray findings. Steve >>>I had swollen gums on the lower left side and pain while chewing. >>> [quoted text clipped - 35 lines] >>Brooklyn, NY >>718-258-5001 > You can certainly get a periodontal abscess, which doesn't involve the > pulp (and therefore doesn't require a root canal) until very late, at [quoted text clipped - 9 lines] > Good luck, > Steve Yes, I have re-visited the periodontist He said that it is not a fracture or a pulp infection. He says there is bone loss, on tooth #18, between the roots. He is able to poke inside; he should not be able to do that with healthy teeth.He also showed me a dark spot on X-ray, indicating hole in the bone. This forms a pocket for bacteriaand causes gum inflammation. He says I willI need to have bone grafting surgery. He said that the surgery was not 100% guaranteed to succeed. I then asked what the chances were and he said 80%.. I learned that the surgery would not hurt. The alternative to surgery is to remove the tooth. I think I got the picture and will probably go with bone grafting procedure. But I guess it would be a good idea to seek a second opinion before choosing bone grafting surgery. >> You can certainly get a periodontal abscess, which doesn't involve the >>pulp (and therefore doesn't require a root canal) until very late, at [quoted text clipped - 32 lines] > But I guess it would be a good idea to seek a second opinion before > choosing bone grafting surgery. Reasonable to seek a second opinion, but you'd probably need a workup from any new periodontist. Your periodontist's assessment sounds reasonable from here. Thanks for the update, Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 > >> You can certainly get a periodontal abscess, which doesn't involve the > >>pulp (and therefore doesn't require a root canal) until very late, at [quoted text clipped - 35 lines] > Reasonable to seek a second opinion, but you'd probably need a workup > from any new periodontist. Thanks for the response. I am not sure what you mean by "workup". Does that mean surgery? Allso, a new question came to mind after my last visit. (My next appointment is in 2 weeks). The orthodontist mentioned the 2 options: Bone graft surgery or extraction of tooth #18. I am wondering. If the tooth is removed, how does that solve the problem of the periodontal pocket? Won't the peridontal pocket continue to cause problems (plaque buildup and swollen gums) even if the tooth is removed? Could bone graft surgery still be required even if the tooth is removed? > Thanks for the response. > > I am not sure what you mean by "workup". Does that mean surgery? It means exam, any needed x-rays (you may be able to provide recent copies from your current dentist, evaluation and consultation. > Allso, a new question came to mind after my last visit. (My next > appointment is in 2 weeks). The orthodontist mentioned the 2 options: > Bone graft surgery or extraction of tooth #18. > > I am wondering. If the tooth is removed, how does that solve the > problem of the periodontal pocket? I'm assuming you mean periodontist and not orthodontist. The intent of the bone graft is apparently to "shore up" the bone support of the tooth and allow it to be retained. A periodontal infection is around (perio) the tooth (dontal). If there is no tooth, the infection will resolve. Of course, the tooth will be gone. > Won't the peridontal pocket continue to cause problems (plaque buildup > and swollen gums) even if the tooth is removed? > > Could bone graft surgery still be required even if the tooth is removed? Good question. If replacement of the tooth with and implant-retained prosthesis is being considered, you may well still need a bone graft. Steve SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thanks. I will discuss with the periodontist on my next visit because I am still not clear on why the removal of the tooth would resolve the infection. My understanding is that the infection is in the gums and that the tooth is OK -- I only have pain from the swollen gums around the tooth (when I chew), not really the tooth itself. The swollen gums are caused by plaque build-up in the periodontal pocket. So it seems like the swollen gums problem will continue to remain even if the tooth is removed and no prosthesis implanted. I don't see how removal of the tooth resolves the gum infection. > > Thanks for the response. > > [quoted text clipped - 31 lines] > Brooklyn, NY > 718-258-5001 > Thanks. I will discuss with the periodontist on my next visit because > I am still not clear on why the removal of the tooth would resolve the [quoted text clipped - 7 lines] > > I don't see how removal of the tooth resolves the gum infection. The infection resides in the space between the tooth and gum, and follows the contours of the root. If you're talking about tooth #18, usually there are two roots, more often than not separated by a space. This is a fertile breeding ground for infection esp. in those with a pre-existing periodontal infection. When the tooth is removed, the infection will drain and the socket will heal from the bottom up. There is no more space between the tooth and gum--because there's no tooth. Resolving the infection is easy; what isn't so easy is saving the tooth and getting it in salvageable shape. HTH, Steve >>>Thanks for the response. >>> [quoted text clipped - 31 lines] >>Brooklyn, NY >>718-258-5001 SignatureMark & Steven Bornfeld DDS http://www.dentaltwins.com Brooklyn, NY 718-258-5001 Thanks for the reply. I