A Toothless Situation | External Root Resorption | 2018 Update
Back to blogging about my teeth again...
I was debating taking a trip to California to try
meeting with Dr. Hansen to try and save my tooth...
Here was my situation...
I had not seen a dentist in 11 years since I had my braces. my upper teeth were rapidly moved and the left cuspid was torqued during my 1 year orthodontic procedure.
I developed a cavity in my top right third molar (wisdom tooth).
In August 2008 I finally went to the dentist (which is very difficult for those of us with MCS) and had the top right 3rd molar removed and a cavity filled in the top right second molar. At that time I showed the dentist a small red mark near the gum line on the left Cuspid.
He drilled it thinking it was a small cavity only to realize it was "nerve tissue". At that time he capped it over with a standard white filling. I had very little pain and seemed to recover well.
In March 2010 I had the second and third molar on the top left repaired, the second molar had an amalgam removed and replaced with composite and a large composite filling was also placed in the third molar. I had a lot of pain after the fillings.
Pain radiated to my jaw and temple and across my cheek bone. I returned a few weeks later to explain the pain and nothing could be found. I explained that it felt like the two molars were fractured and air was getting up through them.
Later that month the original filling on the cuspid fell off and I returned to have it repaired. Two dentists spent much time examining the tooth as they had never seen a nerve this close to the surface. They looked at a previous x-ray of the tooth and with uncertainty decided that perhaps the “shadow” on the x-ray was from the filling. It could also possibly be a large cavity. After a long evaluation and irritation of the nerve, they decided to replace the filling with a calcium hydroxide ( as I suggested to them) and a bonding agent used for veneers.
By the time the filling was placed I asked that they not file it as the tooth was extremely sensitive due to the irritated nerve.
A few weeks after the filling was placed I returned with a gum abscess due to the rough edge on the filling. After a course of prescribed antibiotics I returned to have the filling filed down at which time he added some composite to the filling.
I waited a day but the pain and abscess got worse. I had to take Amoxicillin. This was the first time in 5 years that I have needed antibiotics but I'm glad I decided to go ahead with them in this case.
The filing is not pretty and looks like a bit of plaque but at least I still have the tooth. Unfortunately due to the filling being so close the the gum-line ether the filling itself irritated my gums or something got trapped between the gum-line and the filling and caused an abscess....totally not fun.
So if you want to know what an abscess on the gums looks like here is a pic of my tooth...
grose I know but educational at least:
I returned as the pain from my molars is becoming a thorn in my side from daily pain. I explained that when I eat anything and it gets stuck between my molars my entire cheek bone, jaw and temple hurts, especially things like honey. He briefly inspected the molars and insisted the pain was referred from my cuspid, however, besides some gum irritation around the cuspid, I feel no pain in this tooth.
He struck it with metal several times but there was no additional pain. He x-rayed the tooth again and found a larger shadow on the tooth than before. He now insists the tooth has to be removed and has taken impressions to have me fitted for a partial.
I have read that the original pink mark can be common in bruxism patients (I grind), as well as teeth with external resorption and should not be drilled.
I have also read that it can be a bit dangerous to have such a long rooted tooth removed as it is close to the sinus cavity and can cause a structural change in your face. Also the loss of cuspid teeth can cause more bone loss in your jaw.
I have no idea what to do from here so I have decided to just wait it out. The local dentists feel the tooth may abscess and will cause infection to spread yet at this time I have no swelling, redness or symptoms of abscess.
On June 21st 2010, I went for a second opinion. They too were puzzled that I am not experiencing pain in the cuspid but new x-rays show that there is indeed a hole below the gum-line affecting the root of the tooth, this is why I could not see any cavity even when examining my tooth in a dark room with a flashlight...yes, I am obsessed with my teeth.
It was also suggested by this other dentist that I have the tooth extracted as soon as possible or else wait three months to see a periodontist, and likely I will need gum and bone removal along with a root canal. I was told that this may very likely not be successful and in all probability I will need the tooth extracted anyway in 5 years or so. I'm also not at all entertaining a root canal due to the current problems I have with my immunity.
I am very concerned about how loosing this tooth will affect my facial structure and future bone loss as I currently have about 35% bone loss apparently due to the removal of my bicuspids for braces 11 years ago. I am also told that due to my bruxism, an implant may also fail.
I eat healthy, no refined sugars and organic foods, I floss and brush daily and I am puzzled as to what has happened to this tooth and wish to save it if possible. I have sensitivities to many synthetic products but there is no dentist here which uses biocompatible materials.
I have contacted both Dr. Hansen and Dr. Goldman.
