Dental advice needed

[Mog]

Know we have a few people with dental knowledge on here so I'm just back from a new dentist and have been yet again given conflicting advice so am confused.

Had a deep filling while pregnant and was warned by previous dentist that it might need root canal in the future. Flared up towards the end of pregnancy and went down the antibiotics route as had an infection on different tooth at the end of my first pregnancy and know this happens to me when there are extra stresses on my body.

After birth, dentist x-rayed and said I had a low-level infection and she would x-ray again at my next check-up to see if it had increased.

When returned there is a new dentist and without x-raying he says it needs root canal as it might flare up if my immune system was compromised i.e. cold,flu. He confirmed that pregnancy could be the cause of flare ups and that it is possible that I might not have any problems with it now.

But I'm confused. If I just leave it he said there is the danger if it flares up it could spread through the soft tissue -what would this mean?

Also he said my body will be trying to fight the infection - is it possible it could heal itself and is there anything I can do to help this?

I'm also worried about the rate of success of RCT - it's a prominent side tooth so don't want to lose the tooth. He said there was a higher success rate with a specialist (although it looks a fairly straightforward job from the x-ray). Would it be worth going to a specialist for better results and presumably quicker surgery?

Sorry this is so long but I'm getting increasingly frustrated the recurring dental problems I'm having since pregnancies, despite a rigorous oral hygiene regime.

You could try taking megadoses of Vit C to help fight the infection - 1000mg a day is safe, your body does use a lot of it when you have infections and it's good for gums anyway I believe.

jasper usually posts late in the evening - she will be able to tell you the other things.

Thanks Janh, I'll definitely dose up with vit.C.

Mog it's late evening and here I am.
Frankly I am a bit confused as to the advice you have been given.

Seems there may be a confusion between soft tissue (ie gum ) problems, and problems associates with the tooth pulp (mushy bit in centre of tooth with nerve and blood vessels)
As a summary, gum problems can resolve on their own ifyou improve your oralhygiene , pulp problems (broadly speaking) can't.

If it was a gum problem two x rays taken six months apart may show progression of bone loss. This would not necessarily mean root filling was required, unless the tooth was coincidentaLLY non vital.

If an xray taken at any given point in time showed what is known as a periapical area (halo at tip of root) this would indicate infection from inside the pulp of the tooth which is an ABSOLUTE indication for a root treatment. It is not going to get better on its own. You only get a periapical area in association with pulp necrosis (pulp infected with bacteria - generally from decay withing the tooth). Taking another xray 6 months later without root treating the tooth will show no difference, and in fact probably the apical area will get bigger.
The only reason I can see why your dentist is adopting a wait and see policy is if there is a SLIGHT suggestion on the x - ray of a periapicical area, in which case an x - ray taken a few months later will help to confirm the diagnosis.

X-rays are a useful tool, but only in conjunction with a good history taking of symptoms, along with visual clinical inspection and vitality testing of the tooth.
Hope this helps.

Jasper, while I have seen you posting can I have some advice (sorry to hijack thread)?

Ds2 has cerebral palsy, and went for a 2 week specialist assessment recently. While he was there the speech and language therapist had a look in his mouth. She said that when we next went to his special needs dentist we should mention that he has a v high palate, and it has some sort of ridge running through the middle f(from front to back). I'm not panicking, but we aren't due to see his dentist again until new year, and am womdering why they say this needs to be checked out as a precaution? Have I made sense? Thanks!

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Thanks Jasper and Robinw,
Think there was a halo at the tip so it is probably the indication for RCT.
Before the tooth was filled the original dentist said it would be a medium sized filling but when she started drilling she said she had to go close to the nerve - I hadn't had an x-ray because pregnant so is it usual not to realise how deep a filling is until you start?

Also do you think I should go to a specialist as they would have the microscopic equipment and have a better chance of success - it's the tooth after the eye tooth and current dentist says it looks fairly straightforward.

What is the danger of leaving it as it is if it is not causing any problems and I would really like to know why the body can't fight the infection itself.

I would really appreciate your time Jasper (and anyone else) to help answer. The new dentist said he has had quite a few problems with things the previous dentist has said to patients. Hardly reassuring and makes me want to be totally informed about any decisions. Also concerned because new dentist didn't read any of my notes and relied on me to explain things!

Should add that I am in the same dental practice, it is just one dentist has left and been replaced by another.

Mog,it is indeed comonplace to not know how deep a filling is before starting. Usually one has a good idea but can be surprised by unexpected depth of decay.

I know this all seems complicated but now you have told me a bit more the scenario you describe is completely commonplace. A tooth gets filled, filling is deep, tooth gets sore... the question is will it settle of its own accord or not (ie there is irreversible pulp damage requiring root filling)? This is assesed by a good history taking ( description of pain), clinical examination,vitality testing, and x-rays. SOme teeth are borderline even after thorough investigation and usually the dentist will suggest a wait and see approach. I have to say in my experience that the wait and sees nearly always need root filled!

If the pulp has necrosed,if you are lucky you might not get any symptoms for a long time but the reason the body can't heal itself is that the pulp contents are to all intents and purposes dead. Dead stuff leaks into the periapical area (the bit at the tip of the root, inside your jawbone) usually at some stage causing pain and in an acute episode, swelling.
The purpose of root filling a tooth is to mechanically remove all the dead gunk in the root canal, clean it out, and fill the space with an inert substance which forms a seal at the tip of the root.

