Diving, Flying, Cruising & Root Canal

[Dive00]

Thanks for all the replies.

Larry Stein, I did appreciate the Consumers Reports Book on dentistry and the Reader's Digest article (I figured these would not be all time favorites). Both applied to me from the viewpoint of a patient. I will detail my experience on the board soon. I just wanted to say thanks for the comments.

Jon

 

[Dive00]

Larry,

Hope all is well. Appreciate your prior responses. Would like to pick your brain again.

To simplify, following is the timeline of my treatment:

10/00 Tooth filing (#31)
03/01 Switch dentists,x-ray showed abscess, I was not notified
10/02 x-ray, root canal diagnosis
11/02 consultation with endodontist
12/10/02 1st visit with endodontist (clean,medicate,temp filing)
01/06/03 2nd visit with endodontist (gutta-percha, shaved tooth)
01/16/03 shaved tooth

To refresh your memory, I had a abscess for about 2 years prior to the diagnosis and treatment. On the 11/02 consultation the endodontist said the gum pocket was 9mm. After the first visit the gum inflammation appeared to heal within a week. The dentist said I could dive, but prior to leaving for the Caribbean I asked if he placed cotton below the filing. He did. I decided to just relax and not dive, Murphy's Law. Anyway, I rinsed with warm salt water 2 -3 times a day to help with the bitter taste. The bitter taste seemed to go away. The second visit went well. However, the bitter taste has increased significantly. On 01/16/03 I went to the Endodontist again. The gum pocket decreased to 5mm and he said everything looked fine. He shaved the tooth to relieve pressure from biting and mentioned to scrape my tongue. He keeps telling me the abscess was large. I still have the bitter taste, buts its better. Do you have any idea on why the bitter taste came back after the 2nd visit? Any treatment possibilities? I understand your disclaimer.

Thanks,

Jon

 

[Laurence Stein DDS]

Hi Jon, I thought this thread died and went to heaven.

Please understand that I am answering your questions without the benefit of an examination and with only your input. No definite conclusions can be drawn from these comments.

The bitter taste you mention is commonly associated with a draining abscess. While it could be from the sinuses or a post nasal drip, since you have a diagnosed abscess, my first inclination is to assume that this abscess is still causing the problem.

This is especially true if, as you say, you have a pocket associated with the tooth. A pocket is usually referred to as a periodontal pocket. This is the loss of bone around the root of a tooth or between the roots of multi-rooted teeth. The pockets cannot be cleaned well and tend to persist and slowly get worse.

I don't know if your pocket is of a free standing periodontal problem or associated with an endodontic lesion which has begun to drain into the mouth--a combined lesion (endo/perio).

A traditional periodontal pocket may respond, at least temoprarily to scaling and root planing. If it is a combined lesion, then the prognosis is more guarded.

Some pockets between the rooths of dead, abscessed or endodontically treated teeth are a result of a fracture between the roots. This has a very poor prognosis. It almost never shows on x-ray. Rather, it is a diagnosis of exclusion. Frequently, the fracture may not be visible even during the root canal treatment.

You might want to press on the gum surrounding the tooth. See if you can express some pus or you get the taste. If so, the prognosis is probably poor.

I would advise you to be very careful about diving with the symptoms and signs you present. Have the tooth re-evaluated for a fracture. Have the pocket problem examined and addressed.

Without seeing the tooth, I cannot make specific comments about your tooth.

Hope this helps.

Larry Stein :doctor:

The material provided was for information purposes only. No attempt to
diagnose or treat you condition should be assumed. You should seek care from
you own dentist or physician concerning this matter.

 

[Dive00]

Hello Larry,

This thread is still alive, although the status of my tooth is another story. My aim is not to place the tooth under my pillow for the good fairy.

I understand no definitive conclusions can be drawn from your comments, but they are much appreciated. I'm glad I did not go diving with or without the cotton below the filing. Therefore, I believe I did everything in my power to save this tooth.

I'm looking at the Novemeber x-ray right now. The abscess is large - it goes from the tip of the canal and tapers off to the gum line. Between the October root canal diagnosis and December root canal procedure, a pimple approximately 5mm in diameter developed on the gum on the cheek side (based on my internet search this might be a postule like lesion). After the first root canal procedure this pimple drained and was gone within a week. The periodontal problem is associated with the endodontic problem as so stated by the dentist. The endodontist hoped that the pimple would drain after the root canal, and it did. I thought this was a good sign.

The dentist noticed fractures on the outside of the tooth prior to the root canal, but did not see any inside during the procedure. He mentioned this was a risk that he would evaluate upon entry. During the second visit, he said the canals were dry. I looked at the xrays and the gutta percha travelled to the tip of the canal -- they looked good to my naive eye.

