What should a patient do if his scan reports suggest teeth infection, polyps, osteomyelitis, and infection in the implant?

Question

Hello doctor,

I had systemic inflammation due to RCT (Root Canal Treatment) failure in one of the teeth in the upper right part of my mouth next to my implant. My CRP (C Reactive Protein) was 100 mg/L, and I have been prescribed Clindamycin. I had undergone an extraction of the same tooth, and a bone graft was done as there was an abscess on the tooth. After this, the CRP dropped to 2 mg/L, and the systemic inflammation subsided.

However, after a month, I started having systemic inflammation, and my CRP went back up to 200 mg/L. The doctors think the inflammation might come from the teeth based on the CT (Computed Tomography) scans. I also have a fever at night, along with a sore throat and nasal discharge. Please answer the following questions. Did you see any infected teeth in my scan? What is your opinion on the polyps mentioned in the scan reports? Do I have any infection in the bones or osteomyelitis? Is there any infection in the upper right implant?

Kindly help.

Answer 1

Hello,

Welcome back to icliniq.com.

I will be answering your query shortly .

Thank you.

Answer 2

Hello,

Welcome back to icliniq.com.

It is a common finding in osteomyelitis, so you report all these symptoms like fever, sore throat, nasal discharge, or tooth pain. According to the report enclosed (attachments removed to protect the patient's identity), there are alveolar sinus polyps, which means you continue taking the medications as suggested by the physician. You are prone to a recurrent dental infection due to the sinus polyp.

I have seen the dental OPG (orthopantomogram) as well. The teeth do not look infected currently, but you are at high risk. So you will need a clinical opinion from a maxillofacial surgeon as I feel your teeth are fine except for some generalized bone loss. These inflammatory alveolar polyps should be treated preferably by ESS (endoscopic sinus surgery). There will be varying approaches to that, so you can get the treatment done by an expert maxillofacial surgeon in the clinic and have an excellent prognosis.

If the surgeon feels that you do not need ESS to get rid of these polyps, then you will be again advised of similar antibiotic therapies, just like Metronidazole for systemic inflammation. So do not worry, as there are two ways to treat the polyps: complete ESS and antibiotic therapy.

The teeth or jaws do not look grossly infected, but you need a clinical opinion on how to get rid of the alveolar polyps. So I suggest you visit the oral surgeon soon. The prognosis is also good. It is not necessary that the polyps always need to be surgically removed, but if they are large, then antibiotic therapy will not work continuously. High CRP (C-reactive proteins) and inflammation can also be due to dental causes. Is the dental implant shaking?

Thank you.

Answer 3

Hello,

Welcome back to icliniq.com.

I do not feel that the implants or the root canals have any iatrogenic error. The root canals in both segments have been done correctly. It is common for the implants to dip lightly onto the sinus floor. I think that one of the canals looks overfilled, but it might be a radiographic error.

Also, the alveolar fossa polyp mentioned in the report (attachment removed to protect the patient's identity) would be more common due to maxillary sinus infection around the dental implants because you might be suffering from osteomyelitis or high CRP (C-reactive proteins). I suggest you continue taking the tablet Metronidazole and ask the physician about the impact of the systemic inflammation on the jaw.

You can also consult an oral and maxillofacial surgeon. Yes, the canine looks infected. Curettage can help, but you need a clinical examination and opinion from an oral and maxillofacial surgeon. The probability of secondary infection in the jaw seems more common as a reason for your jaw infection rather than neuralgia-induced osteonecrosis. The lower left tooth filling is close to the root canal.

So the filling is close to the nerve, and you might need a root canal for the lower last molar to get rid of it. I suggest you visit the maxillofacial surgeon without delay as they can give you a better opinion. You need treatment for the sinus polyps. If you have further queries, you can ask any time.

Thank you.