Dentists- please help!!

[nona1]

Visiting from the Allo forums...

So I finally convinced my SO to go to the dentist for a long neglected tooth, and long story short he has to be on antibiotics, have the tooth (#14?) extracted, get a bone graft, wait at least 3-6 months, and then get an implant.

Firstly, does this sound like the normal course of action?

Secondly, he is planning to go abroad for about a year in mid-August. Are there any repercussions to just living implantless until he returns a year later?

THANKS for any/all opinions, you guys are awesome.

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[aphistis]

Visiting from the Allo forums...

So I finally convinced my SO to go to the dentist for a long neglected tooth, and long story short he has to be on antibiotics, have the tooth (#14?) extracted, get a bone graft, wait at least 3-6 months, and then get an implant.

Firstly, does this sound like the normal course of action?

Secondly, he is planning to go abroad for about a year in mid-August. Are there any repercussions to just living implantless until he returns a year later?

THANKS for any/all opinions, you guys are awesome.

That all sounds pretty normal for a simple implant case. As for the potential consequences of waiting, the only one I can think of is that if the tooth opposing #14 doesn't touch any other teeth when he bites, it might erupt up into the empty space a little bit. Just make sure he mentions his trip to the dentist, so any treatment adjustments can be made ahead of time rather than after the fact.

 

[toofache32]

You bascially summed up the treatment options when you said, "long neglected tooth". If you wait until the end, there is nothing conservative that can be done...only extracting the tooth.

It's not clear from your information why he has to be on antibiotics, but that's another whole arguement. Otherwise it sounds like he's getting the cadillac treatment plan. An implant is generally better than a bridge because it you don't have to alter the adjacent teeth. Also, if an implant fails you can always just take it out and then a bridge is still an option (but not necessarily the other way around).

Bone grafts are sometimes necessary for implants when there's not enough bone height or width available. After the bone graft is placed you have to be committed to finishing the treatment because the bone graft will start to dissolve away after about 3-6 months depending on where the bone graft is from. The most common sites to harvest bone are from the upper or lower jaws, iliac crest (hip bone), or tibia (leg bone).

If he is going out of the country for a year, he should definately get every other tooth looked at carefully. If he has one tooth that has rotted this bad, I guarantee you there are others heading down the same pathway.

There is a problem if you wait a year to get the implant placed. The teeth next to the empty space tend to move and crowd the space. The bottom tooth will erupt into the space unless there are other top teeth holding it down. In other words, after a year or 2 there might not be any room for an implant and the adjacent teeth may start getting pretty crooked and keep him from chewing well.

 

[grmaster1]

Visiting from the Allo forums...

So I finally convinced my SO to go to the dentist for a long neglected tooth, and long story short he has to be on antibiotics, have the tooth (#14?) extracted, get a bone graft, wait at least 3-6 months, and then get an implant.

Firstly, does this sound like the normal course of action?

Secondly, he is planning to go abroad for about a year in mid-August. Are there any repercussions to just living implantless until he returns a year later?

THANKS for any/all opinions, you guys are awesome.

Not really, unless he's got lotsa spare money or a very good insurance plan...

The drugs and extraction is OK, but why not get a 3-unit bridge?

He can ask for many styles, including porcelain (tooth-colored). It's cheap, fast, and no surgical (very involved by the way) intervention...

Another option, is to go without the tooth (less chances for dentist to make mistakes)--he'll just need to grin less on the left side.

Supereruption, bottom teeth "growing" up into the hole, should not be a problem--unless he's got an abnormal occlusion.

What are you doing with a guy who has bad dental hygiene habits anyway?

 

[aphistis]

The drugs and extraction is OK, but why not get a 3-unit bridge?

He can ask for many styles, including porcelain (tooth-colored). It's cheap, fast, and no surgical (very involved by the way) intervention...

That's the best joke I've heard all day. Thanks for the chuckle.

