Failed root canal leaking pus needs to be extracted

[Sky1215]

Hi everyone. My first post here. I am terrified of any dental procedure, so here I am. I have mitral valve prolapse with regurgitation btw. My #31 and #30 teeth had to go through root canal retreatment mid February. #31 is still leaking pus and has a visible fistula. No pain, just gum tenderness from time to time. This tooth had a failed root canal since 2016, so we are talking about a chronic infection. Now, my only option is extraction. The endodontist (who did the retreatment) sent me back to my regular dentist, who suggested I go to an oral surgeon IF I wanted an implant. I went to the oral surgeon but I’m not sure if I want an implant. I need some time to think about it. The oral surgeon wanted IV sedation but I’m scared of complications (just read today a child died during sedation dentistry). He said if not sedation, I need 5 days of clindamycin to take away swelling, because otherwise I can’t be numbed. My dentist says no to clindamycin because I had to use it in February for my root canal retreatments, so he gave me azithromycin to protect my heart (because I asked for it. I know the protocol has changed with ADA). Oral surgeon says clindamycin is safe to use back to back or even for a long time. However, I found an NIH article about it being unsafe. Now, which doctor do I trust? Is clindamycin safe? Why does my dentist seem comfortable with azithromycin plus local anesthesia whereas the oral surgeon claims I will not get numbed like this? I never had an extraction before and I am terrified by the procedure itself as well as who to go with? How painful is root canal treated molar extraction? There’s a suspected fracture at the root tip btw. Please help.

 

[Gordon]

I'm in the UK, not the US (thank goodness) so our guidance will likely be different.

1) In the UK, Clindamycin is reserved as a "last ditch" drug and can cause severe gut problems. IMO there is no reason to prescribe it in your case.
2) You don't need antibiotic cover for your heart issues.
3) I highly doubt you need antibiotics to get the tooth numb. If you did then Azythromycin is fine.
4) I really, really don't think a child died under sedation unless somebody did something extremely wrong. As in potentially criminally wrong...
5) All extractions should be painless, the previous root canal doesn't make any difference.

 

[Sky1215]

Thank you so much.
Is there a preference between a regular dentist and an oral surgeon for a root canal molar extraction? Is this considered a simple or a complex procedure? There is a suspected root fracture.

 

[Gordon]

Tough call, as a general rule, an oral surgeon should be better, all other things being equal.

Root fracture might make things a bit more complex but also might not (sorry!!!), if there's been a fair bit of chronic infection in the area (as it sounds) then there will be less bone supporting the tooth so extraction will be easier.

 

[Sky1215]

Yes, there’s bone loss around the area. I made an appointment with my regular dentist (did not feel comfortable with the clindamycin pushing oral surgeon) for next week. I’m hoping for an easy extraction. Thank you so much!

 

[Gordon]

Good luck, please update us on how you get on.