What is next if clindamycin doesn't work?

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MountainMama

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#1
The abscess from my front tooth appears to have spread. The endodontist was concerned about a lesion on the x ray, and wants to monitor it. My lateral incisor next to the affected tooth appears to now be compromised as well.

I have had a root canal and an apicoectomy. I have had so many rounds of amoxicillin that I am sure I am resistant at this point. The endodontist prescribed me clindamycin. The front tooth (#8) is going to come out, but she wants to wait and see if the one next to it is compromised before extracting the front one. It hurt with percussion and has a tiny bit of lingering pain after endo ice. The abscess edge was right on the root of the second tooth.

So what is next? If both teeth come out, and the clindamycin doesn't work, what else can be done?

I just am at the point where I want the infection gone, no matter what has to be done. I feel like it is in my sinus on that sidr as well. I have pain on that side, and it hurts to blow if I attempt to even gently blow my nose. In the CBCT, the majority of the abscess was behind the tooth, in the palate.
 
Gordon

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#2
Doomsday scenario would be surgical debridement under GA and IV antibiotics. I can't see it getting near to that stage though!
 
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Doomsday scenario would be surgical debridement under GA and IV antibiotics. I can't see it getting near to that stage though!
I wondered if that would be next. I am a bit worried, as I am on day 5 of the clindamycin and everything still hurts as it did before. No improvement at all.
 
Gordon

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#4
I can't see any advantage in not getting the first extraction done at this point, but I assume your dentist has their reasons.
 
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#5
I can't see any advantage in not getting the first extraction done at this point, but I assume your dentist has their reasons.
The endodontist said if the second tooth is compromised, it would be easier to extract both at the same time, and get fitted for some kind of temporary replacement until I can get implants.

I am choosing not to get another root canal if the other tooth is compromised. After two root canal failures, then two apicoectomy failures, I think root canals are not an option for me anymore.

Would extracting the first one actually help the second? If it will make a differencw, then I may ask about just getting it done. My endodontist didn't say.
 
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#6
I also have a really important business meeting on April 3rd, with prospective clients. I would prefer to not be missing my front tooth. :)
 
Gordon

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The trouble is, you won't know for sure if the lateral incisor is involved or not while there is still acute infection present form the central. The only way to be certain is to remove the central and see what happens...
Take your point about the business meeting though there are ways round it...
 
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The trouble is, you won't know for sure if the lateral incisor is involved or not while there is still acute infection present form the central. The only way to be certain is to remove the central and see what happens...
Take your point about the business meeting though there are ways round it...
I didn't realize you couldn't tell if the lateral incisor was infected if the front tooth is still there. I think I will call the endodontist. I doubt they could get me in for an extraction before mid April anyway, though. I would have to be referred for a consult first, then schedule the extraction.

I have noticed today that the front tooth isn't as tender. The endodontist said the clindamycin was a last ditch effort if the infection was truly just in the gums and bone and not in the tooth. Could it be possible that I am just now, on the last day of the antibiotics, starting to see results?

I don't want to get my hopes up. I know the front tooth has to come out eventually, but best case scenario in my mind was to crown it, and hopefully get five more years, when I am in a better place financially. Right now, after all these surgeries, and I have four more crowns to pay for, I would love it if the tooth lasted a few more years.

What did you mean that there was a way around having no front tooth for the business meeting. I was under the impression by the endodontist that I would have to wait a few weeks after extraction and bone grafting before I could get a temporary, due to swelling. I have not talked to the oral surgeon about options, though, so I am curious as to what would be available
 
Judythecat

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Mountain Mama, this is probably no help, but when my upper front tooth was giving me trouble (which turned out to be neuralgia rather than the actual tooth) I asked my dentist about options if it had to be extracted. I like to catastrophise! She said the only circumstances someone would walk out with a gap would be if they had come in as an emergency because they had smashed the tooth out in an accident, or if they chose to have a gap. The bone graft part possibly makes a difference?
 
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Mountain Mama, this is probably no help, but when my upper front tooth was giving me trouble (which turned out to be neuralgia rather than the actual tooth) I asked my dentist about options if it had to be extracted. I like to catastrophise! She said the only circumstances someone would walk out with a gap would be if they had come in as an emergency because they had smashed the tooth out in an accident, or if they chose to have a gap. The bone graft part possibly makes a difference?
I will have to ask the oral surgeon. The endodontist seemed to think that due to the large amount of bone loss due to the abscess and apicoectomy I wouldn't be able to get a temporary right away. But that isn't her specialty, so maybe the oral surgeon will have a different answer.
 
