[Eddy]

In my personal experience, the only problem with an extraction is the cost of replacement. I did not want to disturb the teeth on either side so did not opt for a bridge replacement.

So I had to get an implant which set me back by about 35,000.

[VineetSoni]

Originally Posted by carboy

Thank you for your reply.

So we went to a second dentist. He pushed the teeth harder and it pained. He said there is a sinus infection and because of the infection it's also pressing on the teeth which has decayed. It's an upper premolar.

He said asked us to get an x-ray to determine whether the teeth can be root-canaled or whether it has to be extracted - he said sometimes this teeth is such that root canaling may perforate the sinus.

I'll also try to upload the X-ray later.

Hello sir
First I would like to let you know that what ever we are talking about is based on what you are telling me. Things might differ clinically.

I have one question for all my patients. If there is a injury in your finger will you prefer treatment (25% chance of recovery) or you will straight away get it chopped.

We can get the extraction done any time but if there is even 1% chance of saving it go for it.
Aftermath of the extraction is too much.

Plus chance of perforation will be more after extraction, rather than in RCT. Things will be more clear if I see OPG Xray.

As for your wife please let her know there is a vast difference between the way of treatment as compared to what we had 8 year ago.

In my clinic I perform anesthesia free, painless RCTs.

[VineetSoni]

Originally Posted by carboy

Now I have 2 questions
1) What is the procedure for extraction of teeth - how exactly is it done - i.e. do you just knock it off, drill it and knock it off etc? What are the risks? Is there a local anesthetic given?
My wife wants to do extraction rather than RCT. She has had a very bad experience with dental treatment many years back(bruised nerve which hasn't healed till now - 8 years) and hence wants to do the simplest thing possible.

2) I read that Dolonex has lot of side effects some rather bad & that 30% of all people who take Dolonex have side effects? Can she skip it and just take Enzoflam (which contains 3 pain killers already)

I'll also try to upload the X-ray later.

Answers
1) general procedure: local anesthesia》tooth ligaments are cracked》mobility of tooth is increased》pulled out. (Very simple words so sorry for harshness)
The procedure may differ clinically. For example once I start the procedure I may discover that roots are ankylosed (fused with bone) I might have to use the drilling machine.

So we can not make that call beforehand.
For me Root canal treatment is much simpler than extraction due to advancement in technology.

2) Ofloxcin 》antibiotics 》perfect
Ornidazole 》antiamoebic agent, for dysentery》perfect
Enzoflam 》 anti inflammatory + pain reliever 》perfect

Dolonex》 anti anti inflammatory + pain reliever 》confused
I do not understand the need of second painkiller you can totally skip it.

Open a word file on your laptop or desktop then keep the opg on screen then click the picture. And then upload it.

[carboy]

Mod note: Post deleted. Please follow http://www.team-bhp.com/forum/announ...-team-bhp.html

[VineetSoni]

Originally Posted by carboy

Thank you very much for your replies (and patience), doctor.



Can you elaborate on this

This x-ray was taken with infection still there.




My RCT was done 3 years back with anesthesia (my doctor is rather old & probably not upto date). Also I was in terrible pain before the RCT. What are circumstances when anesthesia is needed for RCT?


After 3 doses of the newer antibiotic, the pain is now far far reduced - 90% gone.

She has no dysentery, so I wonder why this was prescribed.

Extraction: aftermath
1. The healing process allthough simple but if perforation happenes it will require a lot more time plus medication plus regular dressing change of the open socket.
2. Replacement will have two options A. Bridge which will require the support of two teeth on either side. B. Implant the question will be if perforation happenes implant might go out of the window as it requiers bone support.

After looking at the x ray
Go for the RCT maximum it will require will be something called as RCT sealent in case perforation happenes.

Anesthesia is required in
Emergency for example a fresh trauma and the tooth has fractured and needs treatment rightaway
Single sitting root canal might require anesthesia
RCT resulting from attression

Many times dysentery is the most common side effect of antibiotics thats why many doctors prescribe it on the first go only.

As far as I can make it out allthough the x ray is not that clear its a simple RCT. please do not start the treatment before the infection has completely subsided.

[carboy]

Originally Posted by VineetSoni

As far as I can make it out allthough the x ray is not that clear its a simple RCT.