 

[toofache32]

Why get a bridge when you can get a more conservative treatment such as an implant (other than cost)? It takes longer to get an implant, but we're only talking a few months. A few months extra is nothing in the big picture of the patient's lifespan. Also, if an implant fails you can always just take it out or sleep it, with no harm done to the adjacent teeth. If a bridge fails, then you have forever condemned the adjacent teeth for crowns.

One more thing for the original poster...there is nothing we can put in a patient's mouth that is as good as the original tooth. If his original teeth failed, then a bridge or implant will also fail unless he gets religion about hygiene.

 

[12YearOldKid]

Not really, unless he's got lotsa spare money or a very good insurance plan...

The drugs and extraction is OK, but why not get a 3-unit bridge?

He can ask for many styles, including porcelain (tooth-colored). It's cheap, fast, and no surgical (very involved by the way) intervention...

Another option, is to go without the tooth (less chances for dentist to make mistakes)--he'll just need to grin less on the left side.

Supereruption, bottom teeth "growing" up into the hole, should not be a problem--unless he's got an abnormal occlusion.

What are you doing with a guy who has bad dental hygiene habits anyway?

Huh??!!!

An implant is a far better option than a bridge. It's more conservative, longer lasting, and better for overall dental health. The only downside is that it is slightly more expensive, but over the life of the restoration, an implant is the best bang for your buck.

At my school a 3-unit bridge is an anachronism. We will always recommend the implant over a bridge unless the the two abutment teeth absolutely need to be crowned anyway. (It's the same price with school fees.)

For the original poster:

Not getting the tooth replaced can cause three major problems.
1. The opposing tooth may grow down (or up) into the empty space which means that tooth may need a crown and root canal when he does decide to get the space taken care of.
2. The bone surrounding the tooth that was extracted will start to disappear. Generally not a good thing.
3. The teeth on either side may start to shift making it hard to fill the empty space later. This might have to be corrected with braces.

The problems with a bridge rather than an implant are these:
1. The teeth on either side of the empty space have to be cut down a LOT to be able to put crowns on them that can hold the bridge. Crowns have a lifespan of about 10-15 years, but a bridge tends to be even less because they are VERY hard to clean. Implants have an average lifespan of 20-25 yrs or longer.

2. A bridge requires special care. From your desctiption, I'm guessing your SO isn't a regular flosser. Imagine if he had to actually use a special instrument to clean and thread floss uderneath the bridge everyday; it wouldn't happen would it? Implants are easy to keep clean. If even one tooth of a bridge gets decay, the whole bridge has to be removed and remade often resulting in additional trauma to the healthy tooth. Generally, a tooth with a bridge on it will end up needing a root canal at some point in the future.

3. Even with a bridge to replace the empty space, the bone where the old tooth used to be will start to disappear. This isn't healthy for the surrounding teeth and is often unsightly (although that might not matter in the back.) An implant will help preserve that bone for as long as it is there.

A bone graft and implant surgery is NOT a huge deal. It will be done right in the office and the placement visit will probably not be much longer than 45 minutes to an hour. If it were my mouth, I would go for the implant every time.

 

[nona1]

You guys are the best, seriously. THANK YOU so much for your 'second opinions'. After your words of wisdom, he has decided to get the implant. The appointment is next week for the extraction.

He's going to talk to the dentist this week, but the reason he is on antibiotics is b/c a small bump began to grow in the gum palate next to the tooth in question. Supposedly it was supposed to go away w/the antibiotics, but it's actually GROWING! Could this be some horrible tumor thing?! Can the dentist just excise it or...??

Also, I don't quite understand what you mean about other teeth growing into the extracted space. According to the dentist, the plan of action is:

1) extraction and bioplant (the graft? does this come from him??)
2) implant abutment (?)
3) implant crown

So should he just get step 1 done before he goes abroad? Or steps 1 & 2? He leaves in mid-August about and I know they told him certain steps have a wait time of at least 3-6 months?

He doesn't have any other serious problems, and yes, he does have all of his other teeth.

