Gum Flap Surgery vs Extraction

[wml24]

I was recently referred to a periodontist because of a suspected infection (periodontal abscess in the area between the roots) under a heavily filled molar. She confirmed this and offered me two options:
1. Gum flap surgery to investigate and do root planing and clean-up. However, if she found anything else, e.g. a fracture, she would extract the tooth on the spot. Even if extraction isn't necessary at this stage, there is no guarantee that it won't be a bit downstream.
2. Extraction.

Both of these options terrify me. I do not freeze well in the bottom and am scared I will feel what's going on. My gut feeling is to go right ahead with the extraction ... but then I will be faced with a bridge or implant. The idea of any kind of drilling causes me the utmost anxiety, and the idea of compromising two relatively healthy (although filled) teeth is not at all appealing.

My question is (and I'm sure it's been asked before), what if I just leave the gap where the missing tooth was? Is it inevitable that the adjacent teeth will start shifting into it? What's the worst that would happen if this were the case? Oops .. sorry, that's actually three questions. I just want to minimize the time I spend in the chair.

Since the tooth in question is causing me no pain at the moment, nor has it ever, I would much prefer to adopt the "wait and see" approach; however, I am assured this would not be a wise move.


Scared silly.

 

[45andAfraid]

I'm no dentist and can only say what I've heard.

Depending on where the tooth is (molar?) and how young you are and how crowded your teeth are right now will depend on if the other teeth will shift over.

My 16 year old has a molar that just had a root canal but hygienist stated it could easily be extracted as she's young and her other teeth will move over (make more room). Won't even notice.

We opted to save the tooth.

 

[brit]

I would say see an endodontist and maybe save the tooth with a root canal followed by apico (flap) surgery if necessary. A periodontist can't save the tooth if decay is the real cause of the abcess/infection whereas an endo can.

Endos are also usually very skilled at getting people numb. If you are not numb, they can't work on you, is the way to approach this.

The principle here is everything looks like a nail if you only have a hammer. This is why a General dentist should be taking an overview which maybe they are but the talk of immediate extraction would worry me.

 

[RP]

I'm not a dentist either but a periodontal abscess is a little different than a tooth abscess, I think she is seeing the right specialist .... if it were at the base of the tooth- then endo. Flap surgery is not the same as apico - apico cleans out a dental abscess usually after failed rct and clips the roots of the teeth, sort of a root canal from the other end, flap (gum) surgery cleans all the tartar and calculus deep down in the tooth, makes the pocket shorter so it can be kept cleaned then sews the gum back up.

Is it a first molar? Try to save it
Do you have your wisdom teeth? kind of a bonus and in a young person can move up and fill a gap- happened to me when I lost a molar at 14. I think if you have the tooth above it- you should try to save it as that tooth may over erupt. Living with a gap is really not that big of a deal until it becomes a habit............... but once a tooth is gone it's gone. Make sure you tell whom ever that you have trouble getting numb

Can't Get Numb

Find out why you may not get numb enough, what dentists can do to get you numb, and how to ensure your treatment is painless.

www.dentalfearcentral.org

Waiting with any kind of infection is bad news.....it will silently eat bone, as my oral surgeon said, sometimes not having pain is bad thing as he rebuilt the floor of my nose from an abscess/cyst.

rp

 

[wml24]

Thanks, everyone. I think I will try the flap surgery first to see if she can save the tooth. If she can't and extraction is necessary, I guess there's not much I can do about it. Still scared silly just thinking about it. I wish they would put me to sleep, but that doesn't seem to be an option.

 

[RP]

Ask about sedation options, as more and more perio's are doing implants and all do surgery- you might be surprised. With local, though, you should be completely numb.

I was deathly afraid of having a flap for my implants/bone grafts, knowing they were going to expose the bone underneath, but honestly, outside of the stitches getting irritating, it wasn't a bad recovery at all. Much easier than an extraction. Salt water rinses, ibuprofen did the trick.

Let us know how you do.

rp