54 years of blissful dental ignorance has come to an end. Teeth have always been bulletproof. One filling from 40 years ago (that I probably didn't actually need) and 4 wisdom teeth removed about 30 years ago. Brush twice, floss once every day of my life.
Gradual mild pain in lower left jaw. Last week it got bad enough to actually go to the dentist. X-ray revealed "internal resorption" in molar (#19)...second from back on lower left side. Dentist sent me to periodontist/implant guy. Said root-canal won't help, tooth must go. Proceeded to get 30 minute pitch about removal, graft substrate, implant and crown process to the tune of almost $5k.
On antibiotic now which has resolved the pain (infection due to space between damaged tooth and gum/bone). Here are my questions (any dentists in the room?):
- Is extraction the only option?
If you indeed have internal resorption, the tooth is usually unrestorable. The funny thing about this is that is usually always nonpainfull and only identified by radiographs.
- Must it come out asap, or is there a way to buy time (it's not painful)
Another good question. My answer would be no. As long as you are not in discomfort and there is no visible damage to the bone surrounding this, you have some time to work with. Then again, these usually become a "problem" on weekends and vacations.
- Tooth is not visible when smiling, etc., so more a question of eating and comfort.
I had an implant placed about 4 years ago from a root canaled tooth that fractured. I needed grafting and healing so I went more then a year with this missing. Trust me, I never got use to it. Found I would chew only on one side to avoid anything sharp cutting the gum where the tooth was. Frequently bit my lip trying to avoid this. Once I had the tooth replaced with an implant, I got use to it in a day and a week later it was like I never lost it.
- Is graft substrate really necessary for a future implant ($1000)? Seems the bone would fill in on it's own given time. Have read blogs indicating such.
This is touchy subject to me. My friend who did mine generally does this gratis figuring the price the patient is paying will absorb the cost. Meanwhile, I have had patients that were sent to other offices walk out with cost of the grafting material being more expensive then the actual extraction. Consider everyone that already has a tooth missing and desires an implant, they generally aren't going to have any grafting done in the placement. If everything is equal, yes grafting is helpful.
- Can life go on happily without that tooth and no replacement?
See above comment.
- If not, what about a removable denture, or bridge (not thrilled about the bridge idea).
I do a lot of bridges and most patients like them, (not all love them). I am a firm believer that a tooth is best with no restoration because the likelihood over time is that it will need replaced. Did you ever hear the joke about the Orthopedic surgeon and only needing to work for 10 years have a lifetime of work. The remainder of his work will be redoing everything he has done. I've seen my share of patients with bridges that need redone. Many times when that happens, they are left with no remaining posterior teeth and that $5k has turned to $10k.
- Any other ideas?
I would try another visit with a specialist or two, one that you don't feel is pitching and more like advising.
Have a consultation scheduled with family dentist later today to brainstorm with him. He's a good guy and a trusted dentist, but felt the Periodontist was giving me the "Timeshare" pitch.
Anyone had such a tooth removed and not replaced? Open to suggestions. Appreciate thoughts or advice from the Pelican braintrust!