Sometimes, the real story lies beneath the surface.
A 17-year-old boy landed up in my dental operatory with a pimple on his gums above the 2 upper front teeth. He was in a lot of pain. He also gave a history of a fall and chipping of the upper front tooth a few years ago. This had been repaired with some filling material.
An X-ray showed an alarmingly huge black shadow which had surrounded the roots of his upper 2 front teeth. A 3 D image of the region revealed that the infection had eaten away the bone and had even penetrated the base of the nose.
Now at this juncture I would like to take a step back and look at our patient who was only 17 years old. How could I get rid of this infection without causing any permanent defect in his upper jaw bone and get those teeth to last in his mouth for a very long time? These were the questions that I asked myself. To get an answer we must analyse the cause of the infection. It was the trauma to the tooth that has caused the nerve within the tooth to swell and die. The tooth communicates with the surrounding bone through a canal. This is how the surrounding bone gets infected. When undetected this infection can spread to involve a large part of the jaw and can be perceived through pain in the gums or through a gum boil.
The mystery of the cause was solved. But how could we treat it effectively while protecting the surrounding healthy tissues? “Non-surgical root canal therapy” was the answer. We had to reach the infection in the bone, and eliminate the bacteria from within the tooth. This was best accomplished by accessing the root canal through the tooth itself, and continuously replenishing the chemical used to treat the infection. A dressing was placed inside the tooth and replaced a few times over several months until some resolution of the infection and bone formation was seen. This was followed by completion of the root canal treatment.
Subsequent 3 D imaging taken at the 1 year and 3-year mark showed very good healing and bone formation. A recent dental X-ray when compared with the first X-ray shows healthy bone formation around the roots. This case demonstrates the power of the human body to in some instances take care of aggressive infections when the cause of the problem is taken care of. Surgery was avoided in this case. The treatment of modern root canal therapy was carried out with minimum discomfort and the patient could carry on with his day-to-day activities without any hindrance.
To me and to the patient and his family, treating a complex case in this manner is a huge win. Minimally invasive dentistry is all about preserving what is healthy, treating only what needs to be treated, and intervening thoughtfully.
