dental implant or leave it alone

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tooth confused - 20 Sep 2006 15:38 GMT

Last year I had the left back toothextracted as it gave me terrible
pain ,.It might have been fractured ,but nothing showed up in x-rays
and eventually, the tooth basically fell apart during root canal. My
dentist suggested that I advise with a periodontist, about replacing ,
(implanting)
Can I leave the empty space alone? I have no problem eating or chewing,
my appearance is unaffected. I'm 48, in good health generally.
Do I need an implant in order to save me from future infection, or
drifting, or further tooth loss? Can I wait & see? My inclination is to
leave it alone & cross that "bridge " if I come to it & save a ton of
money>
What do you think?

Confused

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Mark & Steven Bornfeld - 20 Sep 2006 15:46 GMT

> Last year I had the left back toothextracted as it gave me terrible
> pain ,.It might have been fractured ,but nothing showed up in x-rays
[quoted text clipped - 10 lines]
>
> Confused

Some issues to consider (and discuss with your dentist)
1) How much do you miss the tooth now?
2) What is your periodontal health
3) How often do you get cavities
4) Is it possible to get an implant
5) What tooth precisely is this?
6) Are there teeth directly in front/behind/above the one extracted?

Teeth sometimes drift, but for any particular patient it is difficult
to impossible to know beforehand how much your teeth will drift, or
indeed whether they will drift at all. Hints to this can definitely be
garnered from your bite and condition of other teeth. Other than this,
if you don't miss the tooth you should be monitored at least a couple of
times a year for evidence of drifting.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

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Citizen Bob - 20 Sep 2006 17:53 GMT

> Teeth sometimes drift, but for any particular patient it is difficult
>to impossible to know beforehand how much your teeth will drift, or
>indeed whether they will drift at all. Hints to this can definitely be
>garnered from your bite and condition of other teeth. Other than this,
>if you don't miss the tooth you should be monitored at least a couple of
>times a year for evidence of drifting.

I am facing a similar situation, although I am one step earlier. My
upper left molar - the one next to the wisdom tooth - was overdrilled
and the crown broke into pieces leaving a stub that is flat with the
top of the gumline. It has fillings in it but is otherwise not
damaged. Recently it erupted into a toothache as it did for the last
15 years even with the crown intact. Eventually the toothache goes
away for several years and I have had no problem.

Assuming that the toothache will go away this time like in the past, I
wonder if I should nevertheless have the stub extracted. My philsophy
is that if it works, don't fix it. But then this is an unusual
situation with a broken stub. It may never fix itself in which case I
will have to have it extracted. Once extracted I am not going to do
anything else - I will have another hole in my head.

Should I get the extraction anyway or is it possible I can last it out
like in the past? If I do get it extracted, I will follow your advice
above in dealing with the hole.

--

"There is no distinctly native American criminal class save Congress."
--Mark Twain

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Mark & Steven Bornfeld - 20 Sep 2006 20:51 GMT

>> Teeth sometimes drift, but for any particular patient it is difficult
>>to impossible to know beforehand how much your teeth will drift, or
[quoted text clipped - 26 lines]
> "There is no distinctly native American criminal class save Congress."
> --Mark Twain

You are taking a chance retaining the stump. You haven't said (and you
may not know) whether there is active decay. There may well be (based
on your pain) an infection there, and even if the pain subsides there
will probably be a chronic, low-grade infection there.
You should have the roots extracted.

Steve

Signature

Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

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Citizen Bob - 21 Sep 2006 12:49 GMT

> You are taking a chance retaining the stump. You haven't said (and you
>may not know) whether there is active decay.

I cannot see any.

> There may well be (based
>on your pain) an infection there,

I believe the evidence points to that fact.

> and even if the pain subsides there
>will probably be a chronic, low-grade infection there.

Can't that be dealt with using antibiotics?

> You should have the roots extracted.

It would be easier to get the entire tooth extracted. Then I would at
least be done with that part of this problem.

Based on what you said to the OP, I have a good chance that the hole
will not result other complications.

