Advice needed re Root canal failure and need for Oral surgeon

[Eva]

When my root canal that was done about 20 years ago failed in October 2013, I had an Apicoectomy or Root Repair Surgery where an incision is made in the gum tissue to expose the roots and the surrounding infected tissue. The damaged root tip and infected tissue are removed. A root-tip filling is placed to seal the end of the root and sutures are placed in the gum. The bone will heal naturally around the root once the infection is removed. The desired result is to return your tooth to comfort and full function.

Infection returned. An endodontist up in Northern Ca. redid the root canal.

3 days after finishing the second course of antibiotics, my gum above three teeth is swollen and hurting. Endodontist recommends extracting the tooth
She believes there is a crack in the tooth. She refused to prescribe more antibiotics despite me reminding her of my mechanical valves.


Any advice in general?!

Any advice about oral surgeon's choice. Endodontist recommended Alex Hoghooghi in Palo Alto who is an acquaintance of hers. He has great reviews on Yelp.
Eight months ago I saw Jeworski in Sunnyvale who took 3d X-rays which did not show any crack then. He has great reviews too.

Who should I choose?! I'm losing trust in doctors when they refer you to their friends!

Should I see cardiologist soon?

Thanks in advance.

 

[pellicle]

Hi Eva

I'm sorry you are having to go through that ... nothing disturbs me as much as dentistry gone wrong, I can only assume its the same for others.

When my root canal that was done about 20 years ago failed in October 2013, I had an Apicoectomy or Root Repair Surgery ...and infected tissue are removed. ... will heal naturally around the root once the infection is removed. The desired result is to return your tooth to comfort and full function.

Infection returned.

3 days after finishing the second course of antibiotics, my gum above three teeth is swollen and hurting. Endodontist recommends extracting the tooth
She believes there is a crack in the tooth. She refused to prescribe more antibiotics despite me reminding her of my mechanical valves.

evidence is not shaping up to support the idea that they are good at their job

Who should I choose?! I'm losing trust in doctors when they refer you to their friends!

that would be my feeling too ....

Should I see cardiologist soon?

YES! is my first thought. They will most likely have a fit about this and put you on more antibiotics. That your infection has returned is immediate reason to immediately recommence antibiots and implies to me the course was too short. Or they left something behind in there ...

Any advice in general?!

how long was the course?

Richard Craniums like this Dr. D. Ork (the endontist) are exactly the reason we are developing antibiotic resistant strains of things. Short courses do more damage on this front than almost anything except for irregularly taken courses (then the patient needs a spanking).

The next thing I'd do (although its too late perhaps) is to see an infection specialist. I say perhaps too late for once you have antibiotics in your system its almost impossible to obtain a functional swab to culture and thus identify what the infection is.

First things first however, I'd pick up the phone and call your cardiologist to get antibiotics. Hopefully they will see the urgency here and not dilly dally.

Prevention is the better cure in the case of endocarditis.

Best Wishes

 

[Paleowoman]

Hi Eva - do let us know what transpires and what you decide. I don't like it that too much is left to patients to decide, we're neither doctors nor dentists.

I'm currently having root canal problems as you might recall from other posts I wrote. It turns out I now have Temperomandibular Joint Dysfunction which is, or was, the cause of my pain, all my jaw pain, facial pain, ear pain etc. It was a really brilliant dentist I went to who worked it all out - a local dentist - I would not go to a dentist farther away as when things go wrong you need to get to a dentist quickly….and last wek I had to go to see him two days in succession as the pain was so bad. The tooth that had the root canal is stable, and inbetween treatments, the dentist doesn't want to work on it until my jaw is in a better state or it will get worse. The root canals currently have antiseptic dressings in them (big molar with two root canals). There is a crack so he may end up extracting the tooth but he's going to give it a chance first. I'm not on any antibiotics now as there's no infection. I'm prescribed a tiny dose of diazepam (valium) for the jaw as that reduces the msucles spasms.

