Too much decay even for crown

M

Miker

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My farthest back upper left molar (not wisdom tooth which has already been removed) has severe decay. I have known that restoration by filling would not be possible so assumed a crown would be the answer.

My dentist advised that because of the amount of decay (apparently the tooth is also cracked) a crown may not "take" and suggested having it extracted instead. I reluctantly agreed to the extraction but am now having second thoughts (I have not had the procedure yet so still have time to change my mind.

I thought that adding what I believe is referred to as "post and core build up" could provide the support needed for the crown. The tooth is not loose. I do have minor perio disease and will be having root scaling/planing done to correct that.

Even though no one will ever see it (part of my dentists argument for extraction) I would really prefer it not be extracted. But, as my dentist mentioned, I may spend over $1500 to attempt to save the tooth only to have it fail and eventually extracted anyway.

Any opinions? Is it true post and core does not always provide enough support for a crown?

Thank you
 
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annie778

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funnily enough I have just been to see an endo about a back tooth today. I say funnily enough because the endo says the tooth has a crack running through it and that he will try to save it, but if the crack is below the gum line then he will recommend extraction with a view to replacement with an implant. So it seems that if a tooth is cracked there are very few options if the crack extends below the gum line.

Therefore if your tooth has been found to be cracked below the gumline then your dentist is probably giving you very sound advice.
 
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Miker

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Thanks Annie, I do not know if the crack is below the gumline. I'll have to ask about that when I have the perio work done next week (I don't think that is done by the dentist, hopefully I will be able to speak to him about this at that time though). Any one else? Is there a way to tell if the crack is below the gumline based on the xrays taken?
 
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annie778

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Mike the endo told me he would not know how far the crack went until he started to work on it. There is a big filling in my tooth that has a seal underneath covering the nerve. (Apparently this used to be done a lot twenty years ago instead of immediately root filling teeth. I've had the filling twenty four years so it looks like seals weren't such a bad idea. ). I think if my dentist didn't spot the crack and the endo could only see it with his microscope then an x ray won't tell you much. Some of these cracks must be very fine.
 
brit

brit

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Mike the endo told me he would not know how far the crack went until he started to work on it. There is a big filling in my tooth that has a seal underneath covering the nerve. (Apparently this used to be done a lot twenty years ago instead of immediately root filling teeth. I've had the filling twenty four years so it looks like seals weren't such a bad idea. ). I think if my dentist didn't spot the crack and the endo could only see it with his microscope then an x ray won't tell you much. Some of these cracks must be very fine.

Yes - good old NHS back then Annie - when I had an old amalgam filling replaced recently, the EU country dentist pulled out a liner/seal thingy and commented on it...I thought to myself at the time...why don't they still do this...I never recall having post-filling sensitivity back then whereas I do now. Like yours it had lasted a long time 30 plus years....and as a problem tooth had only rumbled with sweet things.
 
Zzzdentist

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At some point teeth do become questionable as to whether it's worthwhile trying to restore them. In the case of severely decayed second molars I have seen some doozies where there's just not a whole lot left to anchor to even with a core and post and pins galore after a root canal. The dentist and patient have to think hard about the value of spending the money to try to salvage a possibly lost cause. It's sort of like trying to rebuild a run down a farm house that has been left in the field. It's tilted sideways, and the boards are pretty well rotted through. It may still be standing, but is it worthwhile restoring the building or just tearing it down to rebuild anew? :confused:
 
brit

brit

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At some point teeth do become questionable as to whether it's worthwhile trying to restore them. In the case of severely decayed second molars I have seen some doozies where there's just not a whole lot left to anchor to even with a core and post and pins galore after a root canal. The dentist and patient have to think hard about the value of spending the money to try to salvage a possibly lost cause. It's sort of like trying to rebuild a run down a farm house that has been left in the field. It's tilted sideways, and the boards are pretty well rotted through. It may still be standing, but is it worthwhile restoring the building or just tearing it down to rebuild anew? :confused:
I suppose if you can afford an implant (= a quality new building) it's not so essential to save the tooth come what may.
 
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Miker

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I suppose if you can afford an implant (= a quality new building) it's not so essential to save the tooth come what may.

That is part of my concern. I cannot afford an implant at this time...maybe in a few years. I mentioned this to my dentist but his reply was you wont necessarily need one. It can just be left as a missing tooth and shouldn't cause much shifting of my other teeth.
 
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annie778

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That's not what I've read on here. From what I have read, I get the impression that if you leave a gap over time the bone may reduce and I wonder if that means that an implant is harder to place? Not sure how long it takes for bone to reduce but one of the dentists will doubtless be able to tell you. Plus of course having a missing tooth can affect the overall bite and hence put pressure on other teeth. But then some people seem to get on fine with one or two (or more) back teeth missing. So maybe it's nothing to worry about. (except for me who needs to have all my teeth intact in some shape or form as I have a major phobia about the alternatives).
 
