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Fear of upcoming treatment

J

jim39

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I have just suffered a traumatic extraction of a bottom premolar and i was devastated to learn shortly afterwards that i now need further treatment on an upper molar. Either an extraction or root canal.

I have multiple worries about the root canal.

I dont like being reclined so far back as i have reflux and anxiety.

My main concern is nerve damage. I have suffered it before from dental work and it seems to be hard to avoid.

Then theres sinus complications if the sodium hypochlorite goes beyond the apex. Theres also the problem of saliva pooling in my throat. They dont seem to understand that even with suction, saliva still pools.

And i dont know if i can keep my jaw open for so long and I suffer anxiety too.

Will they be able to numb this upper molar with buccal infiltration only? How do i know if they wont accidentally do a PSA block?

will i be allowed to swallow during the procedure? They dont seem to understand that i physically cant swallow unless my teeth touch and that means i cant swallow while my mouth is open.

Can they quickly open up the tooth then remove all four canals very quickly before sealing it up with a temporary and perhaps i can come back to finish it off?

There are so many fears i am considering extraction but that comes with the complication of sinus damage plus i wont be able to chew properly. I already have a missing tooth on the lower right.

I feel like the list of things that could go wrong is so long that at least one thing will go wrong. I have had root canal before but that was on a singe root tooth whereas this has four roots, is right at the back where its hard to reach and the previous root canal was when the first nerve damage happened.
 
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Gordon

Gordon

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I can't answer all your questions, but I'll do my best.

1) Reclining the chair will let the dentist see what they're doing better which will probably improve the chances of the treatment working. Best thing is to try to come to a compromise between you and your dentist
2) Nerve damage is exceptionally rare and is in fact pretty easy to avoid
3) You'd have to have the manual dexterity of a gorilla to get hypo into the sinus from a first molar. With apologies to gorillas :)
4) Sounds like some sedation might be a huge help for you
5) Yes, if you do an "accidental" PSA block you need serious help. It's a very difficult injection to perform and a large number of general dentists have never done one in practice
6) Up to a point, but there will be times when it's critical to the success of the procedure that you keep your mouth open. Again some kind of compromise would be an idea
7) Not really. The main thing is to clean out the canals with disinfectant and files, this is going to take some time.

Extraction of an upper first molar is very unlikely to cause sinus damage, we're back to gorillas doing dentistry again :)

You'll be able to chew fine with or without this tooth.
 
J

jim39

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it was actually the upper second molar next to my wisdom tooth which needs treatment. Would that still make everything youve said true? about the sinus damage and the chewing?

could they allow me to periodically close my mouth everytime the saliva builds up? the suction doesnt remove all the saliva and I probably couldnt remove it myself either.

can they recline me so that i am partly sitting up? when you say recline, do you mean they would need to put my head at a lower level than my feet?

Can you tell me why it is impossible or unlikely for a PSA block to be done by accident instead of an infiltration? I have read that they are done in the same location.

Also years ago when they did my upper canine root canal, the injections somehow made that entire side of my face go numb right up to below my eye. What happened there?

thanks
 
Gordon

Gordon

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Yes, more so in fact, the 2nd molar is further away from the sinus.
As I said, closing your mouth would be best agreed between you and your dentist, there are times when you simply shouldn't or else things will be messed up, so there needs to be a compromise.

If you have access to the saliva suction tube yourself and an assistant is using the high volume suction, you should be able to control saliva pretty well though.

The partly sitting up bit is what I meant, no I don't mean they'd need to put your head below your feet.

PSA block needs to be done with a long needle and put into a very different location to the infiltration injection, which we generally use a short needle for.

WARNING VERY GORY IMAGE BELOW
























1617206618460.png

Do you see the roots on the molar in the photo? That's the area an infiltration is placed, the needle in the photo is angled for a PSA Block. It's about a cm short of the PSA so needs to be advanced a bit further still. You can see that there's no way you could accidentally perform a PSA Block instead of an infiltration.


When they were doing the injection for the canine they've gone a bit too far in with the injection and frozen the infra-orbital branch of the trigeminal nerve. No real harm done, it just gives a wider area of anaesthetic than desirable.
 
J

jim39

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A couple of other things that have been worrying me are that I have read that it is rare but possible to suffer permanent blindness if the needle hits the wrong area as there are optical nerves in that area.

The other thing is I have a permanent cold feeling in my hard palate following that root canal they did on the upper canine years ago. This is presumably nerve damage of some sort. I am worried that if they did a palate injection again, it could make this worse.

Can they numb the tooth with just buccal infiltration plus intra ligamental if needed?

