Should I cap the other front tooth to match?

[Guest]

Hi I am having real trouble making this decision so could really use your input.

I'm 33, when I was 13 I had my left front tooth knocked out and got it capped. This cap lasted me 20 years and the porcelain finally started chipping away about 2 months ago. So I finally went to the dentist to deal with this (I avoided dentists for 13 years because my childhood dentist was very rough and aggressive) and he did the following over the past month:

1) Full cleaning

2) Apico(something or other) to deal with a chronic abcess I had developed, it went very well and he was very gentle and attentive to my phobia.

3) Removed the old cap (the old post came out with the old cap) and put in a new post, and put in a temporary cap (molded from the old one) until I can be measured for the really nice new cap next Monday.

4) Used a laser to cut away quite a bit of overgrown gum tissue behind where the old cap was. (This caused MUCH discomfort and swelling for about 5 days afterwards and I never want to have it done again).

Ok so I am being fit for the new Cap next week (Had to wait for the gum tissue to heal after being cut away) and I should have the new cap in 2 weeks after that when it comes back from the lab.


Here is my problem...

The matching front tooth (the real one) is quite twisted and large (I had buck teeth as a kid), and my dentist wants to do a root canal on it, remove some of it and put in another cap to perfectly match the new one i have coming, because he said if he makes my new cap a perfect fit, it will look odd beside my somewhat twisted and elongated right front tooth.

I really want to have prefectly fit matching front teeth but I'm worried about a few things...

a) The right front tooth is a real tooth, I'm rather attached to it (no pun intended) and I'm concerned i would be getting rid of a strong natural working tooth for an artifical weak cap that I might not be able to bite into things with as much confidence (ie: Apples).

b) Root Canals terrify me (my childhood root canal on the original tooth was likely the most painful and terrifying moment of my life). The idea of choosing to get one when I don't technically have to seems strange.

So keeping the above in mind, should I get the working tooth removed and replaced with an artifical one that will look great but perhaps not be as strong or reliable. Your input would be VERY helpful.

Thank you in advance,

Casey

 

[Guest]

Hi Casey , first of all - congratulations on dealing with your phobia, well done!

Certainly it's easier to match crowns exactly when they're done at the same time. The question really is just how MUCH you want your front teeth to match. When you said that you're quite attached to this tooth, did you also mean in terms of appearance/self-image/identity, or purely in terms of functionality? If it's the former, it might be possible to reshape/shorten the "odd tooth out" somewhat without the (admittedly rather drastic) action of doing a root canal and crown, and making the cap to match the surrounding teeth. Were you happy with the last set-up (before the cap failed)? If so, you should let your dentist know. It's your mouth, and your self-image, and even if matched crowns might be closer to some "standard" ideal of beauty, that doesn't mean you have to go along with it. You (and others) may be quite fond of this "deviation", in which case there's no need to change your appearance.

If, on the other hand, you're very unhappy with your appearance, you might want to consider matching them perfectly.

So a basic question, as far as I can see, would be: did the difference between the two front teeth bother you in the past? It's your tooth, and you have every right to be quite attached to it !

That's before even going into the dentistry side of it... purely from a dental health point of view (as opposed to a cosmetic point of view), it would probably be better to leave well alone, then again, factors such as bite (occlusion) may play into your dentist's suggestion, I really don't know ??? ? Obviously, he would be concerned that you are happy with the aesthetic outcome (and not turn around later and complain that the front teeth don't match), so he might be pushing a bit on that account.

 

[Guest]

When you said that you're quite attached to this tooth, did you also mean in terms of appearance/self-image/identity, or purely in terms of functionality?

My attachment mostly involves the fact that the real tooth works just fine even if it looks a bit twisted. So my answer would be about 80% functionality and 20% sentimentality (I only had 2 front teeth and this one is the only real one i have left).

So my concern is primarily functionality. With 2 crowns for front teeth will I be ably to bite into an apple with confidence? Most of my life I have eaten apples by biting into them slightly to the right so my real tooth takes the pressure instead of the cap. My dentist assures me the caps will be very strong as long as I don't try to bite down hard onto a metal pipe or something.