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Miker

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That's not what I've read on here. From what I have read, I get the impression that if you leave a gap over time the bone may reduce and I wonder if that means that an implant is harder to place? Not sure how long it takes for bone to reduce but one of the dentists will doubtless be able to tell you. Plus of course having a missing tooth can affect the overall bite and hence put pressure on other teeth. But then some people seem to get on fine with one or two (or more) back teeth missing. So maybe it's nothing to worry about. (except for me who needs to have all my teeth intact in some shape or form as I have a major phobia about the alternatives).

Thanks again for your input Annie! I have been scouring the internet for an answer to my problem. My head is spinning and stomach is turning from all of the different opinions I found.

ZZZDENTIST, could you respond again. Your previous response seemed to be written under the assumption that an implant would be placed. That will not be the case. The tooth will just be gone. Maybe in a couple years I could save up the money to have an implant placed but will it be too late for that by then?

If the problems Annie and others I have read are true, I would rather just leave it there in it's rotted/cracked condition until I can come up with the money for an implant.

Thank you.
 
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Zzzdentist

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Actually in a nutshell I just said that some teeth can be too far gone to be worthwhile restoring so an extraction is often the best solution. The replacement options afterwards do include a dental implant or leaving the area empty.

With second molars, there's not a whole lot of fear that the first molar will drift backwards developing a gap as most teeth have a propensity to move to the front of the mouth. As long as the lower second molar is braced against the upper first molar there should be no problem with the over-eruption of the lower tooth.
 
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If the problems Annie and others I have read are true, I would rather just leave it there in it's rotted/cracked condition until I can come up with the money for an implant.

Thank you.

I think it's always better for your body to have a rotten tooth out. If you have an infected tooth it will be affecting your health. You will start to feel increasingly run down and if it is a top jaw tooth it's also more dangerous because it's nearer your brain. So get it sorted rather than take the risk of keeping it there.

It's not the end of the world having a gap. As I've mentioned above, lots of people seem to be able to live with a gap (I know plenty who seem fine) and I was hoping zz would be able to elaborate more on how long it takes for any bone loss to be apparent if only one tooth is removed (if this happens at all with only one tooth).

The only thing that would really worry me in my situation if I had a gap in my back teeth would be how it would affect my bite. In my case I already have bite problems and wear a splint at night to stop grinding. However, in your case this may not be a problem at all and if it is you can also wear a splint at night until you can afford the implant.

Zz can you confirm how long between tooth removal and bone loss - months, years, or never for one tooth?

Mike if it makes you feel better, I'm procrastinating on what to do with my own cracked back tooth. It's not infected at present and I've been quoted nearly £900 to have it root treated by an endo, which I think is excessive. (it's at least £200 more than they used to charge for molars). If he cannot save it he will still charge me £350 for going into the tooth. On top of that I then need either another £700 for a crown or £2500 for an implant. Bang goes my holiday to india or Vietnam that I was planning for next year. I've another appointment scheduled for a second opinion with another dentist who is very good but not as near to work. I'm even thinking of going against my principles and letting him start the root treatment. He apparently refers on if he starts a treatment and finds it too complex. But I've heard from a dental nurse friend that he is a very good and precise dentist.
 
J

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I'll inject my 2 cents here. I had a back second molar that had been an anchor for a bridge. It eventually failed and I needed a root canal. I did the root canal only to be told now it wasn't strong enough to support the bridge and guess what? It should be taken out or an implant put in.

The extraction would have left me with 3 back teeth missing (wisdom, 2nd and 1st molars). Implants are so invasive and kind of scare me, so I opted to put a cantilever bridge to replace the 1st molar and put a crown on the 2nd molar. Every dentist I saw said that was not a good option and I was wasting my money... but that is what I chose because that is what I was comfortable with.

The 2nd molar crown lasted 5 years and I had to have the tooth extracted this summer. So was it wasted money? Not for me it wasn't. In my eyes, that gave oral surgeons 4 more years of practice putting in implants, not to mention any advancements that might have been made in 4 years time. Practice, practice practice! What is money if you have serious complications from a bad implant? Nothing!

I'm sure someday in the near future I'll need an implant, but I won't be getting one until I'm ready. Me.. my opinion counts....and sometimes dentists only see the teeth and not the patient.

You have to decide what your comfort level is. For me, extracting teeth is a BIG deal. I recently had a front tooth root canal retreated for the 3rd time (it's been a fun summer lol). My dentist wanted to yank it out and put an implant in. A 'slam dunk' she called it. Hmmm. I'll retreat the tooth and take my chances. So, yes, I went against my dentist's wishes (again), and yes I spent extra money (again). It's just something she has to deal with. I laugh and tell her she can say "I told you so" when it all fails, but until then, we'll keep plodding along.

Sometimes dentists tell you what the best road is, but that doesn't mean it's the path for you. It's your money. It's your mouth. Do what makes sense (within reason of course! lol)
 
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Miker

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Thank you Zzz, Annie and Jane for your opinions. I am feeling more comfortable about having the tooth extracted now.

I do have A LOT of other dental issues, on top of this extraction right now. Even when I was a child I never left a dental exam without needing several fillings. The dentist I went to at the time was very demeaning, degrading, rude etc. towards me. This led me to avoid dentists for probably close to 15 years (or even more) now.

