I currently have a very high CRP, and the doctors suspect it may be coming from my teeth or a dental bone infection. I have attached the following:
1. X-ray (attached as a picture).
2. CAT scan report.
Could you please provide advice on the following:
1. Do you see evidence of any infected teeth?
2. What is your opinion on the polyps mentioned in the CAT Scan report? (What is causing this, is it an infection?)
3. Do you see any evidence of bone infection or bone loss, or osteomyelitis?
I had the upper right third molar extracted (prior to having the high CRP). Does the bone socket here look infected? Does the upper right implant look infected or show bone loss? Does the sinus cavity look infected?
Thank you for the reply.
I have seen all the information provided, and I will answer all the queries one by one. Based on radiological reports (attachment removed to protect the patient's identity), there is not much evidence of tooth infection, apart from the presence of polyps, which must be evaluated. Polyps could be caused due to a wide variety of reasons.
1. For suppose, the apex (tip) of the implant present in the sinus wall may be responsible.
2. The presence of any residual infected tissue during tooth removal may be responsible.
3. There is no evidence suggestive of osteomyelitis of the bone (as of now.)
4. The implant does not show any radiological signs of bone loss and infection.
5. There is an infected sinus present.
And medication is required for the same.
Thanks for your response.
Please see additional follow-up questions below:
1. How would we identify if there is any infected tissue during the scan? Would the scans not show this?
2. Is it normal for a dental implant to be present in the sinus wall? How would we investigate an issue here?
3. Could the polyps and sinus infection cause a high CRP and systemic inflammation?
Moreover, my endodontist and dentist spotted the following issues listed below in the CAT scan and X-ray. Can you please confirm if you agree with their assessment:
1. The upper third molar behind the implant is definitely infected with drainage into the maxillary sinus. Can you confirm this?
2. The existing root canal is infected because they missed treating the mesiobuccal root completely. The mucositis or polyp in the sinus is related to the infection in the dental cavity. Can you confirm this?
3. The bone loss around the root tip and into the sinus is related to the root infection and should heal with extraction, good retreatment, and possibly surgical curettage. Can you confirm this?
4. There is also an infection on the bicuspid tooth in front of the implant on the same side. Can you confirm this?
5. Dentist also suspects the presence of neuralgia-inducing cavitational osteonecrosis (known as NICO). Can you confirm this?
6. Abscess in the lower left tooth may cause a failed filling.
Please let me know if you were able to access the CAT scans or had any access issues.
Thanks again for all of your help. I really do appreciate it.
Welcome back to icliniq.com.
The scan (attachment removed to protect the patient's identity) does not show any infected tissue. The dentist correlates the symptoms with the scan and draws a conclusion. The implant breach to the sinus wall does not cause any issues. If it is present within the sinus antrum (cavity of the sinus), then there are only chances of infection (not always present).
The CRP (c-reactive protein) values are not alone dependent on dental infections. Any infection present in the body causes a rise in CRP values. Sinusitis could also be one of the factors. Cold and cough also cause a rise in CRP values. We need to make sure the causative of the rise is diagnosed properly and treated.
The upper molar draining into the maxillary sinus cannot be confirmed by radiological reports. As I told you previously, it has to be evaluated based on both clinical symptoms and radiological assessment together to come to a conclusion. Is the molar tender to touch also? After knowing the clinical situation only, we can come to a conclusion.
The scan shows that a canal is missed with the treatment, and there is a radiolucency around that root which could probably suggest that infection is present.
The success of retreatment can again be evaluated by the reduction of symptoms and signs of infection clinically (if any) and radiological assessment. If the retreatment does not produce a satisfactory result, then we can think of the removal of the tooth.
There is an infection on the tooth in front of the implant, and the radiolucency on the tooth present distally suggests that.
NICO (neuralgia inducing cavitational osteonecrosis) is again based on clinical evaluation and the signs and symptoms experienced.
I was able to access the scans with absolutely no issues. I wish you a speedy recovery and smiles again.
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