Expert: Mark Bornfeld DDS - 9/17/2007

Question
Dear Dr. Bornfeld,
Here is the original email I sent Dr. Tieg.  He asked for more information but
he it maxed out and I can't reply to him.  Thank you in advance for picking up
where he left off.  My reply is at the bottom.
Carol
Subject     apicoectomy
Question     Dear Dr. Teig,
I actually have several questions.  Briefly (as possible), I have had over twelve
root canals (I lost count) over the years.  Suddenly in the past two months,
I've experience several infections.  One lower molar and two (now maybe
three)upper molars. I had one extraction and one apicoectomy with a bone
graft so far.  The extraction site is healed (six weeks post).  The apicoectomy
site is still painful and swollen (four weeks post).  The pain runs into my eye
and into my tmj. The oral surgeon and my dentist of thirteen years have told
me to wait and be patient.  They have offered no explanation for what is
happening.
I am 47.  I gave birth at 45 and nursed for two years.  -Could this have
something to do with all these oral problems.
-Is there something I could be doing preventatively?
-Does is sound like it is time to have the tooth (with the apicoectomy)
extracted.
The pain is really starting wear on me. I am very depressed and often very
dizzy.
Answer     Carol - You don't say which tooth had the apicoectomy.  If by any
chance it was an upper tooth, the proximity to the sinus can often produce
the symptoms you describe.  Occasionally the cutting off of the tip of the root
and removing it can actually perforate into the sinus.

So let me know which tooth you had the apico on and I might be able to be
more specific as to possible symptoms and treatments.
   I think you will not be disappointed.  I will try to answer your question
fully and try to give suggestions, if necessary or requested

The apico with the graft was performed on a top right molar.  I wake up
feeling ok but as soon as I eat something soft I start to experience pain and
swelling into my eye, temple, and tmj with a general tightness in my sinus.  
Three Advil take the edge off a bit.  I have to chew on that side a bit because
I'm missing two teeth on the top left.  It is painful to chew soft food.  My most
recent extraction was performed on a tooth that was the anchor of a bridge
for many years (over 20).
Another question I have is:  Could I be reacting the the grafting material.  

Answer
Dear Carol,

You could indeed be reacting to the grafting material, although these products are usually well tolerated. A more likely reason for your pain, though, may be an inadvertent perforation into your sinus and/or remaining dental infection.

Suffice it to say that pain and swelling a full four weeks after a procedure suggests that there is residual infection, and the most direct way to address that problem would be to re-enter the surgical site and explore it for infection or sinus perforation. I can understand why your surgeon may prefer to try a more conservative approach, such as watchful waiting or antibiotic therapy. However, there is just so long that this approach can be considered practical; at some point, your surgeon is going to have to take it to the next level, and that would probably involve re-entering the apico site.

Good luck!

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY