 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / General / Dentistry / September 2007Time between visits
Situation: I had the first part of a root canal on the last lower molar performed on 7/11/07 by an endodontist who did not complete the job because I was having so much pain he sent me home to wait for six weeks for things to "settle down" which I assume he meant for the root to completely die -he said part of it was not dead. He tried injecting the root directly(very painful) but that did not numb it and he explained the infectious fluid being acidic neutralized the numbing agent(xylocane?). I believe he got all of one branch of the root and most of the second. My six week appointment was postponed because the endodontist had an injury, so it will be exactly two months to the day between visists. In spite of the pain during the procedure, it was not at all painful after it, not even a single ibuprofen was needed, and continues to seem normal. I do not chew on that side as directed. I did take the prescribed Penicillin, though I wonder if I should have held off and taken it only if the infection flared up. Questions: Should I be concerned that the time delay could make things worse in any way? If there are further delays should I be concerned at some point? It would help if we knew the original diagnosis of the problem. If the pulp inside the tooth was diseased but vital when the procedure started, then the delay would give bacteria enough time to finish off the remaining of the pulp and establish themselves in the root canal anatomy as a biofilm that makes treatment more difficult and decreases success rates. However, if I go by your exact words, it seems that what the endodontist encountered was a (relatively rare) phenomenon occurring in multi-rooted teeth, where one root may be infected while another may still contain vital pulp. In this case there is already an established bacterial base in at least one of the roots. These cases should also be treated in a timely fashion when possible. Normally I wouldn't wait 6 weeks before attempting to treat again, but I don't know what your endodontist encountered or the circumstances surrounding that tooth. It's good that you followed his advice and took the penicillin, although remember that penicillin will not affect the bacteria inside your tooth directly since it has no way of getting in there. Lastly, I would suggest discussing your concerns and seeking some reassurance from your endodontist next time you'll see him since he knows much more about your tooth than I can ever hope to learn from my bedroom computer! Regards, George >However, if I go by your exact words, it seems that what the >endodontist encountered was a (relatively rare) phenomenon occurring >in multi-rooted teeth, where one root may be infected while another >may still contain vital pulp. Gotta tell you that I strongly disagree George. See this very often, but then again probably do more endo than the average GP. A quite common presentation is a lower first molar with distal decay into the pulp. Often the distal canal(s) is/are necrotic, the ML is partially necrotic, and the MB is hyperemic and in the final throes of irreversible pulpits. > In this case there is already an >established bacterial base in at least one of the roots. These cases >should also be treated in a timely fashion when possible. In cases like this when intrapulpal anesthesia fails, often intra-bony anesthesia will allow completion of the case with complete patient comfort. If CaOH is placed as an interim RC fill there will be no formation of biofilm and a weepy canal will simply dry up. >Normally I wouldn't wait 6 weeks before attempting to treat again, but >I don't know what your endodontist encountered or the circumstances >surrounding that tooth. Agree that 6 weeks is a rather long time but removing any biofilm is no more difficult than treating any other necrotic canal. A little EDTA (only at first), copious irrigation with Hypochlorite, complete and thorough instrumentation and a final rinse with Chlorhexidine (let it sit for 2 min) before obturation and any canal can be sanitized. To answer the OP's question, the time frame shouldn't pose any significant problem. On Aug 26, 4:05 am, New...@bix.nex wrote: > >However, if I go by your exact words, it seems that what the > >endodontist encountered was a (relatively rare) phenomenon occurring [quoted text clipped - 4 lines] > See this very often, but then again probably do more > endo than the average GP. I have no reason to doubt you, but I haven't seen more than a handful of such cases in the last few years. An interesting thing I've noticed (purely anecdotal of course) is that the state at which the pulp is when symptoms become apparent may depend on the progress rate of caries. When I used to practice in your average area, I would usually see endo cases that came with already established periapical lesions as the result of caries. Now that I'm practicing in slums where most people brush twice