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Scared of needing apicoectomy! Had recent re treat.

J

Jmh552

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I have never really had dental fears until the root canal saga that has come into my life 9 months ago! I accidentally hit my front tooth, number 9 beginning of the year (so mad at myself). Had to have a root canal and it never healed. Was in pain daily, was pain on pressure and talking was agony. Gums in front of tooth started to swell come May but no pimple of drainage. Back incisive papilla started to swell come July. Went to my endo and just had retreatment done. It was done in two sittings. Filled with medicine and then finished it up. I’m about a week and a half out from re treatment and still in pain. Gums still swollen and tooth still hurts to pressure and talking. Would never dare bite into anything! If it’s not good in 4 weeks endo wants to do an apico. And I’m terrified. Got two second options and all have advised not to pull tooth yet as x rays looks okay. Not huge abscess or crack. One threw out it could be a neuralgia? I don’t think so. It’s the tooth. I’m terrified of the apico and just need this pain to go away. It’s been a terrible 9 months and taking a toll on my mental health. I can’t imagine doing the apico and then it still not being right. I’ve had cbct and no known fractures. Everything on x Ray looks good. My endo is great and I trust them. When she went in for retreat there was still drainage and inflammation. Had anyone had a successful apico and can calm my fears on this?????
 
M

MountainMama

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Yikes, sorry you are going through this. I hope someone can give you a success story.

I had a similar situation with tooth #8, but the injury happened at childhood. It abscessed last year, when I didn't even know the tooth had died. My root canal failed, and the apico failed. However, my endodontist had told me that the front tooth apico was the easiest and most successful one. Mine likely failed due to the size of the abscess. Not all the infection was removed. Yours may be very successful, since you don't have an abscess. The apico itself was not terrible. I couldn't even really tell what the endodontist was doing most of the time. If you have more questions about what it is like, I can answer them.

I can tell you, though, that if the worst happens,as it did with me, it isn't the end of the world. I had my tooth out two weeks ago and the surgeon manually removed the infection. He was able to remove the tooth and infection, do extensive bone grafting, and put in an implant all in the same surgery. I am already healing very well and have a temporary flipper until the implant integrates with the bone. I actually feel better than I have since all this started, which is a relief.

I can totally sympathize with you, though, on the neverending pain for months on end.
 
J

Jmh552

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Messages
19
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Yikes, sorry you are going through this. I hope someone can give you a success story.

I had a similar situation with tooth #8, but the injury happened at childhood. It abscessed last year, when I didn't even know the tooth had died. My root canal failed, and the apico failed. However, my endodontist had told me that the front tooth apico was the easiest and most successful one. Mine likely failed due to the size of the abscess. Not all the infection was removed. Yours may be very successful, since you don't have an abscess. The apico itself was not terrible. I couldn't even really tell what the endodontist was doing most of the time. If you have more questions about what it is like, I can answer them.

I can tell you, though, that if the worst happens,as it did with me, it isn't the end of the world. I had my tooth out two weeks ago and the surgeon manually removed the infection. He was able to remove the tooth and infection, do extensive bone grafting, and put in an implant all in the same surgery. I am already healing very well and have a temporary flipper until the implant integrates with the bone. I actually feel better than I have since all this started, which is a relief.

I can totally sympathize with you, though, on the neverending pain for months on end.
Thank you so much for your reply. I am so glad you are finally finding relief. That is great! So happy for you. Thanks for sharing your experience. After your apico did you just have the same pain? I am so scared to go through all that to still be in pain. I got the opinion of an oral surgeon this week and he said he found nothing wrong during exam or x Ray so he wouldn’t recommend or do an extraction at this point. Then he said the pain can still be there after extraction which I don’t understand. Just so frustrating because it’s really impacting my quality of life and I just want it to be fixed and seems it never will. I want to save the tooth since I’m the front and I like my smile but I just don’t know how much longer I can take it.
 
