re root canal /periodontal abscess

[chatname]

I wonder if there is anyone who knows anything about dentistry who could help me. I have been having regular check ups with an NHS dentist. Last time I went I mentioned my gum felt a bit swollen sometimes at the back. I hadn't actually had any pain with it though.

Basically, the NHS dentist seemed a bit unsure what she was doing. She thought I had an longstanding abscess in the gum, and suggested that I might
-have the tooth out or
-have a "bone transplant" (!!!) or
-just leave things as they were as I wasn't in pain, because the infection was draining out via a sinus.

At first she had thought I needed root canal work (which she refers elsewhere), then she changed her mind to the gum abscess theory, then she decided to refer me to the dental surgeon who does her root canals anyway, and she also suggested that an opinion from a periodontist might be helpful, although that hasn't been organised.

I have seen the dental surgeon "root canal" specialist. He thought the problem was with the root canal and thinks I need 2 session of root canal work. However, the tooth itself does look fine on Xray.

What with all these different opinions and suggestions, I am feeling a bit confused. I am booked in for the root canal work in a couple of weeks. But what if the problem is really with the gum? Should I see a periodontalist as well?

A periodontal abscess would not make the tooth look any different.

A periodontal abscess presents as a black mass at the Apex [base] of the root, so it is entirely possible that your tooth looked fine & that you need a root canal treatment.

So being that it is at the Apex of the tooth, it is within the gum. The best way to deal with it, is to have a root canal performed.

You can have a Apicectomy, but that involves cutting the gum away, drilling through the bone & draining the abscess that way. Then stitching. These are usually performed AFTER an unsuccessful root canal treatment, not a first option.

And with all due respect, your tooth probably would look fine to you on the x-ray, because I suspect you haven't been trained how to read them.

I have got a periodontal abcess at the base of a failed root canal.

I have not had it treated as yet (cost of endodontist is putting me off). It doesn't give me any problems other than it swells up slightly every now and then.

New Year's resolution - get it treated!

Actually, I have been trained to read - different sorts of - X-rays, though that was a long time ago and I wouldn't put a lot of faith in my ability!

It was the dental surgeon I was referred to, who said that there was nothing to see on the X-ray. Apparently it has probably been picked up quite early on.

As long as I don't have unnecessary root canal work, I don't mind.(I am more concerned about the pain than the cost!)

Well in that case I think I'd be seeking a second opinion! If he is doing a RCT, but saying there is nothing on the x-ray, I would be worried!

Many thanks for the advice sandcastles, though I'm not sure how to organise the 2nd opinion (you're not on the south coast by any chance, are you?)

Somewhat worryingly, the past 2 days I have had a very sore throat with pain and some difficulty swallowing, enough that I have been eating a lot less. I also have inflamed glands in my neck. I thought it was a cold at first, but I don't have any other symptoms of a cold. Last night I started wondering if it might be related to the abscess. I am planning on seeing my GP tomorrow, and wondering whether antibiotics would help.

As regards the findings, the first dentist found a sinus coming out below the tooth that was causing the infection to be drained. She thought it would be a root canal job, but looked on the Xray and thought the problem was in the gum rather than the tooth.

The second dentist, who is more expert in RCTs, did another Xray. He found no evidence of a problem with the tooth, but said that in his opinion, from the situation of the problem, the tooth would definitely need a RCT.

My concern in posting was that, from googling, it does seem possible to have a RCT or extraction, if you have a periodontal abscess, and for the problem not to be treated at all, because it was in the gum all along, rather than the tooth.