Question:
My wife got an abcess (or 2 actually) after having had bridge work and
then a root canal, about 9 months ago. She's had the abcess for about
4-6 months, and it is getting smaller with 2 courses of antibiotics
and some liquid she's been putting on it. Now we are trying to decide
what to do. Some dentists say she may need surgery. Others say she may
need to lose the tooth. Others, like this one below say that the
infection will spread to her system if we don't get rid of the tooth.
I've discussed this at Dr. Weil's dental discussion group and got the
following response. I'd like to see what you dentists and experts here
have to say about it:
Answer:
Endodontic treatment is a time-tested technique over 150 years old.
There are reasons that they sometimes fail--some of these reasons can be
remedied, some may not. A vertical fracture of the root, for example,
is sometimes difficult to detect, and nothing can be done to save the tooth.
In my opinion, sterilizing dentin is a red herring. Most patients over
the age of 35 or so have dentin exposed to the oral environment, which
is loaded with bacteria. The issue is removal of infected material from
the tooth and sealing the canals with a biologically acceptable
material. A good endodontic operator will be able to do this the vast
majority of the time. Anyone claiming 100% success, however, is bogus.
The only major issue I have with your post is your assertion that
"traditional" dentistry gives little thought about the connection
between the mouth and the rest of the body. Whoever told you that is
not correct. I'm out of dental school 27 years, and we had two years
study of biochemistry, general gross anatomy, general histology, general
pathology, microbiology, and general pharmacology before we were
permitted to treat patients. The A.D.A. is a professional organization
whose function is to represent the profession and its members
politically. You are being treated by a dentist, not the A.D.A., and
that is where you should address your questions.
Well, you may be right. But we noticed the abcess got smaller after
she started putting this liquid on it that we bought at the health
food store. If you want I can look up the ingredients and/or product
name. Just coincidence? She wasn't taking antibiotics at the time, or
anywhere near the time we noticed it getting smaller with this
liquid...
What, in layman's terms, is an apicoectomy? How much does it generally
cost? And what are the dangers/drawbacks of it? Is it something an
average good dentist can do or does it require a specialist? Does PPO
dental insurance usually cover any of it? How do I know if the dentist
is good at it? What should I ask him before doing it? I want to make
sure my wife gets it done right if it has to be done!
Apicoectomy is a surgical procedure whereby the tip of the root is
exposed through the gum and bone. The tip of the root is removed, and
the end of the canal is prepared and filled with a filling material.
Most apicoectomies are performed by oral and maxillofacial surgeons, but
some endodontists perform them. At this point, the standard of care is
rapidly becoming performing this procedure under the operating
microscope. Not many general dentists are equipped with one at this
time. A PPO (or any other kind of insurance) may or may not choose to
cover the procedure according to the whim of whomever is writing the
policy; there is no industry standard. You should be able to call the
insurance company and ask specifically how their reimbursement works for
this procedure.