Of course even if the caps would be as strong and reliable as real teeth, there is still the root canal to deal with if I crown the second tooth.

Thank you for the warm welcome and quick response. I have until Monday to make this decision

Casey

 

[Guest]

I actually find this one exceedingly difficult... um, personally speaking, doing RCT/crown on a healthy tooth strikes me as overkill... but then again, I don't know HOW bad it would look without the teeth matched, and how much you'd enjoy having matching teeth. I have to admit that I'm very much biased towards conservative dentistry, so it's hard for me to be objective about this. The worry I'd have with the root canal is not that it might hurt, because it doesn't if you're numbed properly, but that the tooth will not have the same chance of lasting you for the rest of your life, purely statistically speaking (of course, it may well do, but there's more risk of things going wrong at some point in the future). Biting into things like apples should not be a problem. But... a vital tooth (one with a live nerve) will, on average, last longer... so if it's at all possible to leave out the RCT...

I'm still wondering if there might not be a less invasive option that would give a good aesthetic result - something that wouldn't require RCT (orthodontics? veneer? 3/4 crown?). The problem with high-end cosmetic dentistry is that it's pretty specialized, and it can be difficult to get a good result unless you know that your dentist does a lot of it and does it well. Crowns are easier to do well, but are less conservative. Then again, if you use veneers to "straighten" teeth, this usually requires quite a bit of tooth reduction anyway, so you might still end up with a root canal.

Maybe some of our dentists can chip in - as I said, I'm a bit lost! I don't know if what you're describing is done frequently, and how happy patients are with it etc. For all I know, it might be quite a common thing to do

What's the proposed crown for the tooth that needs capping? All-porcelain or porcelain-fused-to-metal? Is it going to be bonded or cemented? (or do you know?)

(I'm writing this assuming that the reason why the other front tooth can't be crowned without a root canal is because it's too twisted... but TBH, it's probably impossible, even for a dentist, to give an answer without actually seeing it.)

Sorry for being so unhelpful

[personally, I'd say don't rush into anything - it's not a reversible decision.]

 

[Guest]

Morning from the desert southwest, USA....

everything that "lets" has said, is right on track. Its really hard to make recommendations without much more information, x-rays, photos, etc.... I will say that it is very difficult to match ONE crown, veneer, etc on front teeth and have it look perfect. Placing crowns, etc in even numbers, 2 or 4 or 6, gives us a much better chance of creating the appearance that the patient desires. Maybe a new crown and a veneer on the other tooth may look nice.

perhaps it might be a good idea to get a second opinion or even a third to help you with you decision making.

Glenn

 

[Guest]

"lets" asked me if perhaps one tooth could be done first, and then the other sometime in the future....

I might not recommend doing that. Even though the colors may be close in comparison, if the crowns/veneers are done at different times, there's a chance that they could turn out to be different colors because the procelain would not be from the same "batch".

It is certainly recommended that, for the best esthetic result, the crowns/veneers should be done at the same time.

Glenn

 

[Guest]

Hi guys, thanks for all the info.

I presented everything I learned here and from further research to my Dentist yesterday afternoon when I had my appointment to be fitted for the original crown (the gum had finally healed enough for a 'perfect' fit.

I explored all the options with him and learned the following.

a) Veneers were not an option because the right front tooth (the one in question for the optional matching crown) is twisted, not damaged or chipped.

b) He can leave the right front tooth as is and attempt to communicate to the lab to slightly twist the crown for the left front tooth and it should look fine, like it did before my original crown broke apart. It would look a bit crooked and I the crown would be larger than necessary to match the twisted tooth. I was blessed with buck teeth at birth

c) The root canal on the optional right front tooth is necessary because the 'tooth reduction' will be just enough to come near the threshhold of the nerve. It MIGHT be ok with the root canal but he'd rather not forego the Root Canal and then have the work threaten the nerve which I imagine would put me in great pain.

d) the optional crown on the right front tooth will not have a post. The crown will be cemented right to the reduced tooth structure and will be very strong and feel stronger than a crown attached to a post.


