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Old 07-22-2009, 09:52 PM
 
10 posts, read 48,452 times
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Default Decay on inside of tooth - need expert advice

Hi,

I have decay on inside of my #10 (upper) tooth, i have been to a few different dentists and they recommend to have tooth extracted and then either a denture, fixed bridge or implant to replace tooth, with them leaning towards implant, the implant will cost $3,000 and up and will take 4-6 months plus due to healing after implant placement. I really have no confidence in any of these dentists as they did not take much time to explain all of my options and were all pushing hard for the implant, which obviously was the most expensive option.

I have posted to a dental forum and some experts have mentioned the possibility of a root canal to save the tooth.

I am attaching an xray scan of tooth.

Can tooth be saved?

thanks.
Attached Thumbnails
Decay on inside of tooth - need expert advice-scan0002-01.jpg  
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Old 07-22-2009, 10:43 PM
 
Location: Kirkwood, DE and beautiful SXM!
9,900 posts, read 10,927,367 times
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You don't say if you have dental insurance, but if you don't, it must be very expensive to be going to all of these dentists. Since you think a root canal will take care of the situation, make an appointment with an endodontist and make sure it is one who has excellent references. At some point you will have to believe the docs. Good luck. I had a root canal years ago and had no pain. I can also tell you that my dentist thought I needed one two years ago but the endo that she sent me to told me that I didn't need it. He was a younger doctor so try to find one who has been practicing for less than 20 years but more than 5 (JMO). I am glad that the endo wasn't the type of doctor to do the procedure just in case.
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Old 07-22-2009, 10:58 PM
 
Location: Mostly in my head
16,264 posts, read 29,836,920 times
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I have had a permanent bridge in place of one tooth for at least 15-20 yrs. No problems with it and I think it would be MUCH cheaper than an implant and less painful, too.
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Old 07-23-2009, 06:48 AM
 
Location: nc
1,244 posts, read 1,232,160 times
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If you did a root canal though you'd still be looking at a crown afterward on top of the root canal though right? I mean those a pretty expensive too. Yea I like the idea of talking to an endodontist. Also, I mean you could just ask the dentist what they think about just cleaning it out and filling it to see if that works. I'm guessing they don't think it would though if none of them suggested that but the dentist I work for is definitely not one of those money money money dentists (I'm a little bias), she really tries to work with people if money is a problem and will let people do payment plans if needed, you could ask about that.
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Old 07-23-2009, 09:01 PM
 
Location: Summerset, SD
310 posts, read 1,887,641 times
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I'm a root canal specialist, so I'm obviously biased towards doing root canals... but your tooth has almost no chance with a root canal.*



*I'm making a guesstimate based on a single piece of information, which is that x-ray. There's a lot of other information I'd like, along with an xray that shows the full length of the tooth. However, the guess is pretty good based on what the current xray shows.

Here are your options:
1. Because the cavity is so deep below the gumline, you'd have to orthodontically extrude the tooth, do a root canal, then place a post and crown. Very expensive. You end up with a shorter tooth and possibly esthetic problems associated with a "thin" tooth. Possible? Maybe. Need an xray that shows the full length of the tooth as well as other clinical information to know.
2. Crown lengthening, root canal, post and crown. This would be an esthetic disaster, not only for this tooth but for the adjacent teeth.
3. Extraction and implant. Very good long-term restorative option. However, esthetic problems may arise if your gums shrink after the extraction.
4. Extraction and bridge. Same esthetic concerns. In addition, you have to have teeth on either side shaved down substantially, risking the need for root canals on those teeth as well.
5. Extraction and partial denture. Same esthetic concerns. Maybe additional esthetic concerns if the partial denture uses metal clasps that are visible. It'll be functional, but most people don't like this choice.
6. Do nothing. The tooth will continue to rot out and eventually break. May develop pain, or may not.

Of the above options, I'd look first at orthodontic extrusion. If that's not feasible, I'd go with an implant.
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Old 07-24-2009, 03:58 AM
 
Location: Kenmore, WA
6,837 posts, read 3,401,745 times
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Ouch, that looks like it would hurt! Sorry to learn of it.

I think it's past saving, from the outward appearance. I had some decay in a molar that my dentist in Kenmore found, but it was surrounded by healthy tissue. Thankfully, he found it when it was just a spot in a crevice that the hygenist found. He told me it was necessary to address it then, because if it got worse, I would have problems saving the tooth.

Sorry, but I would go for the other's posts, pull it, and bridge.

