I think I need a root canal...

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#1 Post by **TheSarahMonster** » Tue Feb 06, 2007 10:15 am

So a few days ago I noticed a really hard pea sized lump on my upper gum. It's way up there....like where the gums meet the upper lip. It doesn't hurt at all . I'm thinking it may be a painless abscess (painless because the root of the tooth is dead). I can't remember that tooth ever hurting me, and I'm not sure if I even have a filling in that tooth (if so it's a composite filling, since it's close to the front).

An abscess means a root canal....so how does one go about getting a root canal in braces....I'd have to take the wire and bracket off to get the crown put on right?

I'm also wondering if this could be bone....it feels like bone actually. It's hard like the restof my jaw and doesn't hurt. I'm taking the drug Accutane and I'm on a really high dose. It's usually advised to not undergo jaw surgery on Accutane because it can cause bone overgrowth, and it can also cause exostosis (bone masses) in response to bone injury......I dont know if it's an abscess, or a weird bone growth.....The more I think about it the more I think it's a abscess.....but my braces have only been on for three weeks (exactly). I had a panoramic X-ray right before I got them out on....so wouldn't it have been there three weeks ago??

I have an appointment with my dentist later this week...and I already told my ortho.....

#2 Post by **Kat** » Tue Feb 06, 2007 2:08 pm

Dentist will know right away with a x-ray.
If you do need some extensive work they will take the wire off and bracket fix the tooth then you'll go to the ortho's office and they will put it all back together for you. I had work done while braced but I just made the two appointments the same day a few hours apart then it was done. Wasn't at all as bad as I thought. (Most likely will have to do this again before it's over.)

#3 Post by **blondie** » Tue Feb 06, 2007 7:45 pm

Sounds like exactly my situation. In fact when i first read it, I was wondering if this was one of my old posts!

I have a bump way up in my gums above my left front tooth which also is a crown. They took xrays and it looks like both of my front teeth have to have root canals (both crowns) but I can't afford it right now and have to wait until tax returns. But they didn't say anything about taking off my braces, I think they are going to do the procedure behind the crown.

Root canals are expensive!! I have to pay it upfront and get the check from my insurance, whatever!

#4 Post by **rsprouse** » Tue Feb 06, 2007 9:23 pm

Hi,

I assume you are talking about the top of the gums near where you can move the tissue if you pull your lip? Is it in a spot that looks like near where the root of the tooth in question is? That sounds like an abscess. Pain is what usually gets people to do something about it, but if you have an abscess it means that there is likely an infection present. You mention "The root is dead", does that mean that the tooth you think it is has had root canal therapy in the past? How long ago? Posterior teeth that receive RCT need a full coverage restoration (Crown) in order to protect the weakened tooth. Anterior teeth do not necessarily need it, but aesthetically most people will select that route. If you previously had RCT on this tooth it will need re-treatment, typically by an apico. The endodontist will lay a small flap and treat the apex (tip) of the root to clean and seal the tooth removing all infection and letting the body heal. Don't worry about the semantics of treatment. These things happen and as a clinician you deal with it. It may be a minor inconvenience to you as the patient if you need a crown before your ortho treatment is up, but you may wait until after treatment to get a crown if needed.

I am not familiar with your comments on Accutane. Are you sure you are not confusing Accutane with bisphosphonates (Fosamax, Actonel, Boniva, etc)? And don't get down on your ortho for not spotting it if it is an infection. Pano's are good at seeing the lay of the land, you typically would need a PA to properly diagnose a lucency that would cause an abscess.

Good Luck,
Rory

#5 Post by **TheSarahMonster** » Tue Feb 06, 2007 11:34 pm

I haven't had a root canal in that tooth ever. I've never had a root canal on any tooth. In fact I don't even have a filling in that tooth and I had a checkup from my dentist about 2 months ago.

I'm not confusing Accutane with a bisphosphonate. It's isotretinoin (cis-13-retinoic acid) which is used to treat severe acne. It has all sorts of insane side effects.....and messing with bone growth and bone healing is one of them (breaking a bone while taking it can be a big problem because of improper healing)....I was thinking at first it was bone because it's so hard, but because of it's location, size and shape I'm thinking it's an abscess......even though I have no pain in the area, and the tooth isn't even sensitive. I was thinking the nerve was dead....because I couldn't feel anything....but nerve death does usually involve a good deal of pain....so maybe the pain just hasn't started yet.......

#6 Post by **rsprouse** » Wed Feb 07, 2007 4:57 am

I haven't had a root canal in that tooth ever. I've never had a root canal on any tooth. In fact I don't even have a filling in that tooth and I had a checkup from my dentist about 2 months ago.

If you had a checkup you may or may not have had bite wing radiographs. They do not typically show the root of the tooth so there would be no radiographic interpretation of a lucency or pathology to diagnose an abscess. Lucency's typically form over a long period of time, but an abscess will develop when the infection gets large enough and is raging on...thus the typical association with pain.

I'm not confusing Accutane with a bisphosphonate. It's isotretinoin (cis-13-retinoic acid) which is used to treat severe acne. It has all sorts of insane side effects.....and messing with bone growth and bone healing is one of them (breaking a bone while taking it can be a big problem because of improper healing)....

I am not a chemist or a pharmacist, but I am familiar with Accutane and many of its uses. I looked in the pdr for confirmation and do not see any contraindications or caveats with dental treatment. Nor have I read any journals or articles about this. I am familiar with the implications with bone healing, but did you receive some sort of traumatic injury to the area? Orthodontics are far from traumatic. I have been wrong many times in my life, but I do not see your correlation in this instance. Any chance you can provide your source(s) for more research on my end? This is something that I would like to look into further for my patients in case it comes up in the future and I cannot find anything from a reputable source.

I was thinking at first it was bone because it's so hard, but because of it's location, size and shape I'm thinking it's an abscess......even though I have no pain in the area, and the tooth isn't even sensitive. I was thinking the nerve was dead....because I couldn't feel anything....but nerve death does usually involve a good deal of pain....so maybe the pain just hasn't started yet.......

Pus can be very hard if it is packed into a space. Although if that is the case it is typically sore and inflamed. Nerve death does not mean that there will be pain. I have seen many a tooth with a necrotic nerve that is "dead" to the patient (no symptoms and no response to stimuli) and the patient felt no pain. Pain is a bad thing, it means that the problem has gotten out of control and you waited too long. I suggest you follow up with your friendly local dentist for a thorough exam and diagnosis.

Good Luck,
Rory

#7 Post by **TheSarahMonster** » Fri Feb 09, 2007 4:05 am

I don't need a root canal....yay....

I went to my dentist and she said it was just a part of my jaw, and agreed it was because of the braces moving my teeth. The bump had always been there, but because my canine has shifted it started to protrude and is further back than it should be. She said it is much larger then the bump on the other side, but it's not something to worry about. The tooth in question doens't even have a cavity in it, and is perfectly healthy.

#8 Post by **JumpTheDitch** » Fri Feb 09, 2007 5:07 am

Good news indeed, TheSarahMonster

It's amazing how much more attention we now pay to what's happening in our mouths

#9 Post by **Kat** » Fri Feb 09, 2007 5:49 pm

Don't you just love good news? Congrats!