jhnsndn:
My dentist is recommending that I have a proceedure called an apicoectomy. Basically, there is some infection around the root of a tooth. My question is, how soon after this procedure can I go diving again? I am currently teaching a classroom/pool. Can I still teach in the pool the same week after this proceedure. Any information will be helpful.
Duane
Hey Duane. Man, I'd better answer this before Wolf Eel fixes you tooth for good!
He seems a bit wild to me!
OK. Like DocVikingo said, an apicoectomy is a procedure in which the tip or tips of the roots of a tooth are removed. It may also be called a "surgical root canal". It is usually done to a tooth that has already had a conventional root canal and that treatment has not successfully eliminated the infection around the end of the offending tooth.
There are any number of reasons why a traditional root canal may fail...either immediately or years later. There may be extra or accessory canals which were not detected and filled, branching of the nerve canal may make complete removal of all infected material impossible, canals filled short of the apex, cysts or granulomas that do not respond to traditional treatment and must be physically removed in order for healing to continue.
Generally, a small incision is made into the gum over the tooth. Then a flap of gum is raised to reveal the bone that is immediately over the root tips. Often, the bone is missing or very soft over the infection site. This bone is removed to expose the root tip and this tip is then sectioned across the width of the root. The freed root tip is teased out and the infection/cyst is curretted. The gum is positioned over the bone and sutured to place.
Frequently, the remaining root has a tiny filling preparation created in the area of the center of each root. A filling made of dental alloy, SuperEBA cement or MTA cement is inserted into this preparation to help seal the nerve canal. This additional procedure is called a retrograde filling.
Tooth #14 is the maxillary (upper) left first permanent molar. It usually has 3 roots and 3 canals. However, about 30% have additional nerve canals that may be missed during traditional root canal therapy. This tooth has a somewhat higher root canal failure rate...probably because of the missed, unfilled canal(s). Not all missed canals will result in failure.
There are usually two roots on the cheek side of the tooth (buccal) and one on the palate (palatal). Apicoectomy for this tooth MAY require that a flap is raised on both sides of the tooth...especially if the infected lesion cannot be identified or located. Obviously this makes the surgery more complicated.
Tooth #14 frequently approximates the maxillary sinus so this can become a complicating factor during the surgery.
OK, now that I've grossed you out and increased the anxiety level...Postoperatively, there is usually some soreness...both in the gum from the incisions and in the tooth because it has just had part of it's roots removed. The prescription medication usually work well. You'll want to eat on the other side for a while. Keep ice on the face and possibly expect a bruise. (Rather common for this kind of surgery). You don't want to disturb the sutures during the first week or so. Stay away from carbonated drinks and alcohol for the first few days and no alcohol as long as you are taking prescription medications. No drinking through straws for several days...the vacuum can cause problems with the site. Report any sinus problems or congestion in the event there is sinus proximity during the surgery.
The space left behind by the surgery will quickly fill with blood and form a clot. This clot will organize rapidly to form capillaries and then form bone.
I would recommend waiting at least 2 weeks and up to 6 weeks before diving again. Part of the wait period depends on the maxillary sinus proximity so ask your surgeon.
There will NOT be an air filled space in the properly healing surgical site but you would want to at least have the blood vessels forming. This takes several weeks.
You also have to be able to hold the regulator in your mouth comfortably. If the tabs rub the surgical site, wait to dive. If your tooth is sore to biting pressure, wait. It you are still taking medication for pain or infection, I would recommend waiting.
As long as you are comfortable and free of infection, two weeks may be all you need.
Hope this helps.
Laurence Stein, DDS