So after calling my wife and discussing the options, and mulling it over for about 15 minutes, I came the my decision and gave him the go ahead to schedule the root canal for the right front tooth. This allowed him to take measurments with the matching crowns in mind and send all the information to the lab.

In regards to price, he orignally quoted me the following in USD for the second crown:

$1095 for the crown
$790 for the root canal
$300 for the tooth reduction and buildup

After seeing my reluctance and taking into account I have already paid $1300 for the original crown work, he lowered the price for the second crown from $2100 to $1500. I'm just posting it here to make sure it's competetive, I've put a lot of trust in my Dentist. I don't even care about the money to be honest, I would pay a huge premium for the peace of mind of a successful procedure and a great set of new front teeth

So finally, after making the decision and committing myself. Sitting in the dentist chair biting on the thing that takes your bottom and upper teeth mold to fit your crowns, it finally dawned on my that I was going to be back in the chair getting a root canal in a couple of weeks. Clammy hands, nausea, etc. (he wanted to schedule the root canal for this Friday but I told him I needed more time than that to get prepared psycologically, so it's next friday instead)

I've had one root canal in my life as described in the original post, and it was a horrific experience for an 8 year old to have to go through, and I avoided Dentists for over 13 years as a result.

Anyways, I am trying to prepare myself for next friday's root canal (I'll be getting lidocaine AND nitrous oxide gas during the procedure) and justifying it by picturing myself with a pair of perfect front teeth like those lucky people who were born with them.

I'll post here with the results of the root canal next Friday (I'll probably be high on Vicodin hehe) to let everyone know how it went.

Thanks again for all the support,

Casey

 

[Guest]

Sitting in the dentist chair biting on the thing that takes your bottom and upper teeth mold to fit your crowns, it finally dawned on my that I was going to be back in the chair getting a root canal in a couple of weeks. Clammy hands, nausea, etc. (he wanted to schedule the root canal for this Friday but I told him I needed more time than that to get prepared psycologically, so it's next friday instead)

I've had one root canal in my life as described in the original post, and it was a horrific experience for an 8 year old to have to go through, and I avoided Dentists for over 13 years as a result.

Hi Casey,

this is just a very brief reply (in a bit of a rush).

I just wanted to reassure you that not all root canal treatments are painful. My RCT was about 18 months ago. It was not on a healthy tooth, but on a tooth with an abcess. But the RCT was completely painless. It took two one hour treatment sessions to complete. But no pain or discomfort at all.

G.

 

[Guest]

Hi guys,

Just thought I'd post a quick update regarding what happened on Friday with the scheduled root canal.

I went to my appointment at 11am and they sat me in the chair to wait for the endosomething (different guy from the main dentist handling my crown). The assistant put the nitrous mask over my nose and I began to feel the effects immediately (my eyes water a alot during nitrous, is that normal?).

When the dentist came in I felt quite a bit of panic because I knew he'd have the drill up there killing my healthy tooth in moments. As he grabbed that swab from the nurse for numbing the gum before doing any injections I really started panicing. And as he turned away briefly (to examine the xrays with a somewhat perplexed expression that made me nervous) after placing the swab on my upper gum, something very strange happened.

To say I felt dizzy is a huge understatement. I have been unable to properly describe what happened at that moment verbally so I doubt I'll be able to convey it via text but I'll try. Basically I felt like the world closed in on me and my body was somehow failing. I could hear my own heart beating and it was really fast. I began taking loud audible breaths to make sure I was breathing ok. It was at this point the dentist heard my weird breathing and asked me if I was ok, at which time I suppressed the usual placating 'I am fine thank you' response and told him, 'I don't know, what's happening to me?'.

So they turn off the nitrous and mumble to one another for a bit out of my hearing. Then he tells me he would like to put off the root canal if that was alright with me. Of course I jumped at the chance to get out of there. I asked him what exactly had happened and he said he thought they had given me too much nitrous, but my wife thinks it was something called a Histamine reaction which can be very dangerous. He said he wanted to wait on the Root Canal because it might not be necessary if the cosmetic dentist could reduce the tooth without threatening the nerve. And if they DID get too close to the nerve, I would be numbed and they could do a root canal then because at that point it WOULD be necessary.

