Bridge to Nowhere

Engineering a solution to a destructive tooth infection.

At 80, Les Bromwell has been a professional engineer for 60 years. And he’s not finished yet. He continues to work most days of the week as a troubleshooter for his consulting company. Les works on engineering projects in Florida and other states as far away as California.

Photo by Jordan Pysz.

With his infection cured, Les is living
a more normal life.

“My company specializes in geotechnical engineering,” Les elaborates. “We work on projects involving structures placed on the ground, including those constructed in the ground such as tunnels. Our work also includes structures built above ground such as earth dams and reservoirs.”

While Les has devoted 60 years to this work, he initially had his mind set on another type of engineering – chemical engineering. But a positive experience while working in the civil engineering lab in college inspired Les to switch his major from chemical engineering to civil engineering. His career advanced from there.

“After I graduated, I went on to graduate school and earned a doctoral degree,” Les shares. “I taught at MIT in Massachusetts for 15 years, then started my own engineering consulting business. I ran the business in Massachusetts for three years, then moved it to Florida in 1972.”

After living first in Fort Lauderdale and then in Lakeland, Les relocated 17 years ago to Vero Beach, presumably to retire. But he enjoyed his job so much that he continued working while fitting in plenty of time for golfing, fishing and exercising. Late last year, however, a painful dental issue threatened his comfortable lifestyle.

“Initially, I went to my dentist for a routine hygiene appointment, and he told me I had an infected molar that had to be extracted,” Les recalls. “The molar was part of a 40-year-old bridge that replaced two missing teeth. There was a dental implant that helped support that bridge.

“In October, the dentist removed the infected tooth and gave me an antibiotic to take for a week. After that, I went on a business trip, and the pain became really bad, and my cheek became very swollen. I went to a dentist in New York who took a CT scan, and he said there was still a lot of infection present and prescribed a stronger antibiotic.

“By this time, I was miserable. I was in pain all the time, and I basically stopped everything I was doing. I slept 16 to 18 hours a day just to avoid being up and being in so much pain. On a scale of one to 10, it was as close to a 10 as I’ve ever been.”

At Thanksgiving, Les and his wife took a trip to Tennessee to visit family. While there, Les’ pain and swelling became even worse, so when he returned to Florida, he visited his primary care physician, Curtis Dalili, MD. Dr. Dalili told Les he needed to see a specialist to determine the nature of the problem and recommended he visit Alfons Bucaj, DMD, at Dental Implant Center of Vero Beach.

“I went to Dr. Bucaj’s office that day at 5 o’clock in the afternoon, and Dr. Bucaj took me right in,” Les reports. “He listened to my story, looked in my mouth and said, I see why you have a problem. The approach they took with your bridge damaged your teeth. Thankfully, Dr. Dalili diagnosed my condition and made the proper referral.

A Faulty Connection

“Les presented with swelling on the upper right side of his face, which was suggestive of a tooth infection,” Dr. Bucaj remembers. “He had already been seen by his primary care physician and several dentists, and he was frustrated because none could find a resolution to his problem.

“So Les and I sat and spoke about his history and symptoms, and I performed a three-dimensional CT scan, which helped me formulate a diagnosis. I determined that Les had a residual tooth infection creating a secondary sinus infection. There was also a dental implant adjacent to the tooth that was at risk for failure.”

During his examination of Les, Dr. Bucaj found that the infection affected a remnant of a tooth that was retained in Les’ bridge. The dentist also discovered an oroantral communication, an abnormal opening between the sinus and the inside of the mouth. That abnormal opening was leading to the sinus infections.

“The cause of the infection was a residual root tip that remained after Les’ infected molar was extracted,” Dr. Bucaj explains. “But his sinus was perforated as well, which compounded the infection. Unless the sinus is repaired, the infection will never heal on its own.”

Due to the extent of the infection and the amount of pain Les was feeling, Dr. Bucaj didn’t wait long to begin treatment.

“We performed emergency surgery and removed the tooth remnants, closed the opening to the sinus and removed the at-risk implant,” the dentist describes. “After we cleared the infection, we placed bone grafting material into the bone socket and tooth housing, which is a process called socket preservation.

“In addition, we used tissue and bone to reconstruct the area where Les’ bridge had been. The plan is to go back in six to eight months and place three new implants with three crowns to replace the bridge altogether.”

Ten Years Younger

Les can’t help but compare how he felt before he was treated by Dr. Bucaj to how he feels now. To Les, it’s like night and day.

“That infection took me out of action for a long time,” Les says. “While I was sick, I felt like I was 90 years old, which is 10 years older than I am. But now, I feel 10 years younger, like I’m 70 or even 65. That was just a terrible episode. It was debilitating.

“But I’m fine now, and I have zero pain,” he enthuses. “I’m back to golfing and exercising, and doing everything without difficulty. And I get a normal night’s sleep. I work out most days. I ride my bike and go to the gym. I’ve been on a couple of trips since this happened, including one to California, and had no problems.

“I definitely recommend Dr. Bucaj to anyone with dental problems. In fact, the worse the problem, the more I recommend him.”

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