Have a fistula on gum of tooth#3 which was root canaled twice

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USA2Elsewhere

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I noticed swelling on my gum above this tooth. Dentist says I need the tooth extracted. Not sure I'm going to use this office because I was not offered LA before a test was done on the tooth and fistula (gutta percha test) and it was painful. Mom has used this dentist and has not had LA and had pain here also. How long do I have to choose a dentist before the infection gets too bad. Very nervous older lady here.
 
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geos

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I’m not a dentist, but isn’t the gutta percha test to test the vitality of your tooth? If it is, I don’t think LA would be advisable since you won’t feel the reaction of your tooth.
 
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No, the GP is to find out which tooth the fistula is coming from. It can be a bit uncomfortable without local.

You're probably OK for a few weeks if there's no other symptoms apart from the fistula, the infection will drain out of that and keep things stable for a while. It's not advisable to leave it for months otherwise the fistula will remain even after the tooth is gone.
 
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I’m not a dentist, but isn’t the gutta percha test to test the vitality of your tooth? If it is, I don’t think LA would be advisable since you won’t feel the reaction of your tooth.
I’m not a dentist, but isn’t the gutta percha test to test the vitality of your tooth? If it is, I don’t think LA would be advisable since you won’t feel the reaction of your tooth.
Hi Geos, the gutta percha is to "trace" the infection from the opening of the fistula into the tooth. The xray then shows a line all the way to the end of the infection. Not sure the infection is actually in the form of a "line" but it shows them where it is and proves the bad tooth is truly the one next to the fistula and therefore that's the tooth that needs to be treated.
 
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No, the GP is to find out which tooth the fistula is coming from. It can be a bit uncomfortable without local.

You're probably OK for a few weeks if there's no other symptoms apart from the fistula, the infection will drain out of that and keep things stable for a while. It's not advisable to leave it for months otherwise the fistula will remain even after the tooth is gone.
Dr. Gordon, thank you for your answer. Is this gutta percha test normally done WITHOUT LA???? As I said my mom had pain at this office too. Why would they give us this surprise and shock of unexpected pain?????? Would endodontic treatment be enough to get rid of the infection, at least to buy more time to find a dentist? I'm not sure of the one I've made an appointment with? THank you.
 
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Hi USA2Elsewhere,

sorry to read about how unpleasant your visit was.. I have no idea about LA and gutta percha test, but if there is anything unpleasant involved, the dentist should have forewarned you.. nobody likes painful surprises.. :( hope you can find a dentist you trust soon..
 
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Enarete, you read my mind. My mom also had no idea of the rough sensations and pain she was going to experience and she wishes she had not used this dentist. The last two dentists my mom used for her implants were not referred to her but we went only by reviews and a consultation. The first dentist had a lot of trouble removing her tooth and had her mouth open for two hours and gave her a cocktail of bleedingreducing drugs that other dentists later thought was suspicious and overkill. Fortunately when I used this dentist it was for simpler things. I felt we both should have been forewarned but at least the first doctor offered us LA and we never felt extreme force. The doctor I went to that I described in my first post was the second dentist we went to going only by reviews and this was the one who caused mom pain and was rough, no LA offered and no forewarning. I am going to an endodontist who did my last root canal and he was referred by other dentists.
 
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Dr. Gordon, thank you for your answer. Is this gutta percha test normally done WITHOUT LA???? As I said my mom had pain at this office too. Why would they give us this surprise and shock of unexpected pain?????? Would endodontic treatment be enough to get rid of the infection, at least to buy more time to find a dentist? I'm not sure of the one I've made an appointment with? THank you.

Personally, I would warn the patient that it could be uncomfortable, agree a "STOP" signal and then put in local if required.

I thought from your title that the tooth has had RCT done twice already? Another re-treatment might help but I'd be very doubtful. The specialist endodontist will have a better idea if it'll help from seeing your x-rays.
 