So I pretty much bolted out of there and they told me the cosmetic Dentist would call me on Monday, today.

So now i'm not only scared of root canals, I'm scared of Nitrous Oxide too

Thanks again for the support, I love this board. And sorry for the long posts, but I find it difficult to articulate an experience like this in only a few sentences.

Casey

 

[Guest]

To say I felt dizzy is a huge understatement. I have been unable to properly describe what happened at that moment verbally so I doubt I'll be able to convey it via text but I'll try. Basically I felt like the world closed in on me and my body was somehow failing. I could hear my own heart beating and it was really fast. I began taking loud audible breaths to make sure I was breathing ok. It was at this point the dentist heard my weird breathing and asked me if I was ok, at which time I suppressed the usual placating 'I am fine thank you' response and told him, 'I don't know, what's happening to me?'.

So they turn off the nitrous and mumble to one another for a bit out of my hearing. Then he tells me he would like to put off the root canal if that was alright with me. Of course I jumped at the chance to get out of there. I asked him what exactly had happened and he said he thought they had given me too much nitrous, but my wife thinks it was something called a Histamine reaction which can be very dangerous.

No, it doesn't sound like an allergic (histamine) reaction, but like the symptoms of oversedation, i. e. too high a percentage of nitrous oxide (N2O) in the N2O-O2 mix. This can happen if the patient is not monitored to see how they feel while gradually increasing ("titrating") the N2O in the mix, to get the right level of sedation. Ideally, N2O should be carefully titrated, but I suppose because it's such a safe drug, shortcuts may be taken. I wouldn't conclude from that one experience that nitrous oxide sedation isn't for you, as the effect may have been very different with the right dose . Alternatively, you may simply have been very nervous, and the symptoms might have been due to panic.

He said he wanted to wait on the Root Canal because it might not be necessary if the cosmetic dentist could reduce the tooth without threatening the nerve.

Or maybe it wasn't oversedation, but divine intervention ? I have to say, this sounds like a better idea than the original plan . It would be great if a more conservative solution was possible.

Many thanks for the update !!

 

[Guest]

I think I agree with you. I prefer the idea of not killing the healthy tooth unless absolutely necessary. It seems wrong to destroy the root of a tooth that is functionally perfect, even if it doesn't look perfect.

My remaining concern is, what happens if the dentist installing the crowns does get too close to the nerve. Will I feel sharp pains immediately during the procedure? Or worse perhaps, could everything appear to go smoothly and then I feel sharp pains later because the nerve was subtly damaged during the procedure?

I want to keep the tooth alive if possible but he's going to be significantly reducing it to remove the twisted aspects of it and shaving away a tooth with a nerve....sounds painful.

Casey

 

[Guest]

My remaining concern is, what happens if the dentist installing the crowns does get too close to the nerve. Will I feel sharp pains immediately during the procedure?

No, because if you're numbed for the procedure, the nerves wouldn't be able to transmit any pain signals.

Or worse perhaps, could everything appear to go smoothly and then I feel sharp pains later because the nerve was subtly damaged during the procedure?

It's always POSSIBLE that the nerve could be damaged, but really, the cosmetic dentist would be in a much better position to evaluate how likely that would be . Do you have a consultation appointment with the cosmetic dentist first, to evaluate the situation?

 

[Guest]

The pain you went through as a younger child with the root canal should not be a problem. I had 5 root canals plus 3 of them were post core buildups...

You had trauma to that front tooth before it was worked on and that it probably what allowed for such pain.

I would go ahead with the crown. I had 8 crowns placed in one day. I was fine

The thing is that this procedure will feel like a regular filling because there won't be any trauma or infection causing pain before or after. GO for the better look.

I did! I feel great! Plus, I can eat corn on the cob, apples, cookies, anything! You'll be fine. Root Canals usually only cause pain when trauma to the tooth has occured or if there is infection...

You'll be fine!
Nicole

 

[Guest]

Thanks so much for the input

I was at the dentist this morning to get the temp crown re-cemented and to schedule the appointment for the preparation of the second tooth (the one that barely avoided a root canal). My appointment is on August 16th and I can't wait to have all this over and done with.

Casey