During my third visit to the Endodontist on 1/16/03 he pressed down on the tooth, like you said, and did not see any pus. The decrease in the pocket from 9mm to 5mm in approximately 1 month was a good sign. I'll pass on pressing down on the tooth, as he already did, and I'm trying to let it rest. I'm going on a liquid diet to see if the bitter taste fades away. He shaved the tooth again on the third visit because he thougth it rose, possibly due to the gums healing? My understanding was that he shaved the tooth to minmize biting pressure. He said to hold off on the crown and monitor the situation.

I may visit an ENT because I feel a little post nasal drip. I might as well rule out all possibilities.

No diving for me until this is resolved.

Any other ideas?

Thanks again,

Jon

 

[Laurence Stein DDS]

Jon, Nope, I have no other ideas.

One comment though. Sometimes in our effort to "salvage" a tooth, the patient, dentist or both may end up throwing money and effort at a hopeless situation.

Without seeing the tooth, I cannot know if this is the case. However, keeping a tooth that is actually hopeless can be counter productive. If there is a persistent infection associated with the tooth or a fracture within the tooth that prevents complete healing, continuing to keep the tooth may lead to even more loss of the supporting bone. This is the same bone that is needed to support ajacent teeth or an implant.

Keeping the tooth too long can compromise future restorative options.

I'm not telling you to extract the tooth but it does seem like you have tried all your options and if you are not achieving success, you might want to consider the Tooth Fairy

It's just a thought.

Larry Stein

 

[Dive00]

Larry,

Thanks again. I will talk to the endodontist on Monday. I realize extraction may be the end result. I don't want to keep the tooth if it will compromise other options. However, I want to give the root canal a fair shot. I have other questions that I will ask the endodontist, as I don't want to take more of your time. I will post again after I get more information to make a decision.

Have a nice weekend,

Jon

 

[Dive00]

Larry,

Appreciate your feedback.

The bitter taste is gone.

Before and after the 1st root canal visit I had the bitter taste. The taste went away during my vacation as I consumed food I don't normally eat. After the second root canal visit the bitter taste returned with force.

Since our last post, I decided to eat foods similiar to the vacation, just to see what happened. I had spaghetti, coke, etc. for a week. The bitter taste went away. I know it sounds strange and it was not what I expected. I thought my tongue looked abnormal, and you mentioned post nasal drip as a possibility, so I went to the ENT. I mentioned that I had a root canal and had taken codeine prior and during treatment (caught a cough during my trip). He said he could see codeine on my tongue, and the interaction with novocaine could produce this taste. He prescribed yogurt and zinc. I happened to have yogurt every day of my trip. My tongue is slowly looking better.

Anyway, I'm getting the crown. I'm probably going to get a gold crown. I was just wondering if a temporary with a band around it would work as well until I see if the abscess heals, or am I taking a risk? Gold or temporary crown?

 

[Laurence Stein DDS]

Dive00,

You wrote:

I was just wondering if a temporary with a band around it would work as well until I see if the abscess heals, or am I taking a risk? Gold or temporary crown?

The usual treatment for a tooth that has had a root canal is a crown. In the process of preparing the tooth for a permanent crown, a temporary must be made. So, the statement you made has confused me because you ARE going to have a temporary crown.

If the tooth is severely broken down, sometimes a stainless steel orthodontic band or a copper band is placed and filled with cement. This is usually done BEFORE a root canal so that the tooth can be made watertight and allow the placement of a rubber dam--to isolate the tooth and keep saliva out during the procedure and between visits. This is NOT the same as a temporary crown.

Now, if you meant to place a temporary crown for an extended period of time to see if the tooth actually heals then I would say that it is a reasonable thought, HOWEVER....keep in mind that the temporary, no matter how it is fabricated and cemented, is still subject to coming lose or developing leakage as the temporary cement "weakens".

To utilize this temporary until healing is noted on x-ray would take at least 6 months. This is a long time to wear it and there is a danger that the temporary will wear down or wear out, leak bacteria/oral fluids/ food debris within the preparation. This can lead to reinfection of the treated root canal.

The most common reason for root canal failure is, in fact, the failure to place a properly fabricated, PERMANENT restoration.

You also should be aware that diving with a temporary crown is tempting the possibility of aspiration. I would recommend that you stay away from diving while wearing the temporary.

Were possible, a permanent crown is the best treatment. I realize that delaying treatment would help avoid the potential cost and loss of a crown on a tooth with a questionable prognosis, but failure to complete treatment may also result in the tooth's loss.

This is a tough call. Follow YOUR dentist's advice.

