Chronic infections are really important to understand because if you have one of them in your mouth you might not know. One of the symptoms of a chronic infection, if the nerve has already been treated by root canal treatment, is that it normally doesn’t have very much pain. Not always, but normally it doesn’t have any pain.
One common symptom that is often found with a tooth that has a chronic infection is that, when patients bite down on this tooth, ‘it feels a bit different’.
In this case shown below, there’s a back lower molar and the molar in front of it that don’t have some great fillings on them. You can see these are open margins, not very well finished, little bit of decay, things aren’t going great in this person’s mouth. But to top it all off, these are incomplete root canal treatments, and this tooth has had the nerve drilled into, there’s decay in the tooth, and there’s been no treatment done at all.
So in this case, we would definitely suspect for this tooth that it would have a chronic infection if this happened some time ago. There was no pain for this patient at all. All that was experienced is that when they chewed down things ‘felt a little bit different’
Bone loss from bacteria inside the root of the tooth, creating inflammatory toxins that then come out and cause resorption of the bone by the immune system underneath the tooth. Now there’s a granular cyst there, and this patient is in some serious need of treatment.
This tooth had an incomplete root canal treatment, with a little bit of a file left there in the tooth shown in the image with the little curvy white line . Regardless, this root canal treatment was not successful. We can see a darkened area here on this x-ray, there’s scarring, indicating bone loss underneath this tooth for the exact same reasons as before.
So you have to make sure that you’re observing the x-rays that your dentist takes after they finish the root canal treatment to make sure that the job’s been done to a high level of satisfaction. But even then, and we’ll show you this next clinical case, sometimes that isn’t even enough.
This tooth had what would be, by all accounts, if there was no bone loss underneath it, a very successful root canal treatment. The root canal treatment is this part here, and it goes all the way to nearly the tip of the root, and the same in the front roots of the tooth. But still, bone loss underneath it.
So what’s happened? After this root canal treatment, bacteria have propagated into the tubules, lots and lots of microtubules that exist inside the roots of the teeth, and that propagating bacteria has caused a biofilm that’s produced inflammatory toxins. Those inflammatory toxins have come out of the end of the tooth root, and they’ve caused a bunch of bone loss.
There’s granular cystic tissue instead of bone. The immune system’s trying its hardest to overcome this, but it’s just not able to do it. So if you’ve ever experienced, again, I’ve gotta tell you guys, if you’ve ever experienced a tooth that didn’t feel right to chew on, you knew something just wasn’t quite right, get this checked out so that you know in advance.
There’s another case that I’d like to share with you below. This 3D case for a patient who actually had bone loss as well underneath her non root canal treated tooth. It’s critical that we understand that not every tooth with a chronic infection or bone loss or problems has to have had root canal treatment. A lot of the failures that we see in teeth with root canal treatment happen with teeth that have had trauma, old fillings, history of complex dentistry.
We took a scan for this patient because we couldn’t clarify with the normal two-dimensional x-ray. In the 3D scan ee can change the density of the images if we need to, we can get a lot of clarity around what’s happening in this person’s mouth. We can see, underneath this tooth here, as we cycle through the films from the panoramic image, that unfortunately there’s a lot of bone loss up around the tips of these roots.
What does that mean? It means that unfortunately this patient is suffering from a chronic infection from a tooth which had the nerve die, bacteria again bred in that instance inside where the nerve used to be, and that’s unfortunately causing bone loss and cystic granular tissue to be there. Poor immune system’s doing the best it can, that’s why these lesions are circular and they haven’t spread all the way throughout this whole region in the mouth. But it’s not a good situation nonetheless.
Again, another great case for you guys to see and understand what is happening in some other people’s mouths, and hopefully this can give you some context and some great information for your own oral health journey. Getting the right diagnosis is critical, especially in instances where the immune system is being affected by a chronic infection. The body is related to the teeth, and the teeth are totally related to what happens in the rest of the body.
I hope this has been helpful. If you have any questions, make sure you get in touch, leave a comment below. Make sure you look after your teeth, look after your health.