Dr. Hansen in California specializes in laser dentistry and feels this tooth can be saved. This is a long way to travel and surly will cost a lot of money.
Dr. Goldman has sent me this message...
"Hi, You probably have what's called resorption either internally or externally - which probably means nothing to you but the dentists should have recognized it. You need to see an endodontist. Not just a dentist that "does root canals" but a SPECIALIST that ONLY does root canals and has had advanced training in it. Maybe it can still be saved and if so you will need a strong "post" or rod placed down the center of the tooth to help give it strength after the root canal, assuming it's still possible to do a root canal. If it can't be saved it can be extracted and a bone graft placed in the socket to help prevent shrinkage of the bone and then an implant can be placed. Good luck. DON'T WAIT!"
I started researching resorption and found that it can happen after people have had rapid tooth movement. I had braces which moved my teeth in one year rather than five. It can also be caused by trauma...Maybe drilling.
I have been scheduled for an extraction and am having partials made as I type, however I still would prefer not to lose this tooth and will be trying to get an appointment with an Endodontist on Monday. I'm getting tired of all the unsure examinations and x-rays.
Anyway here are more fun tooth pictures..yea right, but If anyone knows of any specialist who could help please let me know. Bone graphs, partials, implants, gum surgery...eeeeK!
2 years after initial drilling & filling
I went to see a periodontist in June 2010 who also confirmed that I have external root resorption and suggested that I have the tooth removed and an implant placed immediately. He only offers titanium implants and I'm not liking the thought of a metal rod in my mouth, especially since I have metal sensitivities. I decided to do more research and wait it out. I have sensitivities to many metals and dental implants are not a simple as it seems.
While titanium itself is considered to be fairly inert, many implants are made with titanium alloy. Titanium alloy contains roughly six wt percent of aluminum and four wt percent of vanadium, which doubles its tensile strength relative to commercially-pure titanium, but reduces its ductility (craig, Powers and Wataha, 2004, 316). However, it promotes good osseointegration (connection with the bone). A complex mixture of adherent oxides of titanium and oxygen are used to coat either titanium or titanium alloy, and the presence of these oxides appears to be necessary for the osseointegration process to occur.
Another factor to consider is that the abutment and crown can also be made from different metals or metal alloys from the implant itself and this can create a galvanic action between the implant and crown, leading to possible corrosion of metals in the mouth.
Just as my body is attacking my own tooth (resorption) for some unknown reason, I also have concerns that my body could launch an autoimmune response against the expensive implant as this is possible with anything that is foreign inserted into bone.
No matter which option I choose there will be risks. I have decided I would prefer to have a metal-free zirconium implant, however finding a local dentist to do it has proven difficult. I went to my doctor and a specialist to order allergy testing for titanium but surprise-surprise, it's not offered here in our province.
All that said, I am now in search of a dentist who will do an immediate placement after extraction of a metal-free zirconium acid etched implant and matching zirconium abutment and crown.
CerraRoot looks most promising.
6 years later...
8 years have passed since the initial filling on my cuspid (Canine) tooth, 6 years since the second "filling", and it looks like I have to finally need to have an extraction. The last few months the filling has been degrading, food has been getting trapped under the gum line and I've been getting some drainage that smells awful. The floss gets stuck on the hitches in the filling and honestly it looks and smells pretty bad now.
I returned to the dentist today (2016-10-14) to have the filling replaced but after taking an xray and checking the tooth, it seems that aside from the resorption, I now have some decay below the gum line and likely under the filling.
There's still nobody that I know of in our province who will do zirconium implants so I've been researching other options while I wait to see the surgeon as it looks like the tooth is going to be complicated to have removed since so much of the structure is now compromised.
After doing more research, I was hoping to have the option of intentional replantation:
First of all, I'm not 100% sure the resorption is actually any worse since the xray from 2010 and the one in 2016 are on slightly different angles. Unfortunately I was told that decay is starting below the gum line (around the filling).
Because metal-free implants are not available here and because resorption sites are not ideal for implants, I've been looking at my options for a fixed or removable appliance.
Most interesting to me would be either a winged pontic bridge (maryland or Carlson) As I really don't want to have a traditional bridge which will require grinding down of adjacent teeth. The winged bridges are much less invasive but I'm not sure if they are an option for a cuspid tooth.
I already have a traditional flipper, but with my sensitivities, I'm not sure my gums will enjoy being rubbed by plastic all day, not to mention they look terrible and the lab got the colors way off:
$300 flipper - Ewww
Again, I'm not sure if the snap on smile version will work for a cuspid, but it looks much better than a standard flipper, so I'll definitely be looking into that option as well. But of course, it's not available here, so I will need an on-line source.