I should add to this that symptoms don't necessarily correlate to what is happening in the tooth, so with respect, if you started chewing xylitol gum and it felt better you could NOT conclude it was a gum rather than pulp problem as it is often in the nature of pulp problems to come and go pain wise.

A specialist endodontist, on the balance of probabilities would do a really top job, but root filling the tooth you are descibing is usually pretty straightforward, and general dentists like me do them all the time in practice.
If you need me to explain anything else please ask.

lou33, how old is your little boy?

2y 8m Jasper.

Jasper,
Thanks so much. I feel better armed for going to my next check-up in a month. Basically it looks like there might still be a chance the tooth will be all right but the odds are that a RCT will be needed.

One of my reasons for being resistant to RCT (apart from being a total scaredy-cat!)is the long term stability of the tooth. Aren't RCT teeth made weaker, whereas if there is any doubt about the need for it then is it better to go with the 'alive' tooth I have at the moment. I haven't heard of vitality testing but presumably that tells how alive the existing tooth is?

Would you say RCT is uncomfortable? I would imagine pain can be eliminated but don't you have to get the tooth drilled really deeply? I'm squirming as I'm typing this and wondering if I really want to know!

Also forgot to ask - the new dentist seemed to indicate that if there is a flare-up it could spread to other teeth and cause more damage. Could this happen or do you think this is just a worse case scenario? If it is a possibility, how often do you see it in practice?

Thanks in advance, Jasper.

Mog, I've had lots of root canals done in the past - not recently although I have a molar that needs it and I keep putting it off (I'm a scaredy cat too!).

Anyway as far as I can remember the injections, and then having to keep your mouth open for ages with one of those suckers in, are the worst parts. I don't remember any pain from the drilling - just an aching jaw (I have one of those clicky ones). The teeth I've had done have lasted for years.

Mog, NO IT won't spread to other teeth! You can rest assured about this one.

A wait and see approach is entirely reasonable, particularly if you are sure you can be seen quickly should a future emergency arise.

As for long term stability/viability of the tooth following root treatment. It is not the root treatment that might shorten the life of the tooth , but the NEED for root treatment.(whether it gets RT'd or not)
Does that make sense?
A tooth needing RT which gets RT will survive longer than one needng RT which does not get RT.

Lou33 I was a bit puzzled by your original post as I could not see what was significant about a high palate . It is just one of those things some people have.
If your child had been under a year perhaps the specialist was concerned about whether certain teeth were present but in view of your son's age this would not be a concern.
Anyway I sent your query to a friend who is an expert in special needs kiddies' teeth and I have cut and pasted hs reply as follows...

I've seen patients with this kind of thing before, not necessarily
with CP but I can't see why it would be a concern. Possibility of
candida infestation if he doesn't swallow very well. If the food
doesn't clear out very well then you tend to get candidiasis, I
suppose a deep groove would be a good site for that, but otherwise I
don't have a clue.

I hope this puts your mind at rest.

Thanks Jasper. I thought it must be that sort of thing, but was puzzled about the mid line in his palate she kept mentioning. Nothing I need to rush him to see her about then.

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Coincidentally I just had to take 2 of mine for an emergency dental appointment at the sn dentist ( they all see her for one reason or another, lol). I mentioned ds2 to her, and she agreed he had a very high palate, but it was properly formed, and no cause for concern, so that's all sorted. Thanks Jasper for making the effort to contact your colleague, I appreciate it.

Jasper,
Thanks everso for all your help and as always wish you were my dentist

Just wanted to add my thanks to jasper for explaining about root canals so well. It's good to know what my dentist is charging me all this money for.

Bobthebaby, I was told yesterday that I need a root canal. I had one a few years ago and vowed I would never go thorugh it again. Decided to ignore it for a few months.

Sorry for hijacking too!
jasper - dunno if you remember but about a year ago you encouraged me to go to the dentist (which I'd not done for 10 years as was terrified by bad experience).
Well, I went when I was pregnant and got a diagnosis - dentist was fabby and really reassuring (basically I didn't want to be lectured). And I do need quite a bit of treatment, 3 extractions of roots (only roots left, was so scared I let 3 teeth crumble in my mouth), plus 2 replacement fillings. But last Thursday I had my first extraction and it went fine, I let him do injections and pull things and everything. Am going back once a fortnight until it is all done, and I am not going to be scared any more!

So thanks for encouraging me to do it, it was on your advice I went (you told me dentists didn't give bad tellings off any more, which was what scared me away at the time) and you were right! Thankyou and look at my lovely teeth!

Since I started the original post I'll add that I've adopted a wait and see approach with regards to RCT and the tooth has been O.K. so far. I'm recently pregnant again so say this with some trepedation as towards the end of pregnancy seems to be when I get flare-ups which I think is due to the extra demands on my body.

Bob, very glad to be of help.
Susamnt, I remember it well, and am delighted to hear you have found a lovely dentist and are not feeling so scared. I was a complete phobic until a lovely dentist cured me when I was in my early twenties - that is the reason I became a dentist as a matur(ish) student.

jasper - I don't think there is any chance I am ever going to become a dentist, though there is such a chronic shortage of them up here I think they'd let anyone with a white coat, a nice manner and a pair of pliers loose on the public's teeth!