Hi Dive00,
Consumer Reports and Reader's Digest........hmmm......I'm thinking.....er......OK! Be careful what you read--not everything is as it seems. Since those articles are published without a particular diagnosis in mind, they can be misleading. I cannot accurately comment on your condition for the same reason...except that I have a Code of Ethics which requires me to refrain from making false statements or statements that can be misconstrued. Reader's Digest is under no constraint.
Back to the reason your dentist missed an abscess on an older x-ray...all dentists have missed pathology--fortunately not very often. When a tooth is first abscessed, there may be NO RADIOGRAPHIC evidence. Sometimes, only a little "suspicious" area may exist and it is easy to miss it on reading. An early cementoma will appear as a radiolucency ( a dark spot) and may be misread as an abscess. The mental foramen below the lower bicuspids can appear as a radiolucency and so can the bone trabeculae. A small lesion is actually easy to miss unless the patient has symptoms to match.
Some x-ray view don't show the root apices so it will not be imaged on every visit. A view called the periapical is needed to show the entire root. Check-up x-rays often use two or four "bite wings" of the posterior (back teeth) and two periapicals ( of the upper and lower front teeth). Root pathology will not be seen on the bite wings.
The endodontist was right not to comment, except to tell you to ask the treating dentist.
I am also not telling you that your dentist did NOT miss something. I simply don't know and no other dentist who wasn't there when the potential failure to diagnose occurred could know either. It's too tough to call. Consumer Reports can say anything they want.
Remember, I told you that the more often a tooth is treated, the more likely it can abscess? This MAY have happened here. The dentist, in good faith, puts in a filling but that tooth is a gonner. The dentist didn't know this would happen. Without any symptoms prior to the filling and assuming your x-rays were "within normal limits", the dentist recommended a filling.
I also told you that old fillings may lead to fractures. It turns out that fractures ALMOST NEVER SHOW ON X-RAYS. Undetected fractures are often the cause of dental problems that lead to nerve death and root canal therapy. Sometimes the fracture can be seen using high intensity light...trans illumination and sometimes it can be seen during the cavity preparation if the light is just right. They are very easy to miss and they are a major aggrevation for patients and dentists trying to do the right thing.
Antibiotics...only actually needed for an acute infection. It may do no good for a chronic (long standing) infection. They are used too often and often misused by the patient..."I'll keep 4 for a sore throat." So do you need an antibiotic...maybe......
I meant by the canal and chamber that any temporary filling should be placed WITHOUT a ball of cotton in the chamber and a temorary filling on top. This air space is the problem and is to be avoided. A ball of cotton is the norm for most root canals. Yes the endodontist can place a permanent filling but they often don't because they do not normally place final restorations. They might not have any or if they do, they may not be proficient in permanent placement. They are a specialist and in most cases haven't placed permanent fillings in years.
A crown is most appropriate in most cases. Sometimes we tend to leave lower front teeth alone. They get less force applied on them and the preparation of such small teeth with a hole already down the middle for the root canal access ends up sacrificing too much tooth. It can be done if necessary along with a post.
Back to fractured teeth. When they occur, they sometimes form at the root end of the tooth and cannot be seen--except by an endodontist who might have a fiber optic scope capable of seeing to the apex (root tip). Not all dentists, even specialist have this device. BTW if the endodontist happens to see a fracture running along the floor of the pulp chamber, ask them to tell you. It can affect the prognosis and almost always ends in the extraction of the tooth but it might take years to occur. You'll have a decision to make.
Diving with a known fracture can be a potential problem. Gas can get into the tooth through the blood supply of the periodontal ligament surrounding the tooth. Pain and rarely, breakage of the tooth may occur. Nothing can predict if or when it might occur.
Large abscesses also destroy a lot of surrounding bone. This compromises the prognosis. If the pulp abscess communicates through the gum with a periodontal abscess, this is called a combined lesion and it has a very poor but not 0 prognosis.
I want you to know that I'm not jumping on you for reading Consumer Reports. Unfortunately, advice, in the form of information has to be taken in the right context and under a known diagnosis. This information can help you to ask the right questions but it may also cause you to become suspicious of the dentist because you assume that your information from the magazine is correct. You should not even assume that the information I am writing is correct pertaining to your specific problem. This is where you have to rely on your dentist.
The patient, under a blizzard of conflicting information, is not able to make an informed decision. The is what the Code of Ethics is supposed to address. Reader's Digest made a serious error years ago and I still am very wary about their reporting.
Anyway, be safe diving. Remember that barodontalgias are very rare (although I'm getting the idea that they are not as rare as reported). Heck Johns wife needed one in Bonaire.
Hey, call me Larry.
Regards,
Larry Stein
:doctor:
Disclaimer
(No representations are made that in any way offer a diagnosis, treatment or cure for any illness or condition, either discussed or implied. Answers to questions are offered as information only and should always be used in conjunction with advice from your personal diving physician/dentist. I take no responsibility for any conceivable consequence, which might be related to any visit to this site.)
Damn, my fingers are tired!