M

MountainMama

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Thank you so much for your reply. I am so glad you are finally finding relief. That is great! So happy for you. Thanks for sharing your experience. After your apico did you just have the same pain? I am so scared to go through all that to still be in pain. I got the opinion of an oral surgeon this week and he said he found nothing wrong during exam or x Ray so he wouldn’t recommend or do an extraction at this point. Then he said the pain can still be there after extraction which I don’t understand. Just so frustrating because it’s really impacting my quality of life and I just want it to be fixed and seems it never will. I want to save the tooth since I’m the front and I like my smile but I just don’t know how much longer I can take it.
I understand, believe me. My endodontist is the best in the area and she told me that mine was the first apico she had fail on a front tooth. It really bothered her, and she offered to open me up and go in again for free, which I turned down. She also mentioned neuralgia as a possibility.

After the apico, (after healing), the pain was gone for about two weeks, then the same pain came back. I don't know what your pain was like, but mine hurt with any pressure on the tooth, and I had pain alongside my nose. I actually had thought it was a sinus issue and saw an ENT. He showed me on the x ray where the infection was pressing on the trigeminal nerve, and my sinuses were clear. He is actually the one who told me I should have the tooth removed and get the infection manually removed. At that point the endodontist was still trying to save my tooth. She put me on antibiotics, clindamycin, since I had been on amoxicillin after the apico. The clindamycin actually helped a lot. It took away the pain when my tooth had pressure applied, but it did not take away the pain alongside my nose, and I had pain behind the tooth, in the palate area. I saw the oral surgeon, who told me that, given the fact that the clindamycin hadn't worked, it indicated that the infection would keep coming back as long as the tooth was in there, even though x rays showed a perfect root canal, with no leaking. I was so tired of the pain at that point that I decided not to keep trying to save it. I also didn't want to fix it now only to have it flare up again later.

You have to do what you are comfortable with. You won't get relief from the pain until the infection is completely gone, and the apico may do that for you. Yes, it really stinks when you shell out the money and it doesn't work, but dental work doesn't have a 100% guarantee. There are so many factors that the dentist/endodontist/surgeon can't control or can't anticipate.
 
J

Jmh552

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Joined
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Messages
19
Location
US
I understand, believe me. My endodontist is the best in the area and she told me that mine was the first apico she had fail on a front tooth. It really bothered her, and she offered to open me up and go in again for free, which I turned down. She also mentioned neuralgia as a possibility.

After the apico, (after healing), the pain was gone for about two weeks, then the same pain came back. I don't know what your pain was like, but mine hurt with any pressure on the tooth, and I had pain alongside my nose. I actually had thought it was a sinus issue and saw an ENT. He showed me on the x ray where the infection was pressing on the trigeminal nerve, and my sinuses were clear. He is actually the one who told me I should have the tooth removed and get the infection manually removed. At that point the endodontist was still trying to save my tooth. She put me on antibiotics, clindamycin, since I had been on amoxicillin after the apico. The clindamycin actually helped a lot. It took away the pain when my tooth had pressure applied, but it did not take away the pain alongside my nose, and I had pain behind the tooth, in the palate area. I saw the oral surgeon, who told me that, given the fact that the clindamycin hadn't worked, it indicated that the infection would keep coming back as long as the tooth was in there, even though x rays showed a perfect root canal, with no leaking. I was so tired of the pain at that point that I decided not to keep trying to save it. I also didn't want to fix it now only to have it flare up again later.

You have to do what you are comfortable with. You won't get relief from the pain until the infection is completely gone, and the apico may do that for you. Yes, it really stinks when you shell out the money and it doesn't work, but dental work doesn't have a 100% guarantee. There are so many factors that the dentist/endodontist/surgeon can't control or can't anticipate.
Wow...you are speaking to me!!! That is exactly where my pain is...behind the front tooth in the palate area. I can’t even touch that palate area when I talk. My Endodontists at first was saying she didn’t think it was related with pain in palate but it has to be. I keep telling her that’s where my pain is. She said it may be related. She said that is not usually where people see pain. That’s exactly where my pain is and still burning under my nose but no one can see anything on an x Ray. I almost wish someone would see something on an x day so I can an answer.

Did they tell you with extraction you may not find pain relief? My endo and oral surgeon both said that. And the oral surgeon said he would not pull
This tooth right now due to seeing nothing on an x Ray. Which give me no hope I will ever have relief.

I have never had any tooth issues and just so angry at myself in the first place and I can’t believe all this has turned into. Thanks so much for your kindness. Feeling pretty low lately due to all this but I appreciate your support.
 
M

MountainMama

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Have you had a 3D x ray done? The reason I ask is that on regular x rays, my abscess looked like just a small spot at the root of the tooth, so my dentist did the root canal, thinking it would fix things. After the root canal, she kept saying the x rays showed a perfect root canal, and it was just taking time to heal. I finally asked to be referred to the endodontist after 4 months with no improvement.

The endodontist did the 3D x ray after the root canal failed and found that the infection actually tunneled backwards, behind the tooth. The biggest part of the infection didn't even show up on a regular x ray. She made a comment about how she usually didn't do the 3D x rays for an apico, but she was glad she did, as she wouldn't have seen that until she got in there. She did say that if it was neuralgia, extraction would not take the pain away.

Then when the apico failed, the oral surgeon did another 3D x ray, as it had been 4 months since the last one. He could see that there was still spots behind the tooth. He said removing the tooth would take away the pain. So far it has been two and a half weeks and I have not had pain in that area at all.
 
J

Jmh552

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Sep 26, 2019
Messages
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Location
US
Have you had a 3D x ray done? The reason I ask is that on regular x rays, my abscess looked like just a small spot at the root of the tooth, so my dentist did the root canal, thinking it would fix things. After the root canal, she kept saying the x rays showed a perfect root canal, and it was just taking time to heal. I finally asked to be referred to the endodontist after 4 months with no improvement.

The endodontist did the 3D x ray after the root canal failed and found that the infection actually tunneled backwards, behind the tooth. The biggest part of the infection didn't even show up on a regular x ray. She made a comment about how she usually didn't do the 3D x rays for an apico, but she was glad she did, as she wouldn't have seen that until she got in there. She did say that if it was neuralgia, extraction would not take the pain away.

Then when the apico failed, the oral surgeon did another 3D x ray, as it had been 4 months since the last one. He could see that there was still spots behind the tooth. He said removing the tooth would take away the pain. So far it has been two and a half weeks and I have not had pain in that area at all.

Wow I am so glad you have found relief. I have had the 3d x ray and the oral surgeon did not see anything wrong which that is why he said he would not take the tooth out. I just know something is wrong though and it isn’t a neuralgia. I know it is the tooth. I have never had any teeth issues since this accident and this has been a nightmare. How long until you and your endo decided the apico failed?
 
M

MountainMama

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Well, to be honest, I made the decision. The endodontist wanted to go back in (through the original apico hole, which had healed but still had the bone gone), and try to clean it out again. She also wanted to do more rounds of antibiotics, which I had enough of. It was 6 months from the apico to when I said I had enough and was ready to get the tooth out.
It is always better to preserve the tooth if possible, but as my oral surgeon told me, the patient is the only one who can decide if they can deal with the pain or not.

Maybe get a second opinion from a different oral surgeon. Ultimately it is your mouth and you have to make the decision. I went through almost a full year of pain from that tooth, with a few weeks relief right after treatment or antibiotics, but it always came back. Honestly, I would never have an apico again, but that was just my experience of having two root canals and two apicos, on two different teeth fail. One was a molar, and I knew it had a lower chance of success. I did not want to lose my front tooth, but it certainly feels so much better now. I can't wait to get the implant crown in 4 months so that this whole deal is over.
 
J

Jmh552

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Well, to be honest, I made the decision. The endodontist wanted to go back in (through the original apico hole, which had healed but still had the bone gone), and try to clean it out again. She also wanted to do more rounds of antibiotics, which I had enough of. It was 6 months from the apico to when I said I had enough and was ready to get the tooth out.
It is always better to preserve the tooth if possible, but as my oral surgeon told me, the patient is the only one who can decide if they can deal with the pain or not.

Maybe get a second opinion from a different oral surgeon. Ultimately it is your mouth and you have to make the decision. I went through almost a full year of pain from that tooth, with a few weeks relief right after treatment or antibiotics, but it always came back. Honestly, I would never have an apico again, but that was just my experience of having two root canals and two apicos, on two different teeth fail. One was a molar, and I knew it had a lower chance of success. I did not want to lose my front tooth, but it certainly feels so much better now. I can't wait to get the implant crown in 4 months so that this whole deal is over.

Yes...your insight is great. Thank you so much. I am so glad you are feeling better. Your story gives me hope one day it will be okay. Yeah, maybe a different oral surgeon would have a different option. I don’t want to lose my front tooth either but not sure if I want to go through the apico and then potential extraction down the road. Yeah I think you are right...ultimately it is my decision and I have to decide what to do in order to move on with my life. Thank you so much for your insight.
 