An interesting thing is that this jaw problem, which could easily be osteoarthritis, could have been topped over the edge by the intubation and ventilator last year as the forces on the jaw can be considerable in intubation and I have an unnaturally small mouth and jaw.

 

[Eva]

Pellicle,

Thanks for responding quickly!

I'm very upset that she refused to re prescribe antibiotics. She has a phobia that antibiotics could endanger my life because she ended up in coma for a week after antibiotics taken to treat ear infection.

The first course was for ten days 100 mg every six hours...(wasn't strong enough). Second course was for SIX days only (150 mg every six hours). I complained that wasn't strong enough. Her excuse was that it was a continuation!

I took amoxicillin before seeing her yesterday in case she needed to poke me. I felt better afterwards but of course it did not dissolve the stone-like felt swelling.

I'll call my cardio right away. Will update his response. I Agree she didn't do a good job on the tooth nor on amount and dose of antibiotic prescription.

 

[Eva]

Anne,

I was having problems with my left ear, left eye, that are on same side of tooth. One endodontist thought I had 'neuralgia' which pushed me to have an MRI. NO neurolgia!
Once I had started the antibiotics for the root canal, other symptoms subsided.

Anne, if there is a crack, it will be hard to save the tooth according to what I was told yesterday. Crack are a good house for bacteria which may linger in there for a long time before causing any swelling but causing fatigue and slow damages!!! I kind of agree with her on this, as I had been feeling low and down since October 2013 when the issue started that resulted in me having apectomy.

My cardio wants to talk to the Endodentist to understand why she refused to renew antibiotics prescription!! I hope I'll stay ok while they come to an understanding!!
Our treatments are becoming like dealing with politics!!

 

[pellicle]

Pellicle,

Thanks for responding quickly!

no worries ... I just happened to be up at 3am because I couldn't sleep ... usual stuff.

 

[pellicle]

My cardio wants to talk to the Endodentist to understand why she refused to renew antibiotics prescription!! I hope I'll stay ok while they come to an understanding!!
Our treatments are becoming like dealing with politics!!

its the usual fight of ego's in medicine. You should have seen the ding dong fight at the foot of my bed back in 2012 when the infection specialist said to my surgeon there was no infection.

Then I got involved after the surgeon left and with a "look on his face" asked "what is it you do for a living". When I told him my background his attitude changed notably. He remarked to me then (said that mildest of men) that I was the most "intense" patient he had treated. I answered that my intensity was proportionate to my desire to not end up with my chest hacked apart even more and living life without a sternum ... and how would he react if he were in the bed.

He took my point.

So if your health depends on it, fight the political fight.

 

[Eva]

Very disappointed with my cardio! I'm firing him. After I waited the whole day, his office called me to request a prescription from my family doctor?!

 

[Paleowoman]

Anne, if there is a crack, it will be hard to save the tooth according to what I was told yesterday.

Yes I know. I don't mind if the tooth is extracted but it would be better for the rest of my oral health if they are able to save it as it helps keep stable two crowns and a bridge. I suppose it depends on how deep the crack is, I mean if it extends down into the root then there's no chance of saving the tooth. He hasn't seen that on x-ray and there was never any swelling in the gum. When the dentist opened up the tooth under an ancient filling the pulp was beginning to decay so that was removed and antiseptic dressing put on. Next time he opened it up to do the root canal there was no decay in the roots, but he took the nerves out and has filled the canals with antiseptic. He won't do the next stage due to my jaw problem until that gets better….it is getting better.

Re your cardiologist - here in the UK cardiologists send a letter or note to GP's to prescribe what they want the patient to have unless they're treating the patient in hospital.

 

[Eva]

Luckily my cousin's dentist was able to accommodate seeing me this morning, as my cousin gave up her appointment slot for me!

His X-ray did not show a crack! He prescribed Augmentin 725 mg twice a day for seven days. I'll check with him next week.

Ah, what a relief!! I'm already feeling better since I took my first pill two hours ago.

Thanks for all your help.

 

[Eva]

Anne,

This dentist's opinion about cracks is very similar to yours...Extraction of teeth depends on extent of crack!