Good luck.
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Old 07-24-2009, 08:40 AM
 
10 posts, read 48,452 times
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Quote:
Originally Posted by Elipar View Post
I'm a root canal specialist, so I'm obviously biased towards doing root canals... but your tooth has almost no chance with a root canal.*



*I'm making a guesstimate based on a single piece of information, which is that x-ray. There's a lot of other information I'd like, along with an xray that shows the full length of the tooth. However, the guess is pretty good based on what the current xray shows.

Here are your options:
1. Because the cavity is so deep below the gumline, you'd have to orthodontically extrude the tooth, do a root canal, then place a post and crown. Very expensive. You end up with a shorter tooth and possibly esthetic problems associated with a "thin" tooth. Possible? Maybe. Need an xray that shows the full length of the tooth as well as other clinical information to know.
2. Crown lengthening, root canal, post and crown. This would be an esthetic disaster, not only for this tooth but for the adjacent teeth.
3. Extraction and implant. Very good long-term restorative option. However, esthetic problems may arise if your gums shrink after the extraction.
4. Extraction and bridge. Same esthetic concerns. In addition, you have to have teeth on either side shaved down substantially, risking the need for root canals on those teeth as well.
5. Extraction and partial denture. Same esthetic concerns. Maybe additional esthetic concerns if the partial denture uses metal clasps that are visible. It'll be functional, but most people don't like this choice.
6. Do nothing. The tooth will continue to rot out and eventually break. May develop pain, or may not.

Of the above options, I'd look first at orthodontic extrusion. If that's not feasible, I'd go with an implant.
thanks everyone for your input

options:
1. what is involved when you "orthodontically extrude the tooth" ? what are ball park fees of this an additional proceedures ? what other clinical info might you need?

2. will orthodontically extruding the tooth help esthetics ?

3. all 5 dentists i have seen (including one who only does implants) have not mentioned any esthetics problems or gums shrinking, now you see why i have no faith in them.

i found american academy of implant dentistry which had some accredited dentists/specialists in my area, any other advice on getting the most profficient implantologist ? (word of mouth has been unsuccessful)

what is your opinion (for implants or root canal) on dental schools (some good ones allegedly in this area) i know you can save money but for this type of problem i'm not sure if lack of experience is way to go, please convince me otherwise i would like to try dental school as i believe they would be more truthful with me.

4. skip (not interested in bridge)

5. can specialist place some sort of temp crown while healing from implant placement ?


6. what are consequences of this other than tooth breaking & pain i.e. if i wait longer will it be more difficult to place implant or can could i get very sick from decay invading bone or other vital areas ( i have inquired with dental school a few months back but had to cancel & wait for appointment is usually 4-5 weeks)

also, i have had 5 sets of xrays from last nov. - april (accepted many promo offers) is this excessive ?

* in recent days there was slight inflammation of gum above this tooth but it went away now & there has been occasional bleeding but not much. plus it hurts if i chew harder foods with tooth i.e. toast, cereal etc. soft foods ok.

thanks again to all (& Elipar) for time answering questions.

Last edited by Caleb22; 07-24-2009 at 09:04 AM..
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Old 07-25-2009, 08:27 AM
 
Location: Summerset, SD
310 posts, read 1,887,641 times
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1. When the cavity has been drilled out, very likely there won't be much of the tooth left. To increase the amount of tooth to work with, the tooth is literally pulled out of its socket. This happens slowly so that the bone has a chance to remodel and lock the tooth into a new position. The trade-off is that the more of the tooth you pull out of the gums, the less of it is locked into bone, resulting in a less stable tooth. It only works if the end result will be sustainable. Typically the tooth will be partially or fully root-canaled, then either a bracket or a post will be used along with a wire to pull the tooth out. After the tooth reaches the final position, complete the root canal and restore with a post and crown. Ballpark costs? I have no idea. It also depends on who you go to, since costs vary tremendously by state and even by dentist. What other clinical info is needed? None... you should be having this discussion with someone who can actually treat you, not some random guy on the internet. For all you know, I could be writing this from prison! LOL. Seriously, you need to find someone with whom you're comfortable and ask these questions again.

2. When a tooth is extracted from its socket, the bone (and gums) typically will shrink. Look at the gums of your front teeth. They usually have a uniform architecture and the gums fill up the spaces in between the teeth. The major concern with a replacement tooth is that the gums will not fill up the spaces between the teeth. It's known as a "black triangle", because the blunting of the gums will form a void in the gums in a triangular patterm.

Try this link: http://www.carsondds.com/images/pics/implant1b.jpg. The pic is kinda small, so you can't see much detail. However, notice how the gums fill the spaces between the teeth on the right. On the left, where the implants are being placed, notice that the gums are rather flat. When the crowns are placed, the triangular pattern of the gums will not magically reappear. In the back, it's not as noticeable. But in the front (your smile), it's not as nice. Does this happen in every case? No. No one can guarantee that it will happen, or that it will not happen. It's just one of the risk factors.