While I have your attention, I asked in another thread why the
toothache would go away when I irrigated my nasal passages and sinuses
with a saline solution (using a Water Pic). The last time I had a
toothache (the tooth was intact then), the pain went away
*immediately* upon full irrigation, and it stayed away for several
years until now, when the tooth finally broke off.

What do my sinus cavities have to do with a toothache and its
remission?

--

"There is no distinctly native American criminal class save Congress."
--Mark Twain

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Mark & Steven Bornfeld - 21 Sep 2006 15:41 GMT

>> You are taking a chance retaining the stump. You haven't said (and you
>>may not know) whether there is active decay.
>
> I cannot see any.

I wouldn't expect you to self-diagnose here.

>>There may well be (based
>>on your pain) an infection there,
[quoted text clipped - 5 lines]
>
> Can't that be dealt with using antibiotics?

No. The source of the infection is within the root; since there is no
vascularity inside a necrotic pulp, there is no mechanism for antibiotic
to clean out the infection. Furthermore, the root canal system will be
continuously contaminated by the saliva through any carious dentin or
exposure of the pulp chamber. Antibiotic will suppress the infection in
the jawbone; but once the antibiotic is discontinued the septic matter
in the roots can (and usually does) reinfect the bone and connective
tissue around the root.

>> You should have the roots extracted.
>
> It would be easier to get the entire tooth extracted. Then I would at
> least be done with that part of this problem.

That's what I meant. I was alluded to what I perhaps incorrectly
remembered--that the tooth was broken off at the gumline. As our oral
surgery professor once said, "God is good; He has already extracted the
crown for us; we need only extract the root.". Well, you get my drift...

> Based on what you said to the OP, I have a good chance that the hole
> will not result other complications.
[quoted text clipped - 8 lines]
> What do my sinus cavities have to do with a toothache and its
> remission?

Ordinarily nothing, unless the infected tooth has fistulated into the
sinus. Based on this, it might be a good idea to have an ear nose and
throat specialist check on you, esp. if your dentist feels the tooth
isn't infected. But you may have two distinct problems here, and it's
unlikely we'll figure out exactly what is going on without you getting
this checked.

Steve

> --
>
> "There is no distinctly native American criminal class save Congress."
> --Mark Twain

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Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

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Citizen Bob - 21 Sep 2006 17:10 GMT

> Ordinarily nothing, unless the infected tooth has fistulated into the
>sinus.

I did not realize that was possible. I imagined some kind of seepage
of the salt water thru the tissue to the tooth. If it is possible to
make a hole from the tooth into the sinus cavity, then that explains
what I experienced.

The bulk of the pain of the toothache is concentrated in the region
just above the tooth, in a volume that extends from the cheek just
under the eye to the temple to the eyebrow. The tooth and gum do not
hurt unless I touch them. It literally feels like someone is shoving
an ice pick up my nose into my brain.

In the past not only did the forced nasal irrigation result in
immediate cessation of the toothache, but after just a few days of two
treatments per day, the pain went away for several years. I understand
what you said about a low-grade infection still being present, but
there were never any symptoms of that.

I went to the dentist between episodes and he did not spot any
infection with his diagnostics. That seems to say the infection was
gone at that time. Since I did not know the problem was caused by a
bad tooth (I was convinced it was a chronic sinus infection), I did
not alert the dentist to the possibility. Maybe he just overlooked the
infection if there was one, or his diagnostics were not able to detect
it.

--

"There is no distinctly native American criminal class save Congress."
--Mark Twain

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Bill - 21 Sep 2006 18:25 GMT

> > You are taking a chance retaining the stump. You haven't said (and you
> >may not know) whether there is active decay.
> > You should have the roots extracted.

___________

> It would be easier to get the entire tooth extracted. Then I would at
> least be done with that part of this problem.

___________

You should contact Joel Eichen -- I hear he knows a guy in Philly who
can extract the roots only, and then leaves the rest of the tooth in
place . . . :-)
- dentaldoc

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