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In general anesthesia isn’t used as the procedure just doesn’t hurt much. Of course different doctors and different patients may need anesthesia
 
Enarete

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Enarete, you read my mind. My mom also had no idea of the rough sensations and pain she was going to experience and she wishes she had not used this dentist. The last two dentists my mom used for her implants were not referred to her but we went only by reviews and a consultation. The first dentist had a lot of trouble removing her tooth and had her mouth open for two hours and gave her a cocktail of bleedingreducing drugs that other dentists later thought was suspicious and overkill. Fortunately when I used this dentist it was for simpler things. I felt we both should have been forewarned but at least the first doctor offered us LA and we never felt extreme force. The doctor I went to that I described in my first post was the second dentist we went to going only by reviews and this was the one who caused mom pain and was rough, no LA offered and no forewarning. I am going to an endodontist who did my last root canal and he was referred by other dentists.

Sorry to read about what happened to your mom. I will keep my fingers crossed for you to find a good therapy option with your endodontist and hopefully be treated in a way that makes you feel cared for.
 
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Personally, I would warn the patient that it could be uncomfortable, agree a "STOP" signal and then put in local if required.
I thought from your title that the tooth has had RCT done twice already? Another re-treatment might help but I'd be very doubtful. The specialist endodontist will have a better idea if it'll help from seeing your x-rays.

Hi Gordon, Yes, this tooth had 2 root canal treatments, about 18 years apart. I'm grasping at straws thinking back to the endodontist telling me that the first root canal wasn't properly done and the post was found fallen down. "I don't know what your dentist was trying to do....." and hoping the second root canal can be counted as the first. So I'm hoping if not another root canal then an apioectomy because I think only one root is infected, at least that's what mom told me she heard. I'd like to keep the tooth long enough to get one of the first stem cell treatments that is supposed to make the tooth stronger, rather than cleaning it out and filling it basically. Wondering if whatever I need can be done with no or minimal epinephrine because last time I had it for a skin procedure, I felt cold and shaky for about a minute. I always fear whatever I feel may not go away. Have very bad health anxiety.
 
Gordon

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The chances of success would depend a lot on why it's failed, so without examining you and your x-rays it's impossible to tell from here.

However, bear in mind that the success rate of an implant is extremely high and very well proven now... probably not much more expensive than the endo retreat/apicectomy/crown that you're considering.

It's easy to get local without epi, every dentist should have some.
 
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The chances of success would depend a lot on why it's failed, so without examining you and your x-rays it's impossible to tell from here.

However, bear in mind that the success rate of an implant is extremely high and very well proven now... probably not much more expensive than the endo retreat/apicectomy/crown that you're considering.

It's easy to get local without epi, every dentist should have some.
The chances of success would depend a lot on why it's failed, so without examining you and your x-rays it's impossible to tell from here.

However, bear in mind that the success rate of an implant is extremely high and very well proven now... probably not much more expensive than the endo retreat/apicectomy/crown that you're considering.

It's easy to get local without epi, every dentist should have some.

Hi again Gordon, I went to the endo who did the 2nd root canal. Mom and I go to him whenever we need a good 2nd opinion about a dental problem. He confirmed what the general dentist thought by looking at the fistula with a microscope and took an xray but without even touching inside my mouth. No sharp pain without warning like the the general dentist did. He said he was pretty sure it was tooth #3, because that's where the fistula is. He said he could take care of it for now with a root amputation but any time after that another root could crack and the tooth could fall out so he recommends the extraction. He said it may be an easier extraction with the root fracture because that root is no longer attached to the ligament. I would not mind the tooth falling out as long as there couldn't be a situation where I could choke on it. When a tooth falls out, does that remove the need for any extracting? So anyway he referred me to an oral surgeon, someone he said is one of the nicest people he knows and patients love him. So I hope I'm as lucky as it seems. My primary care nurse said if I get epinephrine I have to be monitored throughout. Consult with the oral surgeon is Feb. 25. So far I have 2 votes for no epi needed (including yours) and 1 vote for epi needed. On Friday I noticed what felt like a fish scale caught on the other side of the upper arch between the wisdom tooth and 12 yr old molar. I pulled it out with my finger and some grayish silvery sandy stuff came out with it. THen I noticed it felt rough against my tongue. I think this came from steamed carrots and I have been trying to chew mostly on that side to avoid the fistula on the other side. The widom tooth is root canaled with a crown and the other tooth I think has a filling with no prosthetic crown but it too may be root canaled with crown. So now I have an appointment on Friday -- 15th? with a new general dentist because I'm not too certain about my current dentist because I've heard some negative things about him which seem consistent with him. Thanks again Gordon.
 
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Sorry to read about what happened to your mom. I will keep my fingers crossed for you to find a good therapy option with your endodontist and hopefully be treated in a way that makes you feel cared for.

Enarette
Sorry to read about what happened to your mom. I will keep my fingers crossed for you to find a good therapy option with your endodontist and hopefully be treated in a way that makes you feel cared for.

Enarette, thnks for crossing your fingers. Mom and I both go to our endo when we need second opinions for any kind of dental work because our experiences with him have been very good. There is more in my post to Gordon. The endo agreed with the general dentist but took a regular xray and did not have to even touch inside my mouth.
 
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In general anesthesia isn’t used as the procedure just doesn’t hurt much. Of course different doctors and different patients may need anesthesia
Comfort Dentist, for me to have general anesthesia, I would not be able to walk into the office. I would have to be sedated and carried in. I am terrified of the idea of general. I had it when I was 5 for baby molar removal and that was scary enough. I can't tolerate the idea of having no idea what's going on with me and that's aside from the risks. I have had more types of procedures with local or local with oral sedation than anyone else I've ever known of. I was awake and alert for open breast biopsy, open vulva biopsy, impacted wisdom tooth, under chin liposuction and a small facelift plus more dental work than I want to realize. But I am not happy about the idea of epinephrine since I had a shaky, shivering reaction when I had a tiny revision of my facelift. Also I have white coat hypertension. Thank you.
 
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Comfort Dentist, for me to have general anesthesia, I would not be able to walk into the office. I would have to be sedated and carried in. I am terrified of the idea of general. I had it when I was 5 for baby molar removal and that was scary enough. I can't tolerate the idea of having no idea what's going on with me and that's aside from the risks. I have had more types of procedures with local or local with oral sedation than anyone else I've ever known of. I was awake and alert for open breast biopsy, open vulva biopsy, impacted wisdom tooth, under chin liposuction and a small facelift plus more dental work than I want to realize. But I am not happy about the idea of epinephrine since I had a shaky, shivering reaction when I had a tiny revision of my facelift. Also I have white coat hypertension. Thank you.
Let me clarify:
In general, anesthesia(local) isn’t used as the procedure just doesn’t hurt much. Of course different doctors and different patients may need anesthesia (local injection)
 
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Let me clarify:
In general, anesthesia(local) isn’t used as the procedure just doesn’t hurt much. Of course different doctors and different patients may need anesthesia (local injection)

comfortdentist, thank you. That helped.
 
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USA2Elsewhere

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Personally, I would warn the patient that it could be uncomfortable, agree a "STOP" signal and then put in local if required.

I thought from your title that the tooth has had RCT done twice already? Another re-treatment might help but I'd be very doubtful. The specialist endodontist will have a better idea if it'll help from seeing your x-rays.

Gordon, the endo referred me to an oral sugeon for a consult. The endo took an xray and said the same as the general dentist. He added that the fractured root was not attached (at least not completely) to the ligament and that should make it an easier extraction but the tooth could come out in pieces.
 
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comfortdentist

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FYI I just removed a fractured root from a lower molar a few months ago. She has been a patient of mine for many years. For years the tooth and bone was fine then she started to have pain. I was suspicious of a crack. The intraoral x-ray didn't show much bone loss. A CBCT showed bone loss along the length of the front root. Consistent with a cracked tooth. I removed the tooth and there was considerable bone loss. I grafted the area and she now has a great deal of bone so the implant surgery will be easy for me.
 
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FYI I just removed a fractured root from a lower molar a few months ago. She has been a patient of mine for many years. For years the tooth and bone was fine then she started to have pain. I was suspicious of a crack. The intraoral x-ray didn't show much bone loss. A CBCT showed bone loss along the length of the front root. Consistent with a cracked tooth. I removed the tooth and there was considerable bone loss. I grafted the area and she now has a great deal of bone so the implant surgery will be easy for me.
Comfortdentist, very good job you did! Glad the implant is well set up for you. What is a CBCT?
 
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