Next, I am not quite sure how your ENT could "see" codeine on your tongue. Perhaps, he could see that your mouth was dry, which is a potential side effect of the medication. The dry mouth may also present with an alteration of taste.

FYI, zinc containing rinses or troches can CAUSE taste perversion. This may persist for several days following the last dose. Antibiotics may also produce changes in taste...from a bitter taste to a metallic taste. Dental rinses like chlorhexidine gluconate (Peridex), Astringedent, Listerine may also alter taste.

The addition of local anesthetic is very temporary and should not make any difference in mouth taste, long term.

If your tongue LOOKED different, then it IS possible that your mouth was dry, or you may have been sick, or you had a glossitis of some kind. This could very likely result in a taste alteration.

Again, I wasn't there so I really can only speculate. I think that you should choose ONE dentist to act as a "clearinghouse" for your dental information. I believe that you are getting bits and pieces from any number of dentists and physicians and this is causing confusion.

Good luck.

Larry Stein

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.)

 

[Dive00]

Larry,

Yes, I meant to place a temporary crown for an extended period of time to see if the abscess actually heals. However, if a crown is placed, I will obtain the permanent restoration as soon as it is fabricated. I don't want to take any chances with regard to reinfection. Paying the additional monies is fine, even if it is not successful. The endodontist recommended the permanent crown.

Agreed, I will not dive until I get a permanent restoration.

Next, I don't know how the ENT could see codeine on my tongue. My last dose of codeine was the day of the second endo visit. I did not want to cough during the treatment. I should have given some codeine to the dental assistant because she starting hacking during the root canal and left the room. I did not get a warm and fuzzy feeling when I heard her coughing. Anyway, the last day I took codeine was on 1/6 and the ENT visit was on 1/28, over 3 weeks later. I don't know how he could see codeine on my tongue. All I know is that my tongue looked strange. However, I never take a good look at my tongue. My tongue had what looked to be a white coating with chunks of white plaque. The chunks of white plaque are going away. I have been using a tongue scraper since the dentist recommended it on 1/16. I have always used Listerine Mouthwash, which I know includes alcohol. I have been rinsing with warm salt water 2 - 3 times a day. Since the ENT visit I have been using Zinc and eating the yogurt, and will continue for 2 - 4 weeks.

All I know is that I had the bitter taste prior to my first endo visit. Prior to the second visit the bitter taste was gone. After the second endo visit, the bitter taste came back in force. After the Endo shaved my tooth on 1/16, I felt the metallic taste you mentioned. I thought maybe the dentist touched the filling while shaving the tooth. Anyway, the metallic taste went away the bitter taste came back. Then I had spaghetti, coke, and garlic bread (not my typical bland meal, but more like the food I consumed during my trip) and the bitter taste went away. I got a more sweet and sour taste. I still have this sweet and sour taste, but its not a bad taste. However, I don't know what it all means.

As you mentioned, I would like to choose ONE dentist for my dental information. I had a great dentist who I trusted, but he no longer practices. He had an analytical mind like yours. Prior to my vacation, I searched the internet on scuba diving and root canal. I thought an abscess and temporary crown might have an air pocket and might pop off or do other damage during diving. That is how I found scubaboard.com. I'm glad I followed your conservative information and did not dive. However, my scuba diving Endo said diving would be no problem, even with cotton under the fillling. I like the Endo, but I'm glad I found your site. I understand there are different opinions. Although it would be easier to just follow one dentist, I prefer to obtain as much information as possible and make a decision.

Anyway, after my last conversation with the Endo I discussed my visit to the ENT. I said the ENT thought the taste came from the interaction of codeine and novocaine. I said the bitter taste was gone. The Endo said if that is what the ENT thought with regards to the origination of the taste, go ahead with the crown. However, I will call the Endo again. It seems like I have the following options:

1. Wait to see if the taste goes away. However, I would need to stop taking the zinc. Also, the 2nd Endo treatment was on 1/6, one month ago, and I'm due for the crown.

2. Place the Crown. The Endo did not see drainage and thought the gum pocket was healing (form 9mm to 5mm). If the abscess gets worse, extraction.

3. Extraction. If the Endo recommends, I will follow. However, he saw no drainage. I have a taste.

I'm not sure of the origination of the taste. It sounds like its from a draining abscess, but the Endo sees no drainage. How can one know for sure? What is the downside in getting the crown, other than money, and checking the status in 6 months? Will the taste remain or go away?

Thanks again,

Jon

 

[Dive00]

Larry,

Thanks again for all your responses. I went too far after my last post. Your answers to all my questions were appreciated. After just speaking with the endodontist, I am going forward with the gold crown. We'll see what happens upon my 6 month checkup.

Happy Diving,

Jon