Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 11/5/2009

Question
Dr. Teig,

I am currently scheduled to have an extraction on tooth #14.  It has previously had a root cannal, and I currently have a 9mm pocket on the inside gum.  It is infected, as can be seen via xray.

I am currently very immuno compromised; I have chronic Lyme disease and also MS.  I am very concerned that this tooth infection is causing systemic infection issues for me.  The tooth itself does not hurt too much.


I don't want to loose the tooth if it is not absolutely necessary, and am wondering if I should attempt the apicoectomy.  My concern is the 9mm pocket that will remain, and the possibility of infection being able to "re-gain access" to this area if I "just" have the apico.  Any advice or input is greatly appreciated.  

Answer
Amy -  I am not at all comfortable with you having an apicoectomy with the 9mm pocket.  That is an accident waiting to happen.  The deep pocket and the surgical exposure of the tip of the root, doing the apicoectomy, could cause a communication between the two and cause a problem.  Removing the tooth should not cause a problem, as long as the surgeon is board certified and skilled in caring for a patient with a significant medical history.  So, what I am saying, is that you should only have the tooth removed by a board certified oral and maxillofacial surgeon to facilitate a good healing, without medical problems.  An apico would probably be a bad choice due to the 9mm pocket.  An easy communication of the pocket and deep bone could occur doing the apico.