M

MountainMama

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Good luck! I know I wish I had consulted with the ENT and oral surgeon before going through with the apico, as they both had told me differently than the endodontist. A second opinion is always good if you are doubting the treatment presented. At least it gives you confidence that you explored all options.

Update and let us know what you decide.
 
J

Jmh552

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Good luck! I know I wish I had consulted with the ENT and oral surgeon before going through with the apico, as they both had told me differently than the endodontist. A second opinion is always good if you are doubting the treatment presented. At least it gives you confidence that you explored all options.

Update and let us know what you decide.
Thank you so much. I will keep you posted. I really don’t want to apico but obviously since I’m hurting so bad there is still something there. Maybe another oral surgeon opinion would be good. I just want to be done with it and get my life back. All this also caused me to have tmj and clench at night also not making matters better. I just got some expensive splints made but the night one is too tight on my front tooth. He tried to adjust best he could but I don’t think it’s going to work at all. It just hurts the tooth too bad.

One last question...with your implant did they tell you that you needed to protect it from grinding and clenching and wear a guard?
 
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MountainMama

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Thank you so much. I will keep you posted. I really don’t want to apico but obviously since I’m hurting so bad there is still something there. Maybe another oral surgeon opinion would be good. I just want to be done with it and get my life back. All this also caused me to have tmj and clench at night also not making matters better. I just got some expensive splints made but the night one is too tight on my front tooth. He tried to adjust best he could but I don’t think it’s going to work at all. It just hurts the tooth too bad.

One last question...with your implant did they tell you that you needed to protect it from grinding and clenching and wear a guard?
I have a nightguard as well. I had it made before I had the tooth out, and had the exact same issue with it hurting the front tooth. I also was clenching from stress. My dentist ended up completely hollowing out where the front tooth was so nothing was touching it. It will also allow me to wear it after the implant crown is placed. Once the crown is placed though, the tooth is sturdy just like a real tooth.

I do have to be cautious of the implant but it isn't like I can't do anything. The oral surgeon buried the implant and placed a membrane over it, so it is protected until it integrates into the bone. I have a flipper, which he adjusted so that it doesn't put too much pressure on the implant or bone grafting. I walked out of the extraction/implant surgery with the flipper in, so I never had to go without a tooth.
 
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Jmh552

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I have a nightguard as well. I had it made before I had the tooth out, and had the exact same issue with it hurting the front tooth. I also was clenching from stress. My dentist ended up completely hollowing out where the front tooth was so nothing was touching it. It will also allow me to wear it after the implant crown is placed. Once the crown is placed though, the tooth is sturdy just like a real tooth.

I do have to be cautious of the implant but it isn't like I can't do anything. The oral surgeon buried the implant and placed a membrane over it, so it is protected until it integrates into the bone. I have a flipper, which he adjusted so that it doesn't put too much pressure on the implant or bone grafting. I walked out of the extraction/implant surgery with the flipper in, so I never had to go without a tooth.

Wow our stories are so similar!!!!!! Yeah he adjusted as much as he could be I think it’s still going to be too tight on the front tooth. I just got it today. I’m just nervous it’s still too tight. I will keep you posted on everything. Thanks for your kindness.
 
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MountainMama

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I really hope you can get a definitive answer that you are comfortable with.

Oh, and I had my nightguard adjusted three times, so don't feel bad if you have to go back and get it adjusted again. Those things are expensive and you want to be able to wear it. My dentist used that carbon paper stuff (don't know what it is called) to make sure there was no contact the last time.
 
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Jmh552

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I really hope you can get a definitive answer that you are comfortable with.

Oh, and I had my nightguard adjusted three times, so don't feel bad if you have to go back and get it adjusted again. Those things are expensive and you want to be able to wear it. My dentist used that carbon paper stuff (don't know what it is called) to make sure there was no contact the last time.
Was your night guard by any chance on the top or the bottom? I have one for the bottom that we hollowed out so front tooth would not touch but was hurting my jaw so I went to more of a tmj specific one with a specialist but this needs to go on the top. Just having any pressure of the guard on the top tooth though is not going to work. He made it looser but it still is not going to fly.
 