Gordon

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#11
There are several ways round it:
1) Take an impression get a flipper denture made and insert it after extraction
2) Take impression get a Maryland bridge made, insert it after extraction
3) Take out the tooth, cut the root off, cement it to the next door tooth with glass fibre matting stuff and composite.

1 and 2 will need a week between appointments depending on labs, number 3 can be done in one go.
 
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#12
There are several ways round it:
1) Take an impression get a flipper denture made and insert it after extraction
2) Take impression get a Maryland bridge made, insert it after extraction
3) Take out the tooth, cut the root off, cement it to the next door tooth with glass fibre matting stuff and composite.

1 and 2 will need a week between appointments depending on labs, number 3 can be done in one go.
Thank you. That gives me a starting point with the oral surgeon. With 1 and 2, is it possible to alter the temporary if the lateral incisor ends up coming out as well, or would I have to pay for a new device?

Number 3 sounds like a good option, and I will ask about that one for sure.
 
Gordon

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1 is easy enough to add a second tooth, No 2 nope and No 3 would be difficult but not impossible, depends on your bite amongst other things.
 
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1 is easy enough to add a second tooth, No 2 nope and No 3 would be difficult but not impossible, depends on your bite amongst other things.
Okay, thank you! I like going in with information so I know my options, so this is very helpful. I am gathering as much info as I can so I am informed enough to ask questions.
 
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#16
Just wanted to update this thread. The front tooth has improved, and I can actually apply pressure to it. It still has pain in the gums behind the tooth, so the endodontist is still holding out on saying it is fixed.
The new issue is the tooth seems slightly mobile. The endodontist was honest and said the mobility may not go away, and that it may have to come out for that reason. I remember with my molar, when I got it pulled after root canal and apico, the oral surgeon said it was mobile.

Bad news is I had a delayed sensitivity reaction to the clindamycin. My mouth has blistered on my lips and inside. The doctor prescribed me a steroid dental paste and some "magic mouthwash". Ugh. It seems like there is always something else. She also said she didn't want to scare me, but to watch for a rash, as Stevens Johnson syndrome presents with the same type of blistering in the mouth. I should not have googled that. :o Do NOT google it. Seriously.
She did say it was really rare, and she did not think I had it. The only reason she mentioned it was because I had asked about hand, foot and mouth, which also has a rash on the hands and feet, and she didn't want me to dismiss it as that if it showed up. Scary stuff.
 
Judythecat

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#17
Glad the tooth has improved - but bloody hell re the reaction!

How mobile is the tooth? My front teeth are very slightly mobile due to bruxism, and my dentist said I can expect them to still be in my mouth in 40 years. Mine are just beyond normal movement and not in one of the classifications of mobility.
 
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#18
Glad the tooth has improved - but bloody hell re the reaction!

How mobile is the tooth? My front teeth are very slightly mobile due to bruxism, and my dentist said I can expect them to still be in my mouth in 40 years. Mine are just beyond normal movement and not in one of the classifications of mobility.
She didn't give me a grade. I can feel it moving when my top lip pushes against it when I talk or eat. It makes a popping feeling. I would say it is more than slightly mobile. I think the issue would be when it is crowned. I don't know that I want to spend the money on a crown when I won't be able to use the tooth.
 
Judythecat

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#19
She didn't give me a grade. I can feel it moving when my top lip pushes against it when I talk or eat. It makes a popping feeling. I would say it is more than slightly mobile. I think the issue would be when it is crowned. I don't know that I want to spend the money on a crown when I won't be able to use the tooth.
That makes sense re the crown. I am so scared about mine, but they have gone from being just at grade one to almost normal which is a positive. I don’t bite with them at all, although my dentist says I should.
 
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That makes sense re the crown. I am so scared about mine, but they have gone from being just at grade one to almost normal which is a positive. I don’t bite with them at all, although my dentist says I should.
I haven't been able to bite with mine since late September. I really want to be able to again. The endodontist said to give it 6 weeks to see if the infection is gone, but it is so hard to wait. I have plans coming up for travel in April and June, and I want things settled, one way or another.