Oral Surgery/Cyst Removal
QUESTION: I had root canals done on teeth 29 and 30 in September. At my 3 month post op, it was discovered that the infection has not cleared and has grown into a 3cm cyst. The oral surgeon suspects it is originating from tooth 29. The oral surgeon would like to extract 29 and 30 to remove the cyst. My question is, why is extraction the right course of therapy? Can't she remove the cyst through the gum itself? I am devestated that my newly completed rootcanals and crowns will be gone and I would have to have implants down the road. Should I seek a second opinion?
ANSWER: Christine - I agree with you. In this day and age, extractions are often performed on teeth that used to be saved. The main reason is that surgeons and dentists alike, will try to replace the lost teeth with dental implants. The usual reason is the cost of the implants and when excess damage has occurred to the bone surrounding the tooth or vital physical structures are nearby and could be injured in saving the tooth with the cyst by a procedure called apicoectomy. In this situation an incision is made and a hole placed in the bone to remove the cyst, the tip of the root where the cyst emanated and the end of the root is sealed.
I am a conservative doctor who always tried to save teeth. I am retired and have not done surgery for a while, but when I did, I did place dental implants when teeth could not be saved and were removed. The reasoning is that dental implants, if done correctly, can last a very long time if the patient keeps them clean and has them taken care of by their dentist.
So what should you do or what should be done. I cannot be completely sure without examining you or, at least, viewing xrays of the teeth and the region. I suggest that you see another board certified oral and maxillofacial surgeon near where you live. Make sure the surgeon is board certified.
If you should have additional questions, don't hesitate to get back to me.
[an error occurred while processing this directive]---------- FOLLOW-UP ----------
QUESTION: Hello Doctor.
Well I went ahead and had the surgery. I was warned that due to the size of the mass, there was potential for nerve damage. Well, low and behold I am 4 days post op and have numbness to my lower lip and chin. I was told there is no guarantee if it would be temporary or permanent. I am devastated. I am having tingling sensations on and off. I am wondering if that is a good sign and in your practice, how often have you found this type of nerve damage to resolve itself...if ever? I am still very swollen and bruised. What are the chances of the numbness subsiding?
Thank you for your time.
Christine - it is definitely too early after the surgery to determine the extent of nerve damage. Inflammation, excess bleeding within the bone and the surgery itself are all possible causes, but unless the surgeon, who visualized the area, realized that he cut or severed the nerve. No matter the trauma, it is too early so you now need to be patient and wait to see if the numbness changes. Does the numbness lessen with time, do you begin to feel itching, burning or even shocks. All those changes to the numbness helps to determine the extent of trauma rendered by the surgery. You need to wait for about 6 weeks after the surgery to determine if the numbness remains without any changes. Any changes are good and indicate that at least a portion of the nerve is still living.
If, however, nothing changes by 6-7 weeks, you should make an appointment with an oral and maxillofacial surgeon skilled in repairing jaw nerves. If you cannot find one, you may have to see a neurologist or neurosurgeon to assist is repairing the nerve.
I hope you are a little patient and changes do occur before 6 weeks.