Will ortho extrusion improve esthetics? It won't improve it, but it may maintain it better. When you slowly extrude the tooth, the gums are maintained, so you don't develop the black triangles. However, since the tooth gets skinnier as you pull it outward, the resulting tooth may be thinner than what it is currently. Placing a crown will fix the majority of that, but it may still have a slightly compromised look to it.

3. Properly informing patients is sorely lacking in many places of dentistry and medicine. Did you know that root canals are not 100% successful even if everything is done perfectly? How many times have you been told that? I tell that to every patient, along with other risks, before doing a root canal, and almost all of them are surprised to hear it.

I've never placed an implant, so I'm not the best person to ask about finding someone qualified in implants. Quite honestly, unless you know someone who is very experienced in placing implants, any opinion you get about how good someone is, is just guessing. I'm not sure if that last sentence made sense... In other words, if you asked me, a root canal specialist, to find another root canal specialist in Houston who did excellent work, I could do that. But if you ask me to find a good oral surgeon, I'd be guessing because I don't know enough to personally evaluate an oral surgeon's work. What you're asking is worse because I have no idea what city/state you're located in.

How are dental schools? Well... I'm in one right now. If you're looking for exceptional work, you're better off going to private practice. If you want good work at a low cost, then a dental school is excellent. Now, I'm not saying that a private practice produces excellent work all the time, and dental schools produce only average to good work all the time... Sometimes the dental school produces exceptional work. I'm just saying that, on average, the previous is true.

5. A temporary of some type is usually placed in the gap. No one likes to walk around for 6 months with a missing tooth. By the way, there is no established specialty for implants (yet). The closest thing to an implant specialist is a periodontist. A periodontist is a gum specialist, not an implant specialist. But they typically place thousands of them, so they are for all intents implant specialists. Anyone who claims to be an implant specialist is lying and should immediately be reported to the state dental board. It's false advertising.

6. No one can tell you the exact course your tooth will take. But typically, the nerve inside the tooth will die (if it hasn't already). That will lead to a chronic infection that may sometimes flare up, resulting in swelling. Rarely, the infection may spread to other areas. If the tooth decays enough, the adjacent teeth can tilt into the now open space, creating gaps between other teeth.

7. Is 5 sets of xrays excessive? To answer your question directly, no, it is not excessive. According to one website, the federal maximum occupational radiation exposure limit is 5000 mrems per year. A full-mouth set of 18 xrays is 72mrems, and with digital films its less than that. So 5 full sets is much less than the federal maximum.

Now, to answer the question you DIDN'T ask... is 5 sets too much? Yes. What you're doing is "tire kicking". After meeting 5 dentists, you're not likely to find anyone who can satisfy all of your needs. If a patient comes in for a second opinion, dentists are more than happy to accomodate you. But if my receptionist told me a patient is coming in for a 6th opinion, I'd be very suspicious that I'm not going to be able to solve his or her problem. Put it in context to any other situation. Do you go to 6 different hardware stores to find the right hammer? Do you contact 6 different plumbers to get quotes? I'm all for being informed, but at some point, going to additional dentists does not yield anything of value. If you're worried about getting sick from the cavity invading bone, isn't being sick worse than having an ugly tooth?

As Larry the Cable Guy would say, git'r'done.
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Old 07-29-2009, 08:41 AM
 
Location: nc
1,244 posts, read 1,232,160 times
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If you do get a temp make sure you don't stay in it too long, once you're healed get the real deal because if your temp falls out your teeth will move and then the permanent they've made might not fit, so always call ASAP if a temp falls out. I mean, sure you can do adjusting, but you don't want to have to get a whole new one or anything
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Old 03-17-2010, 10:13 PM
 
10 posts, read 37,101 times
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Without doing a clinical exam it is always hard to tell. Based on the x-ray the cavity appears to be extensive. I would have to agree with the other two dentists that extraction and an implant is the best option. You could possibly save the tooth but it will cost you a lot because you will need root canal treatment, crown lengthening (removing some bone and tissue), post and core and crown. everything will run you about $2000. Cannot do anything without the crown lengthening which in itself costs from $600-$800. The cost of an implant is higher, however if you take care of it you will have it for life. At the same time the adjacent teeth will not need to be shaved down, which will save you the cost of replacing those crowns in the future. Even though it seems like the implant is the most expensive it will save you money over a long run. If you would like to learn more check out this site:
Dental Implants- Cost of dental implants. Find dental implant dentist.
You will save money over your lifetime with the implant. Thanks.
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