NERVE ISSUES - YIKES IS RIGHT = = = OVERVIEW - There are several nerves that run through the upper and lower jawbone. Under normal circumstances all these nerves are fairly deep. But with severe periodontal infection two bad things happen. First is that the bone retreats, so the nerves are closer to the surface. Second is the infection infiltrates down the side of the tooth into nerve territory. All in all, as is obvious, this is bad news. ALSO... I have looked and looked and found virtually nothing. A little bit here and there on Anastassia or on implants. But nothing on saving the teeth with nerve involvement. So this essay here with its combination of practical experience, logic, imagination, make-believe and ignorance may be most of what there currently is at the present time to say about the subject. I have also looked in a few periodontology textbooks too. So it could turn out that both your dentist and your periodontist don't know much about the subject either. Except to say - pull! Google it and see what you can find <> besides my stuff. PLUS... I will try the best I can to be honest with you here for once in my life... All I really do is to try to avoid the nerves... But when I have to get up close and personal I do. Sometimes sticking an irrigation needle or a hyaluronic acid laden brush pick past the nerve. Or otherwise trying to figure out how to approach the area of the nerve with the curette and always trying to make sure to move away from the nerve and not towards the nerve. ALSO... most of the time the nerves will give you lots and lots of warning. Like lots. Like if you get any closer you will start screaming. So if you go really really slow and always try to move away from the nerve, plus realize that nerves are usually not shrinking violets then you should be okay. Unless you screw up of course. Also have to be extra careful about hygiene too. Plus don't blast with the water pick. Also avoiding doing anything that could poison the nerve. Which means to stay away from any undiluted iodine. Also stay away from any liquid calcium except after long healing cycles. Plus do not use any powdered mineral compounds under any circumstances - danger danger!! Since any undiluted granular minerals or concentrated liquid minerals can irreparably damage the nerve. So who is crying now? - Also avoid concentrated flouride. Plus no bleach! Bad bad! Plus no powerful streams of irrigation. Stay clear!! Don't screw up! = = = LIST OF NERVES - damage to any one of these nerves can be quite tragic. A little bit of jostling is not likely to permanently damage them. But obviously anything more than than or anything that could nick or cut them is very very bad. Additionally they can be severely damaged by chemicals. Like Chlorine. Iodine sounds fairly dangerous too, but probably not so bad if the exposure is peripheral. Minerals are bad. Like Frankenstein brainchild hydroxyapatite. Hyaluronic acid is okay. Honey should be okay too. My guess is citric acid is probably dangerous too. IS THERE ANY AVAILABLE INFORMATION ON THIS? - Not much. Issue is that when the disease reaches the nerves it is usually time to pull the teeth. So if you want to keep the teeth even if there is nerve involvement then you are dealing with tricky stuff with very little guidance. But the basic principles still hold. Stick with the teeth. Stay away from the nerve. And if you have to "swim with the nerve" then be very very careful! -- TRI-GEMINAL NERVE - UPPER JAWBONE -  This is a very very serious nerve. Largely what will happen here is any nerve involvement will create twinges further up the nerve. In particular there may be a twinge around the outside of the eyelid. Also in the upper lip. Also in the muscles pulling up the upper lip. - - LOWER ALVEOLAR NERVE - LOWER JAWBONE - This nerve basically infiltrates the lower molars up to the eye tooth. With lots of branches. It travels from the lingual side of the wisdom tooth to the bicuspids. Then it goes between the bicuspids through the jawbone. Then it travels along the outside of the lower canine until it branches off. This nerve innervates the lower lip and the outside of the tongue. - - BUCCAL NERVE - This nerve comes from the outside buccal side past the wisdom tooth to a deep spot between the second molar and the wisdom tooth. It then branches off. But the main branch activates the jawbone muscle. You can actually more or less feel where it ends by feeling the muscle to where it approaches the teeth. Sore jaw muscles are a sign the infection has invaded the nerve. But supposedly the nerve is very deep WHERE IS THE DANGER POINT? One possible danger point is in the bottom of the maxillary sinuses. As side example if somebody has a sinus infection the tri-geminal nerve can be affected. BUT for periodontal purposes the primary danger point is right around the upper second bicuspid. In my case that bicuspid was pulled for braces, so my danger point is behind the first maxillary bicuspid. Problem is I have a deep abscess there. WHAT IS THE BASIC TOPOGRAPHY? Right around the apex of the second bicuspid the tri-geminal makes a loop. So if you have an abscess there or the infection has infiltrated down to the apex the nerve can be affected. In addition the first bicuspid has two roots which can harbor an infection.  