have bad news update. I went in to the periodontist today for scheduled bone graft surgery on tooth #18. (I decided to go ahead without a second opinion). After administering the anaesthesia he noticed that the tooth is cracked and said that there was nothing that can be done to save the tooth. I am upset because I had thought there was a chance of saving the tooth and wondering why the crack was not detected when I was having pain and took X-rays/ periodontal cleaning 2-3 weeks ago. The diagnosis at that point was that there was no fracture and the recommended treatment was bone graft surgery with 80% chance of saving the tooth. When I asked about this, the periodontist said that the crack may have been there 3 weeks ago but not visible. Is it possible for a crack not to have been visible a short time ago and now cracked so severe that the tooth is untreatable? If the crack was detected 3 weeks ago, could the tooth have been saved? I am very dissapointed. I will need to consult with my general dentist but I guess there is no hope of saving the tooth. Periodontist notes to my general dentist: "Vertical crown fracture running M-->D. Not restorable. Recommend extraction" > > Thanks. I will discuss with the periodontist on my next visit because > > I am still not clear on why the removal of the tooth would resolve the [quoted text clipped - 62 lines] > Brooklyn, NY > 718-258-5001 > Thanks for the reply. > [quoted text clipped - 26 lines] > "Vertical crown fracture running M-->D. Not restorable. Recommend > extraction" Sadly, unless separated, these fractures usually CANNOT be seen on x-ray. Sometimes their presence can be inferred from bone loss patterns on x-ray, but your situation is quite common, unfortunately. Three weeks wouldn't have made a difference, except you may have done dentistry in a vain attempt to save a hopeless tooth. Sorry, Steve >>>Thanks. I will discuss with the periodontist on my next visit because >>>I am still not clear on why the removal of the tooth would resolve the [quoted text clipped - 62 lines] >>Brooklyn, NY >>718-258-5001 I have seen some articles about saving fractured tooth. Do they have any validity? Are there any specific dentists that I can consult with that practice these type of tooth-saving procedures when most other dentists recommend extraction? http://www.mynewsmile.com/fracturedtooth.htm Abstract: When a vertical tooth fracture extends below the gingival attachment, the recommended treatment has been extraction.[1][2][3][4][5][6] As asserted by Walton, after the diagnosis of a split tooth is confirmed, saving the tooth is not an option. "Maintaining an intact tooth is impossible," the text explains. "If the fracture is severe (that is, deep apically), the tooth must be extracted. If the fracture shears to a root surface that is not too far apical, the smaller segment will be very mobile. Then there is a good possibility that the small segment can be removed and the remainder of the tooth salvaged."[1] The rationale is that when a fracture extends from the supragingival area to below the attachment, the fracture line can become a nidus for progressive inflammation. As stated by Simon, Glick and Frank, "Once this attachment is breached and the groove becomes involved, a self-sustaining infrabony pocket can be formed along its length. This condition is nonresponsive to periodontal treatment."[7] This paper will challenge these assertions by offering literature citations and long-term case studies of up to twenty years which show conditions under which a split or fractured tooth can be completely salvaged, intact and fully healthy. > > Thanks for the reply. > > [quoted text clipped - 102 lines] > >>Brooklyn, NY > >>718-258-5001 > I have seen some articles about saving fractured tooth. Do they have > any validity? [quoted text clipped - 28 lines] > conditions under which a split or fractured tooth can be completely > salvaged, intact and fully healthy. The crux is the extent of the fracture. It is sometimes possible in an oblique fracture to do a crown lengthening procedure where the gum overlying the fracture is removed, and the smaller fractured segment is removed as well. But if the fracture is vertical this is not possible, as removing the fractured segment would require too much bone as well to leave anything behind that is restoratively useful. I have heard of early fractures being treated by crowns, which can function to hold the fractured segments together. But this will only work if the fracture hasn't extended under the gum and esp. under the bone. I'd have to see you to say for sure, but based on what the periodontist said (and my experience with mesio-distal fractures in molars through the marginal ridges) this fracture is way too late--and as I said, if there is a picture of periodontal bone loss that can be related to this fracture, it's almost certain that 3 weeks ago the story wouldn't have been any different. Steve >>>Thanks for the reply. >>> [quoted text clipped - 102 lines] >>>>Brooklyn, NY >>>>718-258-5001 Usually if "you tap the tooth and it hurts," its a per-apical or "around the apex, or root tip" type infection. If it is a periodontal abscess, that's between the teeth. Of course, abscess = bacterial infection. Joel a.k.a. "Mr. 'if you tap it and it hurts, its an abscess." This is my moniker given to me by Carlo or Carlos ... I fergit his name. He is one of the musical dentists -- Joel34 |
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