So while I wait to see the surgeon, I'll keep on hoping for a better option to become available here locally...8 years have passed and I've done everything I could to save this tooth, but it looks like I may be saying goodbye to it before the year is gone.
I'm always open to hearing suggestions of treatments or options after removal, if anyone would like to share, please comment below.
In 2017 I was told by my dentist that I needed 3 teeth extracted, my top right second molar, my top left third molar (wisdom) and that cupid tooth we've been discussing. She booked my appointment and several months later I went to see the surgeon, it was not a good experience. The facilities are not suitable for those with Chemical Sensitivities/Allergies even though I was told they have a "scent-free policy".
Initially, I thought it may have been from another patient, but after moving to another location, I realized that it's something being used throughout the entire facility. This product was so strong, even my husband could smell it on me after I left and got in the car.
I had to wait 45 minutes past my appointment time to see the surgeon, while the pleasant kind staff member (nurse I assume) opened the window for me, I had become overwhelmed with a migraine, burning nose & eyes and was starting to get brain fog after 45 minutes so I decided to leave, but just as I was leaving the surgeon was outside the door and asked where I was off to...
He mistaken my allergic reactions for "anxiety" which I found to be quite inappropriate... I do sometimes have anxiety and am very aware of my own medical issues. He immediately told me that I would require IV sedation (because of his opinion that I was having anxiety issues) and seemed to brush off the fact that I have severe reactions to many medications and would not be comfortable with any such treatment.
Also, I was under the impression that I was referred there to "discuss options" for 3 of my teeth, however since I do not want extractions at this time, no other options were offered and because only 2 teeth were mentioned in my referral, these were the only ones he could comment on. I spent all of 10 minutes with the surgeon, after waiting and exposing myself to an unhealthy atmosphere for more than 45 minutes. I was charged for a 30 minute appointment.
He later called me and apologized after I left my rating on RateMD's.
I decided at this point to do nothing.
And the search for another dentist continued...
I finally found a dentist that I can talk to, he may not have the most modern equipment but is very open to my suggestions. I explained that I did not want to lose 3 teeth (especially not the cuspid) and although I am aware that it may fail, I asked that before extraction would he give one last-ditch effort to repair the tooth...HE AGREED! He too was unsure if it would work, but I agreed that if it didn't then we would go ahead with extraction. Extraction can't be reversed so why not give a repair a try.
He checked for infection and x-rayed the tooth and things looked okay. So he did the repair. 1.5 hours in the chair! but I'm very pleased.
As for the molars, for now it looks like they have settled down, I am a bruxer so the grinding is likely causing the pain, more than likely that pain in my molars is caused by TMJ and acute Trigeminal Neuralgia rather than the actual teeth.
I've been faithfully brushing with a soft toothbrush, I'm already a flossaholic, I oil pull several times a week and do saline rinses daily.
10 years later and I still have all my teeth!
Cuspid 2018 (10 years later)
WOW such an improvement from this:
The cuspid is still doing well, I'm sticking with my routine. My top right second molar (tooth #2) has been causing some issues on and off. It has a number of fillings and because of my bruxism, the gums are receding around tooth # 3, which worries me about extracting #2 and that it could cause further bone and gum recession. If this happens I could also end up loosing tooth #3 a short while later.
I've been looking into Pinhole gum surgery and will see if this is something that may help this situation. As I would prefer to repair the gums rather that patch it with gum-line fillings.
On another note, my hubby also has a tooth that he has been struggling with but to to repetitive infections which he can't get under control, he will be having tooth #13 removed.
Hubby's problem tooth
Luckily our new dentist is open to our suggestions and we mentioned that he would like to get the snap-it style flipper. He initially tried filling it but because the center of the tooth was filled, the enamel cracked off, he had two more repairs to it but it continues to be infected.
We discussed his options:Root canal - Don't want it for health issues and his tooth is actually not a candidate for one anyway.
Implant - Maybe in the future but not at this time.
Standard Bridge - Will file down the two adjacent teeth and are difficult to clean around.
Standard Partial with plate and metal or flipper- Somewhat archaic.
He decided to discuss a Maryland Bridge or the removable snap-on partial our dentist also suggested a hugger bridge which is very similar to the snap on smile style flipper but is actually bonded in.
He will be opting for the removable partial, the bonded one may be more difficult to clean around and having a gumless removable will be more comfortable than a standard partial or flipper (no gums, no plates, no wires) and will leave his options open for the future if he wishes to get an implant. His appointment for the procedure is in the next few months and we'll keep you all posted.