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“Dear Doctor,
I seem to have a problem. If my mouth gets dry, or when I am out drinking or if I stay up late (I work freelance, so sometimes I have to stay up late) a sore appears around my top right canine. This sore is basically just a rough patch of skin and there is no discharge at all. But around it on the cheeks and near my canine small blisters tend to appear. They are not filled with anything they are just small blisters of air. My canine was root canaled several years ago, and since then tiny bits of tooth material have been breaking off from time to time. What is the problem? Is it the tooth? Is it periodontitis? What should I do? I live in rural Winnipeg and do not have access to a dentist readily, I have to make a call for months in advance.
Thank for your help,
Phil”
Hi Phil,
Truth to be told, a number of things can be wrong with you, and to get a proper diagnosis and treatment you will definitely have to go to a dentist, so start making that appointment as soon as you possibly can! But to make matters easier for you, let me just confirm that you most definitely have a bacterial infection of some sort. The little blisters that arise, as well as the sore that only appears when your immune system is compromised (being awake for long and drinking all weaken your immune system) indicates to me that there is a bacterial presence in your mouth, and when your immune system is down, the bacteria flares up. If the sore and the blisters always appear in the same place, that is actually relatively good news, as this means that the bacterial infection is localised, and is not generalized, meaning it is not present in all of your tissue, but just in one place.
What is causing this infection or where the bacteria are located exactly can be very difficult to tell. It could be in the folds in your gums, it could be in the soft tissue, on the tooth, in the dentine of the tooth, in a cyst at the apex of the tooth, it could be anywhere. An x-ray of the region will almost definitely provide answers, but sometimes even that is not needed, if the area is showing clear signs of where the bacteria are coming from. Root canaled teeth are always suspect, as many things can go wrong there that can cause a bacterial infection. One of them is that the bacteria are still alive in the tooth somewhere below the gumline, have eaten away at the tooth and now have access to the soft tissues in the gums. Aside from this, a cyst can develop at the apex of the tooth. This happens when the bacteria have eaten through all of the tooth, and have gone out the root, punctured it, and are pooling below the root. When this happens, the body forms a cyst, a sterile bubble of flesh around the bacteria. These cysts have an aperture that they discharge bacteria from, and these may be the cause of your troubles.
Whatever the cause of this infection it is almost certain that you will need to take antibiotics, but it is also possible that you will need to receive periodontal surgery, and your tooth may also need to be extracted. I suggest talking to a dentist at once, as there is not much you can do to maintain the situation, and over time, it will get worse. What you can do though is when these flares happen, use mouthwash to keep the bacteria from spreading. This way when your immune system is down, you are helping it work by killing the bacteria that proliferate, essentially taking things into your own hands, but beware! This is simply relieving the symptoms, and is not by any means a solution to your problems.
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