WHAT IS THE SOLUTION? - Realistically the basic common sense solution would be to extract one or both of the maxillary bicuspids. Plus possibly to extract the first molar too. That way the infection that is residing on these teeth can be removed from the locality of the nerve. BUT any leftover infection could continue to disrupt the nerve. Also could get a bone graft to bury the nerve more deeply. But could also have an issue with implants too. So basically bad news. WHAT ABOUT KEEPING THE TEETH? WISHFUL THINKING LIKE - Here if you could both wishfully and realistically banish the infection from close proximity to the nerve then perhaps it could heal over. But all in all this does not sound very realistic. Unless there is some way or program to eventually get the teeth close to perfectly clean. Even though this is largely deemed to be close to impossible... BUT ... have had reasonable success with a combination of hyaluronic acid and very very detailed debridement... certainly scared out of my mind most of the time... then with every little twinge thinking "This is the big one." Like some sort of Chicken-Little... Then the numbness to the lips, both upper and lower... hell both lips right and left... alveolar, buccal and infraorbital on both sides... thinking "I am royally screwed." But then what happens? The symptoms lighten up and I am thinking "I may just get the upper hand after all. All I have to do is more digging and not screw up and get lucky or rather stay lucky." IS THERE A REASONABLE COMPROMISE? Perhaps yes. The reasonable compromise would be to extract the first bicuspid and try to save the second bicuspid. Basically the first bicuspid is trouble. Reason is it has two roots which become a natural harbor for infection deep in the jaw. In addition this particular tooth is close to impossible to ever get clean. So might reasonably dump this tooth and keep the second bicuspid (if it exists) plus the first molar. Maybe. But the first molar also has fairly deep roots too, which often go into the sinus. So maybe all three teeth have to go. = = =   Here is a list of the basic issues: 1) Under normal circumstances the only way to get to the deep infections without DIY are surgery. What this means is that there are not a lot of actual real-life cases to use for examples. Summary here: Most likely result with nerve issues is that the teeth are judged to be hopeless and get pulled out. Alternate scenario: Before the bone even gets much of a chance to get to the nerve the result is serious periodontal abscess, leading to intense pain, again resulting in the teeth getting pulled. Again leading to not very many real-life examples. 2) Is it obvious the teeth need to get pulled? Will the situation just get worse with no way to get it to stop? 3) IF the situation can be halted is it possible for the nerves to rebury themselves and become safe and secure? 4) IF the teeth are not pulled AND the dangers and potential damage to the nerves get even worse THEN what is the NEGATIVE DOWNSIDE? Can somebody realize at some point that they lost and then say OK PULL THE TEETH? - OR - Did they push the issue beyond a point of no return where there is an even more negative downside, such as a serious jaw infection or permanent nerve damage leading to other even worse horrible things, and ALL TO SAVE A HOPELESS TOOTH!! WHAT IS THE ANSWER?? - Realistically most of these issues should be resolvable by just giving up the teeth. SO WHY NOT JUST GIVE UP THE TEETH? - In my case I have nerve involvement problems with four upper molars and at least one bicuspid, plus with the triple combination of first and second lower molars and bicuspid. With one molar already gone. So counting that would mean that I would have to get roughly 10 teeth pulled. OR if I went minimalist and only got the tooth pulled that were obviously in big trouble then would have to lose at least 3 teeth for starters and then probably have to lose at least another three teeth fairly soon, within a few years. SO, what that means is that as long as I have a high degree of confidence that I can save the nerves then I have a strong motivation to keep the teeth. = = = = = = In the shuffling madness Of the locomotive breath, Runs the all-time loser, Headlong to his death. He feels the piston scraping -- Steam breaking on his brow -- Thank God, he stole the handle and The train won't stop going -- No way to slow down. = = =   HOW COME THERE IS SO LITTLE INFORMATION ABOUT THIS ON THE INTERNET? - Go ahead. Look for information. Find anything? Most likely the answer will be no. WHY? My theory on this is that if the disease has gotten deep enough to affect the nerves the obvious thing to do is to pull the teeth. End of story. Bye bye teeth. But what if somebody were to debride and clean the areas well enough for the teeth and gums to heal up fairly well. Then you get the issue of nerve involvement for teeth that are still there. SHOULDN'T THE TEETH JUST GET PULLED? Good question. Reasonably the answer here might be yes. THEN WHY NOT GIVE IT UP AND GET THE TEETH PULLED? Largely this logic is this: 1) Intact nerves can generally do a pretty good job of looking after themselves. Once the source of the problem is removed, if the source can be removed then the nerves can return to fairly normal functioning. 