Seriously, thanks so much you guys. Your response was awesome.

Nona

PS The total cost for this btw is about $2000. His insurance will cover about half. Is this reasonable?

 

[toofache32]

He's going to talk to the dentist this week, but the reason he is on antibiotics is b/c a small bump began to grow in the gum palate next to the tooth in question. Supposedly it was supposed to go away w/the antibiotics, but it's actually GROWING! Could this be some horrible tumor thing?! Can the dentist just excise it or...??

The bump is a parulis. When the inside of a tooth is infected, it has nowhere to drain except out the end of the root. The end of the root is in the bone. From there the pus tends to drain through the path of least resistance which usually ends up coming through the gums near the tooth. Antibiotics may help but usually don't because the infection is in an area (the tooth) where there is no blood supply, hence the antibiotics have no way to reach it. Also, as long as the source of the infection (the tooth) is still there, it will continue to kick out pus, regardless of antibiotics. Once the bad tooth is gone, everything will heal on its own in a healthy person even without antibiotics. You can read more ranting here:

http://forums.studentdoctor.net/showthread.php?t=195639

Also, I don't quite understand what you mean about other teeth growing into the extracted space.

When teeth erupt into the mouth when you're a kid, what makes them stop erupting? The answer is "other teeth". For example, a bottom tooth erupts into the mouth and keep erupting until it hits something that stops it (such as the upper tooth). If you remove the upper tooth, the bottom tooth will begin erupting again until it hits something else (the top gums or another tooth). It doesn't matter if you're 8 or 80 years old.

 

[nona1]

Thanks for the thread referral. So does he have to get an I&D or will the parulis disappear after the extraction? And if yes to the I&D, does the dentist do it? Seems in the thread some people think antibiotics are okay, and some think the tooth should be extracted asap. From what you're saying, it sounds like he's been needlessly taking these drugs, esp since he experiences the nausea/diarrhea side effects...

The bump is a parulis. When the inside of a tooth is infected, it has nowhere to drain except out the end of the root. The end of the root is in the bone. From there the pus tends to drain through the path of least resistance which usually ends up coming through the gums near the tooth. Antibiotics may help but usually don't because the infection is in an area (the tooth) where there is no blood supply, hence the antibiotics have no way to reach it. Also, as long as the source of the infection (the tooth) is still there, it will continue to kick out pus, regardless of antibiotics. Once the bad tooth is gone, everything will heal on its own in a healthy person even without antibiotics. You can read more ranting here:

http://forums.studentdoctor.net/showthread.php?t=195639

 

[nona1]

When teeth erupt into the mouth when you're a kid, what makes them stop erupting? The answer is "other teeth". For example, a bottom tooth erupts into the mouth and keep erupting until it hits something that stops it (such as the upper tooth). If you remove the upper tooth, the bottom tooth will begin erupting again until it hits something else (the top gums or another tooth). It doesn't matter if you're 8 or 80 years old.

That is fascinating. I had no idea your teeth would just keep on growing, jungle style. So how long before he would turn into Snaggle Tooth? Is there something to be put in there temporarily to avoid movement and crazy growth? [These questions are for anyone and everyone btw]

 

[toofache32]

Thanks for the thread referral. So does he have to get an I&D or will the parulis disappear after the extraction? And if yes to the I&D, does the dentist do it? Seems in the thread some people think antibiotics are okay, and some think the tooth should be extracted asap. From what you're saying, it sounds like he's been needlessly taking these drugs, esp since he experiences the nausea/diarrhea side effects...

An I&D is not necessary unless there is a distinct pocket of pus. The antibiotics may keep the infection from progressing, even though they definately won't fix anything. I'm not criticizing the dentist for giving antibiotics...if I was going to leave an infected tooth in someone's mouth, I would probably give antibiotics also.

A vestibular I&D can be done by any general dentist, although some would rather not. The procedure is simply incising into the pus collection and irrigating out the pus.