M

MountainMama

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Mine is on the top. I couldn't get one for the bottom since I have a missing molar that is getting an implant.

My dentist was eventually able to make it work with the front tooth. He had to hollow out a huge area.
 
A

AshNaz

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I was thinking about this discussion more over the weekend and wanted to know what you all think about my concerns below and/or how you dealt with this.

I have an ongoing issue with an extraction site that doesnt appear to be healing well (just taking a long time, but apparently not infected) and then (likely related) clenching of my teeth at night and, to boot - the tooth next to it (IMO) is failing.
So - I have three things going on which I think I can address with the dentist and specialist that I am seeing - BUT I personally think that it will involve medication for the pain I am having, night guard to deal with the clenching, and extraction of my molar (I am not interested in a root canal for this particular tooth).

However, I keep running into an issue, where I feel like I am not necessarily being heard (and I do like both of these Drs.) and/or expected to keep waiting and waiting. I get that they are experts in what they do and that they want to save every tooth and I respect that - BUT this molar that I want pulled is not resolving and I cant even brush it due to the pain. We have run the tests - pressure sensitive, tap sensitive, numb the area the tooth is fine AND this tooth has a fish hook root and is jammed back into my small mouth where there is really no room.

SO......how did you finally get to - we are not saving this tooth - we are pulling it and moving on to an implant, etc. to preserve function. I am just frustrated beyond belief at the time delays that this has and the financial implications of appointment after appointment and procedure after procedure. Any insight that you can draw from to help me understand how you all approached this?
 
M

MountainMama

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I was thinking about this discussion more over the weekend and wanted to know what you all think about my concerns below and/or how you dealt with this.

I have an ongoing issue with an extraction site that doesnt appear to be healing well (just taking a long time, but apparently not infected) and then (likely related) clenching of my teeth at night and, to boot - the tooth next to it (IMO) is failing.
So - I have three things going on which I think I can address with the dentist and specialist that I am seeing - BUT I personally think that it will involve medication for the pain I am having, night guard to deal with the clenching, and extraction of my molar (I am not interested in a root canal for this particular tooth).

However, I keep running into an issue, where I feel like I am not necessarily being heard (and I do like both of these Drs.) and/or expected to keep waiting and waiting. I get that they are experts in what they do and that they want to save every tooth and I respect that - BUT this molar that I want pulled is not resolving and I cant even brush it due to the pain. We have run the tests - pressure sensitive, tap sensitive, numb the area the tooth is fine AND this tooth has a fish hook root and is jammed back into my small mouth where there is really no room.

SO......how did you finally get to - we are not saving this tooth - we are pulling it and moving on to an implant, etc. to preserve function. I am just frustrated beyond belief at the time delays that this has and the financial implications of appointment after appointment and procedure after procedure. Any insight that you can draw from to help me understand how you all approached this?
I just told the endodontist that I had enough and I was done. I think I had a lot of sympathy, though, due to the fact that I had two failed root canals, so she understood where I was coming from. She wanted to try more but I couldn't deal.

Ultimately it is your mouth, not theirs. Yes, they try to save teeth, but if you want it out, you should be able to get it out. When my lower 2nd molar started having pain, but no signs of infection on an x ray, my dentist and endodontist pushed a root canal, since it showed up reacting to the cold test. This was after one failed root canal, and while the front tooth was still "healing" from a root canal. I flat out refused and said I wanted it out. No one argued with me, as I had no uncertainty about it. I was referred to the surgeon.

Maybe ask for a referral to the oral surgeon to get another opinion. Or if you don't need a referral, just call and make an appointment. Tell them the situation and ask about extraction.
 
A

AshNaz

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Yes - thank you. I think that is what I need to do.
I need to stop feeling like an experiment and counting down from one thing to another to see what may happen.
 
J

Jmh552

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Yes - thank you. I think that is what I need to do.
I need to stop feeling like an experiment and counting down from one thing to another to see what may happen.
I understand your pain. I am so sorry you are going through this. I am too still waiting on answers and my tooth continues to hurt and the gums around it. Both my oral surgeon and endo have thrown out the works neuralgia and atypical ondontaglia to me which makes me scared to just pull it. Not sure if they hAve mentioned that to you? This is so confusing and hopeless it feels, I am right there with you.
 
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