Oral Surgery/apico

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Question
Just had my teeth cleaned/checkup 2 weeks ago and all checked out okay.  A week ago a bubble looking cyst appeared under tooth 28 and after 4 days I called my  dentist even though I considered just seeing if it would go away. My dentist wanted to have a look that day.  The tooth involved is #28 & is attached to a bridge. My dentist said it is infected and he sees on the x-rays that a procedure was done years ago. I have no pain and seems the infection is draining. Bubble still there.   He explained why I should see the endodontic specialist. I saw the specialist right away also.  The endontic specialist said I would need a apico. I just looked up my old files ( although I don't remember that much as nothing was explained then) looks like I had a apico in 1986 before this bridge was put in.   He even did a cat scan besides x-rays to clear me for the procedure. I am so afraid to lose this bridge.  Have had lots of bad expericences, but I totally trust my dentist I've had now. I would see no other because I have no trust in some of the past ones.  Procedures done going bad, etc. and all in for $$.   Should I have antiobiotics now instead of 2 days before? Found that unusual.    Also, is this common that the first procedure did not work after all this time? I have the apico scheduled for Sept. 8th. Aopreciate your input.

Answer
Dianne - First of all, just like regular fillings in a tooth for decay, the fillings that the dentist placed at the end of the cut root and into the nerve canal to seal it can eventually leak.  This is not completely common, but it does occasionally happen if the filling was not put in correctly or the root canal within the tooth was not completed properly and pressure built up within the tooth and caused the filling to loosen or become dislodged.  Most apicoectomies will last but some will fail twenty years later, like yours.  

In my experience, the best filling for an apicoectomy to seal the end of the nerve canal is amalgam.  Yes it does have some mercury, but the filling tend to produce oxides and the oxides produce a sealing of the nerve canal completely, unlike the whitish fillings (composite) that do not completely seal and often leak.  That is why decay forms often around composite fillings.

If you presently have an infection that might be draining and you will not have the apicoectomy for another two weeks, I would suggest antibiotics now to quiet the infection and prevent a spread.  I would suggest 7-10 days of antibiotics and then restart just before the apico and then for another 10days.  

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicing for over 20 years. Assistant Clincal Professor at State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA- University of Connecticut DMD-University of Pennsylvania School of Dental Medicine Oral and Maxillofacial Surgical Residency - Roosevelt Hospital, NYC

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