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Question
Hi, I have had excellent advice from you in the past, and can't thank you enough for putting me on the right track.
I would like to mention 2 topics if I may?
Firstly I have Gum Disease which I keep well under control with extreme strict cleaning schedules, sometimes cleaning my teeth gets me so down it really depresses me its such a chore but to keep them as best i can leaves me with no choice, I spend about 45mins a day on my teeth, normal brushing, interdental cleaning with(little stub end type brush)in between, and around  each tooth individually, I have a kitty water pik (thanks to you) I put Corsodyl in the water as well, tepe brush twice a day.
My first question is why do I get so many gum problems, redness soreness, all to do with the GD i should imagine, but I now have the  3rd abcess in approx 18months. I had RCT on 2, now this 3rd one I thought was just a sore gum and treated it with regular salt washes for a few days and it went, but after just going through a family bereavement it has come back. There is no pain just a very sore red area on the gum line below my tooth, I have restarted salt washes again but I think I am fooling myself that it might go away again. The last thing i want is to loose anymore teeth, as I have lost enough with GD I have a reduced upper arch made of crowns and bridges, and I am getting no younger, sometimes I wonder if I keep getting RCT if I am wasting my time, I have heard say that all RCT fail eventually and the tooth has to be removed???
Secondly I have a very large silver filling on my lower left towards the back this was a RCT from many years ago which was redone by a Endontotist 10years ago, as I was moving up country at the time, my dentist did not get chance to remove the tempory filling and crown it. When i found a new dentist he looks at it each time i have a check up, but has never suggested removing the filling and completing the job so I have never pushed it further as it is like with most others another expence. This is now extremely worn and shiny and very tender when cold food is near it, but it has also caused a very sore gash in the side of my cheek which can get extremely sore at times but my dentist says that it is an allegic reaction to the silver substance used for the filling, should I push to get this sorted or should I just leave it as my dentist does not seem to be worrying aboout it? I am so sorry it is long winded and I truly appreciate your advice  
as I feel it should not of being left this long, as there are no teeth directly above the massive filling I am lucky it has never broken or fallen off ? or I am I? thank you so much for your time
kind regards Teri x

Answer
Dear Teri,

There are two different types of dental abscesses that people get. One type is an endodontic abscess where a patient either has a tooth that requires a root canal or has a failing root canal. The other type of abscess is a periodontal one and this one is due to periodontal disease. It sounds like the type you are having is the former.

It sounds like you are trying to do your level best at taking care to keep your gums healthy. Assuming that you are using a good electric tooth brush and getting frequent thorough cleanings, your gums should be reasonably healthy. Some patients have subgingival tarter that doesn't get removed with a regular cleaning. These patients need effective root planning. After a patient is numbed the dentist can use sharp periodontal currettes to scrape the teeth in a quadrant clean and remove contaminated tarter than can cause periodontal inflammation.

It sounds like at least some of your abscess are due to endodontic infections. Well done root canals have a success rate of about 95%. After completion, a temporary filling is placed. This filling should be replaced with a permanent restoration. Most posterior teeth that have had a root canal treatment benefit from being protected with crowns. Although some of these teeth end up having fillings placed instead, crowning is the safer option, since these teeth are missing extensive tooth structure and seem more at risk for future fractures.

The other questions you bring up are best answered by your dentist, since he can examine your teeth and is in the best position to offer solutions and answers. If he can not, then a second opinion by another dentist is a good idea.  

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Lawrence Spindel DDS, www.lspindeldds.com

Expertise

Cosmetic Dentistry, Endodontics, General Dentistry, Preventive Dentistry, Comprehensive Dental Care

Experience

Former Clinical Instructor of Comprehensive Dentistry, and Prosthodontic Department New York University School of Dentistry. Also former instructor of Preventive Dentistry Columbia University School of Dentistry.

Publications
Ask Dr Spindel Dental Blog also numerous articles on http://www.lspindeldds.com (over 100 pages of original content)

Education/Credentials
1980 DDS New York University College of Dentistry 1981 GPR Manhattan VA Hospital

Awards and Honors
OKU 1980 Honor Society 1980 Long Island Academy of Odontology award for highest combined Academic and Clinical Achievement.
In 1997 he was elected to Fellowship into the International Academy for Dental Facial Esthetics

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