Need Dental Advice...

[Chocaholic]

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?
- Must it come out asap, or is there a way to buy time (it's not painful)
- Tooth is not visible when smiling, etc., so more a question of eating and comfort.
- 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.
- Can life go on happily without that tooth and no replacement?
- If not, what about a removable denture, or bridge (not thrilled about the bridge idea).
- Any other ideas?

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!

[GH85Carrera]

Go see another endodontist first off.

You can for sure live without the tooth. Have it pulled and be done. That is the cheapest route. Do you like to chew? Well it might be tough to eat with that side depending on which tooth it is.

I have one molar I think of as my 914. I have spent more money on that one little area of my mouth than I spent to buy a new 1974 914 2.0

Get a second opinion would be my first suggestion.

You can always get a bridge cheaper than an implant, but talk to a different endodontist.

[74-911]

Originally Posted by Chocaholic

Anyone had such a tooth removed and not replaced? Open to suggestions. Appreciate thoughts or advice from the Pelican braintrust!

I had that same tooth (but upper molar) extracted in 1972 while in the USAF (cracked vertically while I was chomping on ice). Being enlisted, pulling it is all they would do and needless to say I didn't have the money to get all the bridgework done (this was long before implants). 40 years later and the only mention I have ever have re: the gap is when I go to a new dentist, they always ask me how long ago was that tooth pulled.

No problems with it and even after I had the insurance / money to have it implanted I opted to just leave it be...

[recycled sixtie]

Yes as the above say get a second opinion. I recently had a root canal done on a wisdom tooth. Initially it was uncomfortable and it was loose. I thought yes let's get it out. Then my wife calmed me down and said let the endodontist take a look at it. He recommended a root canal and it has been done . The current trend is to save your teeth. Back in the 50's it was pull them. Now I have teeth happiness - for a while anyway till the next time!

Yes if you can afford it get it fixed and get a second opinion. I am not a dentist.
Reminds me of the downside of teeth or lack of them. Your teeth are like stars they come out at night. Haha

[Gogar]

Whatever you choose, make sure to do it soon.

2 rules about the dentist:

1. If it hurts, you're too late.
2. The longer you wait, the more it costs.

[Cajundaddy]

If you don't get that tooth pulled it will likely kill you so it probably needs to go sooner rather than later. I had a cracked tooth pulled last year and since it was my last molar I opted to go without an implant. I don't really miss it and my gums are far healthier now. You have some time as I understand it, to decide if you can live without a tooth there or want to proceed with an implant. Long term peridontal disease has been found to damage heart valves and may be one cause for the onset of dimentia, so getting the teeth and gums healthy has long term benefits.

Do seek a second opinion if you need further clarification of your options and timeline.

[89911]

Originally Posted by Chocaholic

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!

Hope all goes well

[mreid]

My ex-wife is a dentist and a very good one in the Philly area. All dentist require annual hours of continuing education. Two thirds of that continuing education is how to sell dentistry and I'm serious. You are 54. You don't need to spend $5k restoring a tooth. If you were 25, I might think differently. Have it pulled and upgrade your Porsche with the money you saved.

[89911]

Originally Posted by mreid

My ex-wife is a dentist and a very good one in the Philly area. All dentist require annual hours of continuing education. Two thirds of that continuing education is how to sell dentistry and I'm serious. You are 54. You don't need to spend $5k restoring a tooth. If you were 25, I might think differently. Have it pulled and upgrade your Porsche with the money you saved.

Is 50 the new 70? If the price is a reason, understandable. Saying your one foot in the grave at 54 is a whole different story.

[Nickshu]

Your resident PPOT board certified periodontist here again...

Best option is to extract the tooth.

Root canal may work if resorption is within the tooth and has not broken thru the external surface then maybe RCT will work but it's usually a heroic Crap shoot. You spend $2500 for RCT and a crown then two years later end up with extraction and implant anyhow. Often it's penny wise and dollar foolish to try to save it as you are delaying the inevitable.

At 54 you are way too young to just leave it an open space. Many reasons for this.

Yes it should be grafted at time of extraction.

Can you post the Xrays? Did you get a CT scan taken?

