Steroid prescription for an apico?

[MountainMama]

My endodontist said I need an apico on my front upper tooth that had a root canal in October. It has still had pain, and I have had sinus issues on that side. She said what I thought was a canker sore developing is most likely a fistula.

She said that because I cannot take ibuprofen, due to my stomach ulcer, I need to take a steroid (she prescribed Medrol), to control swelling. I looked it up and side effects include stomach pain and stomach bleeding! I sent an email to my doctor for advisement, but wanted to ask the dentists here:

It is necessary to have an anti-inflammatory with an apico? Can I skip it or will that deter healing?

 

[Judythecat]

No advice, but bloody hell, sorry to hear you’re in this position. You are having such a rough time.

 

[MountainMama]

My doctor emailed back and said to double my ulcer medication for the week prior, the week of, and the week after the use of the steroids. She said it wasn't preferable, but if the endodontist said I needed them, I should take them. She said to let her know immediately if I had any stomach pain or bleeding. This really scares me, especially since I developed the ulcer from the anti-inflammatory meds after the last apico (that didn't work).

I know the apico is better than extraction and replacement, but I am really in a panic right now about how I am going to manage this. I can't use nitrous since they are working close to my nose. I don't want a valium, which is my other option, because being out of control is one of my biggest fears. With nitrous, I could breathe through my mouth if I felt too out of it, and as them to turn it down. IV sedation isn't an option there.

 

[MountainMama]

No advice, but bloody hell, sorry to hear you’re in this position. You are having such a rough time.

Thanks. Everything just seems to be spiraling down right now.

 

[SallyUK]

Sorry to read your update - I'm still waiting on an appointment to see what is happening with two front teeth post root canal. I have a sinus tract/fistula as well I really don't know about the procedure you are having, only from a quick google.

I only mention that at one point, my dentist mentioned tracing where the fistula went to, in order to fully determine the source of infection. I believe he said that because I have two teeth that initially showed symptoms, confusing and he's not convinced the issue is with the tooth I had root canaled. I have not had this tracing procedure yet but wondered if you had? It seems like maybe a good step to take before you go through with next procedure.

 

[MountainMama]

Sorry to read your update - I'm still waiting on an appointment to see what is happening with two front teeth post root canal. I have a sinus tract/fistula as well I really don't know about the procedure you are having, only from a quick google.

I only mention that at one point, my dentist mentioned tracing where the fistula went to, in order to fully determine the source of infection. I believe he said that because I have two teeth that initially showed symptoms, confusing and he's not convinced the issue is with the tooth I had root canaled. I have not had this tracing procedure yet but wondered if you had? It seems like maybe a good step to take before you go through with next procedure.

She did a cone beam scan at the end of the appointment, and said that it would show where the infection was, but that she was confident that the apico would solve the issue. She felt around to see where the source of pain was as well. I don't know enough to know whether the apico is the next step or not.

 

[SallyUK]

Good that you are confident this will solve things, wishing you good luck - when are you having it?

 

[MountainMama]

Good that you are confident this will solve things, wishing you good luck - when are you having it?

The endo is confident. I don't know that I am. I am super nervous since the last one I had failed. It was on a molar, though.

The procedure is in 2 weeks.

 

[MountainMama]

Sorry to read your update - I'm still waiting on an appointment to see what is happening with two front teeth post root canal. I have a sinus tract/fistula as well I really don't know about the procedure you are having, only from a quick google.

I only mention that at one point, my dentist mentioned tracing where the fistula went to, in order to fully determine the source of infection. I believe he said that because I have two teeth that initially showed symptoms, confusing and he's not convinced the issue is with the tooth I had root canaled. I have not had this tracing procedure yet but wondered if you had? It seems like maybe a good step to take before you go through with next procedure.

I hope they can figure yours out. My tooth was abscessed before the root canal, so the endo thinks the abscess never fully healed. Plus I had an open apex from a childhood injury and she said that usually needs an apico to seal the open end.

The uncertainty is awful!