a year and are addicted to junk food, most of the endos I see start as pulpitis as a result of rapidly progressing caries. It would be interesting to compare this to other people's experiences. Regards, George > In cases like this when intrapulpal anesthesia fails, often intra-bony > anesthesia will allow completion of the case with complete patient > comfort. IME, it is almost always successful (Stabident). Steve >> In cases like this when intrapulpal anesthesia fails, often intra-bony >> anesthesia will allow completion of the case with complete patient [quoted text clipped - 3 lines] > >Steve Am using X-tip, same concept and boy does it work ! >>IME, it is almost always successful (Stabident). >> >>Steve > > Am using X-tip, same concept and boy does it work ! Either (Stabident or X-tip) system will do the job. The X-tip is a little more expensive, but considering you may only use one once or twice a month, the costs would be minimal. You don't have to 'hunt for the hole' as with the Stabident. When I use all of my Stabidents (may take a year or two), I may give the X-tips another try. I'll add another regular injection once on a 'hard to numb' case. If that doesn't do it, the Stabident is next in line. D For the second injection,,,,,,,,,,, use a different chemical. That helps a lot. I always place the second injection Gow Gates and into the sphenoid spaces. Works 100% of the time. I have not yet had to open the new box of X-Tips with this technique.  Signature/ Amatus / > >>>IME, it is almost always successful (Stabident). [quoted text clipped - 14 lines] > > D Would love to see you do this, am familiar with Gow-Gates but am uncertain about the spenoid spaces concept. How about a training video ? :-) >For the second injection,,,,,,,,,,, use a different chemical. That helps a >lot. I always place the second injection Gow Gates and into the sphenoid [quoted text clipped - 18 lines] >> >> D Basically just a posterior superior block,,,,,,,,,, aim Superior, Dorsal and Medially,,,,,,,,,,,, make sure you aspirate carefully. Signature/ Amatus / > > Would love to see you do this, am familiar with Gow-Gates [quoted text clipped - 26 lines] >>> >>> D So are we aiming deep, medially, and superior to the hamular notch ? Any landmarks ? How deep is the needle penetration ? >Basically just a posterior superior block,,,,,,,,,, aim Superior, Dorsal and >Medially,,,,,,,,,,,, make sure you aspirate carefully. [quoted text clipped - 28 lines] >>>> >>>> D You end up with the tip almost even with an imaginary line about 1/3 the width of the palate. I have about 2/3 of a long needle in the tissues. You almost aim for the opposite TMJ. Insertion is behind Hamular notch. Up and back and medial from there. Look at a dried skull. You are aiming for the foramen the mandibular nerve first comes out of. Signature/ Amatus / > > So are we aiming deep, medially, and superior to the hamular notch ? [quoted text clipped - 36 lines] >>>>> >>>>> D >You end up with the tip almost even with an imaginary line about 1/3 the >width of the palate. I have about 2/3 of a long needle in the tissues. [quoted text clipped - 3 lines] >Look at a dried skull. You are aiming for the foramen the mandibular nerve >first comes out of. Thanks, will do. Now where did I leave my skull ? <hehe> > You end up with the tip almost even with an imaginary line about 1/3 the > width of the palate. I have about 2/3 of a long needle in the tissues. [quoted text clipped - 3 lines] > Look at a dried skull. You are aiming for the foramen the mandibular nerve > first comes out of. Aren't you the guy who doesn't do Div. II blocks through the greater palatine foramen? ;-) Steve yup, I don't like trying to get the needle directly into the canal. Tissues are rather fixed in there. I prefer to place the needle where tissue have more give. Or, where you are only likely to stab the nerve sheath of a minor accessory nerve along the hard palate. Signature/ Amatus / >> You end up with the tip almost even with an imaginary line about 1/3 the >> width of the palate. I have about 2/3 of a long needle in the tissues. [quoted text clipped - 9 lines] > ;-) > Steve Don't know what your missin' Great for endo and extractions (with marcaine). :-) D > yup, I don't like trying to get the needle directly into the canal. > Tissues are rather fixed in there. I prefer to place the needle where > tissue have more give. Or, where you are only likely to stab the nerve > sheath of a minor accessory nerve along the hard palate. >>>IME, it is almost always successful (Stabident). >>> [quoted text clipped - 13 lines] > >D I also use an intraligamentary syringe on lower first and second molars in the "hot tooth' situation. If that doesn't work... X-tip. Don't use it very often but it's a nice option to have. On 26 Agu, 10:05, New...