I finally hit what I would call "rock bottom" in regard to the condition and appearance of my teeth and made an appointment with a different dentist that advertised himself to be "non-judgemental" (turned out to be a true claim). This is the dentist that will be extracting the tooth and taking care of everything else that needs to be done. I guess I should feel ecstatic that I finally took the plunge, it's just that the word EXTRACTION was not one I expected to hear.

Hopefully, within a few months, I will be able to give someone a full smile which I have not been able to do for many many years now (I do wonder who that someone will be).

Anyway (just needed to get that off my chest), ZzzDentist, I am also curious about the bone loss and possibility of an implant of second molars questions Annie posted above.
 
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annajayne

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At some point teeth do become questionable as to whether it's worthwhile trying to restore them. In the case of severely decayed second molars I have seen some doozies where there's just not a whole lot left to anchor to even with a core and post and pins galore after a root canal. The dentist and patient have to think hard about the value of spending the money to try to salvage a possibly lost cause. It's sort of like trying to rebuild a run down a farm house that has been left in the field. It's tilted sideways, and the boards are pretty well rotted through. It may still be standing, but is it worthwhile restoring the building or just tearing it down to rebuild anew? :confused:


Personally, I think if the patient is willing to pay the money, then the patient should make the choice as to whether or not its worthwhile. The patient is paying the dentist for his/her professional opinion so it would behoove the dentist to educate the patient in order to assist him/her towards a decision, not to make up the patient's mind for him/her. :thumbsup:
 
annajayne

annajayne

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That is part of my concern. I cannot afford an implant at this time...maybe in a few years. I mentioned this to my dentist but his reply was you wont necessarily need one. It can just be left as a missing tooth and shouldn't cause much shifting of my other teeth.

No, it won't. Oftentimes the shifting gets made more of a bigger deal than it really is. (Dentistry is a business, so what do you expect?) However, one space is one thing, adding additional ones is another. Either way, the human body is made to adapt. Your one space will be fine until you can get an impant of some sort. Just don't keep on getting extractions in the same area. the shiftig becomes a problem with multiple extractions in one location.
 
brit

brit

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Personally, I think if the patient is willing to pay the money, then the patient should make the choice as to whether or not its worthwhile. The patient is paying the dentist for his/her professional opinion so it would behoove the dentist to educate the patient in order to assist him/her towards a decision, not to make up the patient's mind for him/her. :thumbsup:

'What would you advise if I were your daughter, or if it were your mouth/teeth?' can be a good question to ask because it focuses them on someone they care about about and what the optimal solution truly is, is more likely to be forthcoming...rather than a balanced pros and cons of all the options.
 
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annie778

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'What would you advise if I were your daughter, or if it were your mouth/teeth?' can be a good question to ask because it focuses them on someone they care about about and what the optimal solution truly is, is more likely to be forthcoming...rather than a balanced pros and cons of all the options.

Are you saying dentists have feelings too? (a revolutionary idea! :))
 
A

annie778

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Personally, I think if the patient is willing to pay the money, then the patient should make the choice as to whether or not its worthwhile. The patient is paying the dentist for his/her professional opinion so it would behoove the dentist to educate the patient in order to assist him/her towards a decision, not to make up the patient's mind for him/her. :thumbsup:

I've actually found that most dentists I've seen have not tried to make up my mind for me, but have given me the pros and cons. The majority I've met are very professional. If I'm still not sure I go for a second opinion. Generally my philosophy is if in doubt do nowt. But if you are in constant pain & have an infection then nowt is not always a good option. If you are worried about radical dental work then go for a second opinion to a dentist who is into minimally invasive techniques. From what I have read on here and on other forums, there is a broad spectrum and just as much disagreement in the best dental treatment plan, as there is in any field of science. You go from the very radical to the very conservative. So no harm in getting a few different views and then making up your mind.

Bearing in mind that this research should not cost the earth. Dentists who charge an arm and a leg for a second opinion will charge an arm and a leg for treatment and may have a hidden agenda in the treatment options offered (whilst staying on the above mentioned broad spectrum and hence covering their suggestions with a coating of professional ethics).
 
annajayne

annajayne

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I've actually found that most dentists I've seen have not tried to make up my mind for me, but have given me the pros and cons. The majority I've met are very professional. If I'm still not sure I go for a second opinion. Generally my philosophy is if in doubt do nowt. But if you are in constant pain & have an infection then nowt is not always a good option. If you are worried about radical dental work then go for a second opinion to a dentist who is into minimally invasive techniques. From what I have read on here and on other forums, there is a broad spectrum and just as much disagreement in the best dental treatment plan, as there is in any field of science. You go from the very radical to the very conservative. So no harm in getting a few different views and then making up your mind.

Bearing in mind that this research should not cost the earth. Dentists who charge an arm and a leg for a second opinion will charge an arm and a leg for treatment and may have a hidden agenda in the treatment options offered (whilst staying on the above mentioned broad spectrum and hence covering their suggestions with a coating of professional ethics).

Excellent suggestions (all of them).
 
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