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[juanbenae]

ive just gone through a 4 week long tooth saga that my dentist, an endodontist, and an ear nose & throat guy with nary a clue from one of them as to what the problem was. that was until the bone popped thru the gum in the area where the pain was coming from. Then a trip to an oral surgeon for removal of dead bone from the lower jaw in an area where a molar had been removed 25 years ago. OS stated there appeared to have been infection in there for a number of years, just not causing any discomfort. the bone was whacked down lower on my jaw, infected flesh scraped out and stitched back up just last fridee. feeling better almost immediately..

OS said that the lower jaw bone area does not get good blood flow so any healing is questionable at best, and can get infection occasionally. for the statement above regarding letting the bone regenerate?? not so fast...

[Chocaholic]

First....thanks to all for comments. Seems to be varying opinions. Just left consultation with our family dentist. His recommendation...extract the tooth. If it comes out in one clean piece, close up the hole and let it heal. Bone should fill in enough in time to support an implant if desired.

If tooth breaks upon extraction and roots need to be dug out, he recommended having the graft substrate used. That way, there is assurance of enough bone to support an implant down the road.

Nick...resorption has apparently broken through as it was infection between the gum and damaged tooth that started to hurt. Did not get a CT, and don't have the X-rays, but will ask if they'll e-mail them to me.

A couple of reasons for my hesitation to just jump in and do the whole enchilada. First is just the intrusion into life's never-ending demands (work, kids, etc.). Second is my distaste for anything that involves cutting me opened! Third is a feeling that the advice I'm receiving is motivated by money rather than what I really need. It is, after all....a business.

Here is the estimate I received:

Intravenous sedation (conscioius sedation)/analg 1st 30 min $234
Extraction - Surg/erupt tooth $392
Bone repl graft $995
Visit 1 Total $1621

Intravenous sedation $234
Endosseous Implant $1950
Visit 2 Total $2184

Crown to be completed by family dentist $500 (guess)

Happy to pay a fair price, but not fond of getting ripped off as I have no basis for comparison. Appreciate any insight regarding this quote.

[Rickysa]

Internal resorption cannot be fixed...have it removed

Leaving the space will lead to the farthest tooth back tipping into the space which can lead to bone problems and complicate restoration later.

I don't know why immediate grafting was mentioned...the lower jaw has bunches of bone and a graft is usually indicated for long-standing extraction sites where the "alveolar bone", or the bone that exists just to support the tooth, has been lost.

How about a simple retainer to just hold the teeth like they are after the extraction? Wear it periodically at night to hold the back molar in place...we have kids that come through our office that are naturally missing teeth, and make them retainers to hold the space until they are old enough to have the implant/restoration done (usually 18 or so).

(orthodontist, not restorative dentist)

[Nostril Cheese]

I just yanked a wisdom tooth out with a pair of pliers.

[Nickshu]

A couple thoughts....

On the grafting, don't take specialty advice from your GP. The doctor who will be placing the implant should make that decision since that directly affects the implant placement, success and stability.

If the resorption is thru and thru at least some portion of the tooth is swiss cheese plus the associated bone loss around the area of resorption will generally not heal on its own. Given that, it's unlikely it can be removed in one piece.

This is where a CBCT scan is very helpful to decide on grafting strategy and if immediate implant placement (at same time as extraction) is a possibility.


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[Chocaholic]

Originally Posted by Nostril Cheese

I just yanked a wisdom tooth out with a pair of pliers.

Why doesn't that surprise me???

[Chocaholic]

Originally Posted by Nickshu

A couple thoughts....

On the grafting, don't take specialty advice from your GP. The doctor who will be placing the implant should make that decision since that directly affects the implant placement, success and stability.

If the resorption is thru and thru at least some portion of the tooth is swiss cheese plus the associated bone loss around the area of resorption will generally not heal on its own. Given that, it's unlikely it can be removed in one piece.

Makes sense. Will certainly discuss it with the Perio beforehand to see if he concurs. Regarding the extent of the resorption, interestingly, the tooth looks and feels fine (would be easier to rush in if I was in pain). Damage is apparently below gum/bone line which is where the infection was.

[Nickshu]

Sounds like a good plan. Best to set yourself up for success.

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[Chocaholic]

Nick, or others....any familiarity with "mini-implants"? Searching a bit and it seems these can be completed in one session and useable immediately. Too good to be true?

[Nostril Cheese]

Originally Posted by Chocaholic

Why doesn't that surprise me???

Wasnt the easiest thing. Had to dissect some of the gumline first with an Exacto. Been a few weeks, no infection.