 

[Kns]

Oh I am so sorry! You have had so much to deal with! I had my first premolar root canaled in March (finished in May). It has hurt to the touch since June. (This was after nearly a year of monthly visits to the dentist and endo complaining of pain. First said it was a tiny cavity that shouldn’t be causing me pain. Had it filled and it felt worse and odd, like a squeezing pain. Nearly a year later after being told it was “inconclusive”, I convinced my endo to root canal it.) I have gone back three times since the root canal was finished and had a CBCT scan. No infection found. Endo said he wouldn’t recommend a retreat; an apico only had a 50% chance of taking away the pain; I should hope it goes away or see a neurologist amd if it doesn’t go away or becomes intolerable to just do an implant.

I understand your dilemma as it would show if I had an extraction and implants are so expensive. And when the experts don’t have any answers for what is causing pain, how do you know what to do? Maybe yours is more simple, though, if your endo is confident that an apico will help. Also, I am allergic to NSAIDs, so inflammation and post operative pain/swelling is always something I worry about. Hopefully you will be able to get through this easily and it will finally put the pain and dental issues in the past for you! Did your endo explain the results of the cone beam scan to you like you hoped?

 

[MountainMama]

Oh I am so sorry! You have had so much to deal with! I had my first premolar root canaled in March (finished in May). It has hurt to the touch since June. (This was after nearly a year of monthly visits to the dentist and endo complaining of pain. First said it was a tiny cavity that shouldn’t be causing me pain. Had it filled and it felt worse and odd, like a squeezing pain. Nearly a year later after being told it was “inconclusive”, I convinced my endo to root canal it.) I have gone back three times since the root canal was finished and had a CBCT scan. No infection found. Endo said he wouldn’t recommend a retreat; an apico only had a 50% chance of taking away the pain; I should hope it goes away or see a neurologist amd if it doesn’t go away or becomes intolerable to just do an implant.

I understand your dilemma as it would show if I had an extraction and implants are so expensive. And when the experts don’t have any answers for what is causing pain, how do you know what to do? Maybe yours is more simple, though, if your endo is confident that an apico will help. Also, I am allergic to NSAIDs, so inflammation and post operative pain/swelling is always something I worry about. Hopefully you will be able to get through this easily and it will finally put the pain and dental issues in the past for you! Did your endo explain the results of the cone beam scan to you like you hoped?

Thank you for the kind words. No, the endo did not explain the cone beam. She had one of the techs do the scan right at the end of the consult. That is one reason I am hesitant. It seems like the apico is a cookie cutter treatment for the next step after a root canal fails. She is supposed to be the best in the area, and her office is the only endodontic office within a 2 hour radius, so I can't get a second opinion. (They won't do them in the same office).

 

[comfortdentist]

I haven't used steroids for an apico. So you swell for a few days I think it's no big deal. The surgery on a maxillary front tooth is one of the easiest apicos you can have done.

 

[MountainMama]

I haven't used steroids for an apico. So you swell for a few days I think it's no big deal. The surgery on a maxillary front tooth is one of the easiest apicos you can have done.

That is what I needed to hear. I wanted to know if the swelling would be bad enough to deter healing or make it worse. I can handle some swelling. I think I will tell the endodontist I would like to skip the steroids. My doctor did message me back and told me the steroids would not thin the stomach lining like the NSAIDs, and would just possibly increase acid production, so it won't necessarily make the ulcer worse, but could aggravate it.

Thank you so much for your reply.

 

[Gordon]

I agree with Dr K, I wouldn't worry about steroids for an apicectomy. A bit of ice afterwards will help manage any swelling.
You sure they couldn't manage to give you some RA perhaps with a nasal cannula instead of a mask?

 

[MountainMama]

I agree with Dr K, I wouldn't worry about steroids for an apicectomy. A bit of ice afterwards will help manage any swelling.
You sure they couldn't manage to give you some RA perhaps with a nasal cannula instead of a mask?

Thank you for the confirmation as well. I had two molar extractions with only tylenol and an ice pack, and I would think this wouldn't be much worse, would it? I am considering just not taking them even if the endodontist says I have to. I don't have to work the next day, and then it is the weekend, so I have 3 solid days to recover.

I asked if there was any way to get nitrous and she said no. They only have the masks. I am trying to reassure myself it will be fine. Everyone keeps saying it will be easier than the molar apico. I worry about pain, since the nitrous helps me relax so the numbing works more efficiently.

 

[Gordon]

It's really hard to say regarding swelling, it can vary spectacularly between different cases and different types of surgery, chances are it won't be a big deal.
Yes, it will be a whole lot easier than a molar apicectomy, both to numb and to do for the dentist.