Ok - attached again.

Originally Posted by VineetSoni

please do not start the treatment before the infection has completely subsided.

OK. I am assuming if the pain is gone, that means the infection has completely subsided or is there any other way to know.

[VineetSoni]

Originally Posted by carboy

Ok - attached again.

OK. I am assuming if the pain is gone, that means the infection has completely subsided or is there any other way to know.

Hi

Yup these are much clearer

Definately go for RCT no need of extraction. The dentist will require to put sealant as a part of final filling.

If the pain is gone maximum infection is gone but it does not mean all the infection is gone, in my earlier post I meant this stage only when all the swelling, pain and major patient compaints are gone. If you have taken a smaller x ray called iopa. Kindly upload it, it gives a better view of infection. If you do not have it no need for now.

Just get RCT and crown done during rct the dentist will seal the apex of root with the sealant rest is same.


For example in this picture there was a perforation in one of the roots. So sealant is used to close it. That white colour buldge is what I am talking about.
Its a technique sensitive thing so do not think every dentist can do it.

[VineetSoni]

Hi carboy

I showed the images to my wife for her opinion.

She has said the exact same thing, allready the root apex are very close to sinus floor, in addittion she says she would like to see an IOPA in respect 15 (second upper ride side premolar) and 16 (first molar on the same side).

[carboy]

Originally Posted by VineetSoni

I showed the images to my wife for her opinion.

She has said the exact same thing, allready the root apex are very close to sinus floor,

So what does this mean - is it very risky?

Originally Posted by VineetSoni

in addittion she says she would like to see an IOPA in respect 15 (second upper ride side premolar) and 16 (first molar on the same side).

She hasn't done an IOPA.

Another question - is it OK to wait for a week after he antibiotics course gets over. I have some holidays coming up next week - hence it would be more convenient.

[VineetSoni]

Originally Posted by carboy

So what does this mean - is it very risky?

She hasn't done an IOPA.

Another question - is it OK to wait for a week after he antibiotics course gets over. I have some holidays coming up next week - hence it would be more convenient.

It is risky if you are going for extraction. Risky being more chances of a bigger perforation.

When ever u get an IOPA let me know.

Ideally the treatment should be started right after the antibiotic course. As chances of secondary infection is there.

Its your call when to get the treatment done. I will just say carry the medication with you just in case.

And take ketrol DT as pain killer, my choice for even myself.

And if any problem occurs just start the medication again.

[car-dent]

Originally Posted by carboy

So what does this mean - is it very risky?



She hasn't done an IOPA.

Another question - is it OK to wait for a week after he antibiotics course gets over. I have some holidays coming up next week - hence it would be more convenient.

hi,
I feel this is a pretty straightforward case that requires a Root canal treatment and crown over it. Roots for most upper teeth sometimes appear very close to the sinus but that usually has no implications on the success of The root canal treatment. This tooth sure does not need to be extracted and can be easily saved.

(The above opinion is based on the discussion above and the OPG posted. The actual clinical picture may vary)

[carboy]

Doc Vineet, thanks a lot for your all your answers. Doc car-dent also. My wife got the root canal done. Today was the 3rd and final sitting. Everything went well, fingers crossed. Now 2 more sittings for the crown.

First sitting had local anesthesia - was not required in the 2nd and 3rd visit.

[car-dent]

Originally Posted by carboy

Doc Vineet, thanks a lot for your all your answers. Doc car-dent also. My wife got the root canal done. Today was the 3rd and final sitting. Everything went well, fingers crossed. Now 2 more sittings for the crown.

First sitting had local anesthesia - was not required in the 2nd and 3rd visit.

That's Great. What type of crown are you getting? Did your doctor tell you about the metal-free crown option.

[carboy]

Originally Posted by car-dent

That's Great. What type of crown are you getting? Did your doctor tell you about the metal-free crown option.

Getting the ceramic crown. I had a root canal 3 years back (with a different dentists). This seems to be the same kind of crown, I got - ceramic.

[VineetSoni]

Originally Posted by carboy

Getting the ceramic crown. I had a root canal 3 years back (with a different dentists). This seems to be the same kind of crown, I got - ceramic.

Hi

Is it all ceramic crown or metal plus ceramic crown.