Also I had a premolar extraction a few weeks ago using a mental nerve block. After the extraction the anesthesia wore off quickly but now i have a faint but noticeable cold sensation on my chin that comes and goes. It tends to be triggered when i start touching my chin. Is this another permanent thing?
 
Gordon

Gordon

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Where did you read that, it's absolute nonsense :)

The optic nerve comes out of the back of the eyeball through a small foramen (a tunnel basically) and then straight into the brain. It would take unimaginable levels of incompetence for a dentist to get anywhere near it while attempting to put a buccal infiltration into a molar.

You certainly won't need a palatal injection to do a molar root treatment. Buccal infiltration would be fine.

No idea, it's nothing I've ever heard of happening before so I don't have a clue, sorry.
 
J

jim39

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Gordon

Gordon

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They anaesthetised some of the motor nerves by mistake, it causes some temporary issues, double vision and trouble blinking, but no chance of loss of sight. The temporary issues are generally completely gone in a couple of hours as the local wears off.

I still don't understand why you think a general dentist is going to be doing a PSD block for a simple root canal or extraction?

An x-ray might give some information but it's only a 2D photo, so it isn't definitive.

It actually doesn't matter that much in the long run if the roots are within the sinus, 99% of the time any oral/sinus connection will spontaneously repair itself and needs no intervention at all, the remainder are a simple bit of surgery to fix.
 
J

jim39

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Ive seen this video and it looks like they are injecting directly above the second molar to carry out this PSA block.

she says the injection point is distal of second molar at the height of the vestibule.

That sounds like where the infiltration would also go?
 
Gordon

Gordon

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I showed you on the anatomical slide where the injection has to go. The PSA is delivered round the back of the last molar, with a long needle. Typical buccal infiltration for a 2nd molar is a good 2cm further forward and delivered just into the mucosa with a short needle. Utterly different technique.
I'm curious as to why you seem to have such an obsession with the subject? As the patient it makes pretty much no difference what kind of injection you're getting.
 
J

jim39

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I ended up having a filling on this upper molar. The problem is it was very deep so now I am concerned about if and when it might go bad in which case it will need to be extracted. How long do I wait to know if the filling was successful?

I have some additional anxieties too. I noticed following the infiltration injection that my upper lip on the same side along with the palate too became tingly. Is this the normal area that would be affected by an infiltration to this tooth?
and it wasnt just numbness I felt, I also felt a burning sensation on those areas too.

Also i came across this:

.

which talks about the toxicity of white fillings. I would have thought there is a small amount of leaching over time which wouldnt be toxic but the article seems to be more pessimistic. What is your view?
 
Gordon

Gordon

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Usually if the tooth is going to fail after a filling it does it pretty quickly, within 48hrs. Occasionally they can take a bit longer but as a rule of thumb, if it's OK for the first week it'll be fine.
Yes, the nerves around that area are a bit of a tangle, so the numbness can spread a few cm either side of the injection area, it's no big deal.

The article is really concerned with the effects on the nerve (pulp) tissues, not the systemic effects. There's considerable debate within dentistry over how "bad" all different filling materials are towards the pulp, the situation changes regularly and I'm probably out of date now, since I've been retired over 3 years.

Systemic toxicity is really not a big deal with composites, we've got over 60 years of data from composite use now, with billions of applications annually, we'd have seen problems with them before now.
 
J

jim39

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I have noticed now an unpleasant bitter/ metallic taste in my mouth which wont go away and is making me anxious. What could be causing this? He used a lining under the composite white filling. If I feel the filling with my tongue it does have a metallic taste so I assume it must be coming from this filling.
 
Gordon

Gordon

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Not knowing what was used for the filling makes that one kind of hard to answer, you'd be better asking the dentist, sorry.
 
J

jim39

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here is the xray of the upper molar with cavity. It looks like it may need to be removed after all

but it does look like it is right into the sinuses. So will extraction cause unavoidable damage to the sinus floor?

what will be required to repair it? why is perforation such a concern since the gums will seal the hole?
 

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Gordon

Gordon

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Sinus perforation is not a big deal at all, see my response a few messages back. We routinely go into the sinus to move the floor up out of the way to get implants in for example.

If it occurs (and it's by no means certain, x-rays are not definitive) then well over 95% need no treatment at all, the sinus heals spontaneously in a few weeks. In the remainder, then basically the hole is closed by moving a bit of gum over it and stitching it in place.

The biggest issue is that it's a bit annoying for the patient, you can't suck properly, so smokers for instance find that the smoke doesn't get drawn into the lungs the way they want, using a straw isn't possible either.
 
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