@bix.nex wrote: > >However, if I go by your exact words, it seems that what the > >endodontist encountered was a (relatively rare) phenomenon occurring [quoted text clipped - 32 lines] > To answer the OP's question, the time frame shouldn't pose any > significant problem. hai im from indonesia i like to offer my company product " AIRAN " which made from fresh milk and fermented with lactobacilus caucassus please visit us at :http://www.airan-sehat.com or contact me at agung4grd@yahoo.com > It would help if we knew the original diagnosis of the problem. If the > pulp inside the tooth was diseased but vital when the procedure [quoted text clipped - 21 lines] > Regards, > George hai im from indonesia i like to offer my company product " AIRAN " which made from fresh milk and fermented with lactobacilus caucassus please visit us at :http://www.airan-sehat.com or contact me at agung4grd@yahoo.com >Questions: > >Should I be concerned that the time delay could make things worse in >any way? If you haven't read my other post yet, the answer is no. >If there are further delays should I be concerned at some point? Again no. Standard accepted endodontic treament in the US for canals that cannot be obturated <filled> right away is to place Calcium Hydroxide [CaOH2) as a temporary canal filling material. You were treated by an Endodontist, a specialist, so it is very likely that this is the case. Recently finished a case that had internal resorption that was packed with CaOH2 for ~3 years. (the material was changed out at 6 mo. intervals however) The patient did not have any symptoms during that time frame and all is well. So in summary, as the Aussies say: "No worries, mate." Thanks to both of you for your help. But could you please define some of your terms, like biofilm, EDTA, internal resorption, intra-bony anesthesia and MB is hyperemic and in the final throes of irreversible pulpits. About the only thing I understood is the "No worries, mate" which is the most important thing, but would be nice to understand the rest Bill. On Aug 26, 3:34 pm, billsahi...@yahoo.com wrote: > Thanks to both of you for your help. But could you please define some > of your terms, like biofilm, EDTA, internal resorption, intra-bony [quoted text clipped - 4 lines] > > Bill. Most of these terms don't have a direct impact on your case. Discussions here between professionals tend to be full of dental "jargon". But if you're interested here goes: Biofilm = a complex society of closely associated microrganisms held together by an adhsesive/protective matrix. Bacteria in a biofilm are much more resistant to treatment than free-floating bacteria (plaktonic bacteria). Biofilms usually need time to develop and mature. The plaque forming on your teeth if you stop brushing is an example of a biofilm. EDTA = ethylenediamine tetraacetic acid. It's a chelating agent commonly used to irrigate the root canals during treatment to remove debris. Also has many other uses in general medicine. Internal resorption = Destruction of root structure by living cells attacking it. Internal means that it happens from the inside out. Intraosseous anaesthesia = Technique for delivery of the local anaesthetic solution. Since the solution is delivered inside the bone, it is much more effective, so it's generally used for teeth that are hard to numb otherwise. There are a number of systems used, which generally involve a perforator attached to a motor that pierces the bone in the desired location. MB = Mesiobuccal canal, one of the root canals found in multi-rooted molars. It's facing towards the side of your cheek (buccal) and towards the front of the mouth (mesial). Hyperemic = Has increased blood flow, typical during inflammation. Irreversible pulpitis = Inflammation of the pulp inside the tooth that will not resolve on its own and will eventually lead to death of the pulp. Regards, George Thanks George. >On Aug 26, 3:34 pm, billsahi...@yahoo.com wrote: >> Thanks to both of you for your help. But could you please define some [quoted text clipped - 38 lines] >Regards, >George On 26 Agu, 01:44, billsahi...@yahoo.com wrote: > Situation: > [quoted text clipped - 20 lines] > > If there are further delays should I be concerned at some point? hai im from indonesia i like to offer my company product " AIRAN " which made from fresh milk and fermented with lactobacilus caucassus please visit us at :http://www.airan-sehat.com or contact me at agung4grd@yahoo.com On Aug 26, 2:44 am, billsahi...@yahoo.com wrote: > Situation: > [quoted text clipped - 20 lines] > > If there are further delays should I be concerned at some point? There was probably pus in the pulp chamber. No amount of LA would have worked. Under such circumstances, I would open drain the tooth for a day. No need to leave it open though. Maybe for the severe cellulitis which is migrating towards the neck and pus continues to drain after 10 minutes of suction, but those cases only come around once every ten years. Signature/ Amatus / > On Aug 26, 2:44 am, billsahi...@yahoo.com wrote: >> Situation: [quoted text clipped - 25 lines] > worked. Under such circumstances, I would open drain the tooth for a > day. |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.