2) Pulling the teeth does not guarantee that the issue will go away. Especially if a deep area of infection is still left behind after the tooth gets pulled. 3) If the area can be debrided successfully then there is a good chance the area will get invaded by epithelial tissue that will then isolate the nerve from the infection. Additionally some bone should grow back too which will also help to isolate and protect the nerve. BUT ISN'T THIS FOOLISH TO EXPECT SO MUCH AND TO TRY TO FIGHT AND WIN AGAINST OBVIOUS REALITY? - Not necessarily. As described nerves can do a pretty good job of looking after themselves. HOW CAN ALL OF THIS MAKE IT WORSE? - Largely the logic works like this: FIRST -  The general assumption is that it is impossible to ever get an infected tooth to every get perfectly clean. By this to mean to remove almost all of the calculus from the tooth. So once the infection reaches the point of nerve involvement it should also be pretty close to impossible to ever hope that the nerve can escape the clutches of the infection. By clutches of the infection, we can largely refer to any remnant calculus clinging to the side of the tooth. SECOND - The reason why the nerve is affected in the first place is because the bone has retreated, yes? - Largely the answer here is yes - SO shouldn't this also mean that the infection that is still attached to the tooth will cause the bone to retreat some more and eventually lead to the nerves going high and dry? Logically the answer here would seem to be yes. THEN WHY DON'T YOU JUST GET YOUR TEETH PULLED WHILE YOU STILL HAVE TIME? Think a reasonable response here might be that if the tooth is cleaned up fairly nicely that the infection can be put into suspense. Then if the nerve problems can be resolves within some reasonable deadline, like say a year, then perhaps the tooth can be saved and the nerve issue can go into remission. BUT IF THE ISSUE CANNOT BE RESOLVED WITHIN A REASONABLE DEADLINE THEN SHOULD BITE THE BULLET AND GIVE UP THE TOOTH OR TEETH. = = =  WHAT IS YOUR GOAL? WHAT IS YOUR PLAN? -  My basic goal is to free the nerves from adjacent infection on the nearby teeth. THEN to let it heal with epithelial tissue penetrating the wound and surrounding the nerve. THEN to continue to debride the teeth until the infection can be driven away by some distance, assuming the teeth can stay alive. Ultimately this will create the tooth equivilent of a living museum. (HUH?) By this I mean that it is really fairly unrealistic to expect to be able to drive off the infection completely, especially where it is so close to the tooth nerve. The most you can expect would be to keep it at bay. Also can't really expect the nerves to bury themselves in very deeply. The most you can expect is for them to cover themselves up with a thin layer of epithelial tissue. Leaving what? Basically leaving a truce between surviving destruction and ongoing infection. Basically creating a time capsule where time goes very slowly. And where it is agreed to get the tooth pulled as soon as the tooth reaches the point of no return. Which would be signalled either by the tooth dying or by continued nerve involvement that doesn't get better within say a year. Or maybe longer, as long as the symptoms are intermittent and not chronic. As example here I have had symptoms with my infraorbital nerve going on several years now, due to a massive abscess that invaded its territory. So why haven't I gotten the tooth pulled already, like I promised? Well... to be honest with you I still like the two involved teeth. And I am rationalizing that the only reason the nerve is still involved is because I have gotten deeper and deeper into its territory. So it is only natural that the deepest infection will start acting up, right? Of course! So what is my excuse now for not getting the teeth pulled? My excuse is I still have the deep deep debridement to do. And once I get that done then the nerve will become free. So that's my story and I am sticking to it until hell freezes over, okay? As long as I don't start spontaneously screaming or something. Or have no choice but to have to go see somebody.

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