About Mark Bornfeld DDS Expertise I can respond to all questions dealing with the practice of dentistry, from both the dentist`s and patient`s perspective. I am knowledgeable about all dental disciplines, from cosmetic dentistry to surgery, from restorative dentistry to root canal treatment. I have strong opinions about controversial issues in dental practice, including those topics which directly impact on the reputation of the profession in the eyes of both the lay public and our health profession colleagues.
Experience
Past/Present Clients Editor, Queens County Academy of General Dentistry newsletter; contributor to Dentistry.com 29 years practicing general dentistry partnered with brother Steve as one-half of the DentalTwins®
Question I had a root canal on #24 in the mid 1960's when I was around ten years old. In 1996 I developed an infection in the gum under #24 and the dentist removed a cyst. In the past month I have developed an infection again in the same area although I haven't had hardly any discomfort I started on an antibiotic last week and noticed a white pimple that formed on my gum and I have been carefully popping it using hydrogen peroxide to keep it clean. I saw an endodontics specialist before I started on my antibiotic. He told me he could do an apicoectomy but with the history of the tooth he said there would be a 30% chance that the infection may come back again and I may want to opt for an implant. I then went to an oral surgeon who explained the long process of having an implant. I do have an appointment in a week with my dentist to discuss these two options. I would really prefer to keep my tooth as long as possible. The dentist that removed my cyst in 96' has passed away and they don't have records regarding wheter or not when he removed the cyst that he also did an apicoectomy on the tooth. My dentist is assuming he probably did. Also, is there any way that if I continued on a strong antibiotic that the infection may eventually go away since stuff is coming out of this pimple that keeps developing. I have been on some websites where some herbal type products claim they can eliminate gum disease or infections. I wondered if it is worth it to give them a try.
Who generally has more experience with apicoectomy's and endodontics surgeon or oral surgeon. The oral surgeon told me he can do an apicoectomy.
Thank you for your time!
Donna
Answer Dear Donna,
The dentist who removed your cyst in 1996 almost certainly performed an apicoectomy at the time, although there are other techniques that could now be employed to improve on its effectiveness, such as a retrograde filling. I understand your desire to save the tooth if possible, and this would be a factor to consider in choosing a course of treatment. However, the infection has already returned twice after the initial root canal therapy, and this would forecast a less optimistic outlook for additional efforts in behalf of this tooth (I'm not sure how that endodontist arrived at his 30% chance of failure figure, but that may be a bit unrealistic.) If you really wanted to give another apico a try, then there is nothing intrinsically wrong with that, as long as you keep your expectations in check.
As for the antibiotics or some other herbal remedy eliminating the infection-- I would think that the chances of that happening are vanishingly small. At best, antibiotics can temporarily suppress a dental infection, but will never eliminate it.
Not all endodontists perform apicoectomies, but when they do, I would give them the edge over oral surgeons. This procedure is more specifically endodontic in nature, and falls more neatly into the endodontist's scope of practice.
Good luck!
Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY
