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I possibly need a root canal. There is a fistula/boil on the…

I possibly need a root...
I possibly need a root canal. There is a fistula/boil on the gum near tooth #3 that is draining into my mouth. There is some sensitivity to chewing especially early in the morning but no pain. The Endodontist says that I should wait a few months until she is surer of what is going on. But my regular dentist thinks it should be done now!
Do you have any suggestions on how I might resolve this dilemma?
Thsnk you for your help.
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Answered in 4 hours by:
4/16/2010
bpkdds
bpkdds, Dentist
Category: Dental
Satisfied Customers: 136
Experience: 8 yrs private practice
Verified
If you have an actively draining fistula, you have an infection that needs to be addressed. The nerve in the affected tooth (#3 presumably) is dead and rotting. The rotting nerve is causing an infection that has "squirted out" the root of the tooth and has eaten its way through the alveolar bone (the bone that hold the teeth in place). You are lucky it is draining. If it wasn't draining into your mouth, the infection could spread underneath your skin.
Your options will include:
1) leave the tooth alone.... let the infection continue to fester. This could also result in an infection of the surrounding bone, osteomyelitis.
2) root canal.... remove the nerve and the source of the problem
3) remove the tooth..... remove the nerve and the source of the problem if the tooth is not restorable.
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Customer reply replied 8 years ago

Thank you for your reply. In essence, I know most of this already and I am sure it accounts for the fact that my dentist wants the work done asap. But the endodontist who will do the procedure has examined the area (with more thoroughness than the dentist) expresses doubts about what is actually going on - for example she believes that the nerve is still alive! And there is no sensitivity to biting or heat. I have no clue how to resolve this. If, I delay and it is necessary, I run the risks that you outline. But if this is not the problem, I will go through the whole procedure and will not have a cure!

How do I resolve this. I would like them to be on the same page

I wish my patients would come to that realization. The patient, dentist, and the specialist need to be on the same page.

So the source of the infection is still in question.
Ideas that I am sure the dentist and the endodontist are aware of. If you have a chronic draining infections, there will be a "tract" that goes from the source of the infection to where the infection drains. If they insert something radioopaque (usually gutta percha) into the track, you will "point" to the source of the infection. The tooth in question could be tested for vitality, cold / hot / electric testing methods. If there is no "sensitivity" when testing for vitality, there is a chance that the nerve in the tooth is already dead.

Other things in the area that can be the source of the infection:
Tooth
alveolar bone
sinus
soft tissue (muscle,fat, connective tissue)
pathology
Again the usual is the tooth. Nothing else should be in the area. It is possible that there is something foreign along the side of the tooth that is the source (popcorn hulls are really common).
Good Luck.
bpkdds
bpkdds, Dentist
Category: Dental
Satisfied Customers: 136
Experience: 8 yrs private practice
Verified
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