I had a

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I had a tooth (2nd going back after lower right canine) root treated and crowned several years ago. This has now apparently failed according to two dentists and the area on the outside of the tooth is now infected.

The 1st dentist offered a choice of extraction, £600 specialist re-root treatment or a “recommended” procedure involving drilling through the bone to clean out the infection. This latter option I was told carried a very small risk of nerve damage though. I was asked to make the decision on the spot but decided I would like to try a further course of antibiotics-to buy some time as much as in hope.

I then saw a different dentist who said the only option was extraction as it was too infected. This would then be followed by a bridge. No mention was made of a specialist to re-treat it and I was told that no good dentist would recommend the previously recommended procedure as it was too dangerous due to the proximity of the nerve.

My symptoms include pus draining from the side of the tooth when the slight swellings are pressed (which relieves the pain). The swellings seem to appear when I eat but sometimes go down a short time later. I have unfortunately loosened the crown myself as I discovered accidentally that moving it seemed to help.

I do not want to lose the tooth if I can help it but cost is obviously a factor so my question is really about my options. I also don’t really like the idea of further bridge work on two unrelated teeth if not necessary-especially if there is a possibility this might then fail also and leave me with three missing teeth.

Also why there is such dramatic differences of opinion – I thought dental treatment was about facts mainly? I am quite concerned that it might be impossible to get an objective opinion.

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Asked on 23/08/2010 12:00 am
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Private answer

I would concur with what others have said
The two dentists you have already consulted appear to be at opposite end of the decision making process. One is suggesting trying to save the tooth by whatever means are possible and the other is suggesting cutting your losses and looking at ways to replace the tooth. Both are right but you will need to weigh up the pros and cons. It looks like this tooth is going to be difficult (and expensive) to save with not guarantees that the treatment will be successful long term.
The implant replacement will always give the best long term success but take advice before the tooth is removed as the proximity of the nerve may also complicate implant placement in the same way that it would the surgical treatment options already discussed to save the tooth. A CT scan of the area would give a high definition 3D image of the situation and allow better planning but this would increase the cost of treatment. However I would avoid anyone who proposed placing an implant in this area without one

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 07/09/2010 12:00 am
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Hi Jim
Peter Workman's answer is a very good summary of your options but to help you resolve your dilemma you could ask for a referral to a specialist endodontist who could advise if the tooth was suitable for retreatment.
Regards, Michael Lowdell

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 06/09/2010 12:00 am
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Dr Workman and Dr Lowdell have answered you question comprehensively.

There are as you can see ,several ways to treat the situation. The decision will be made bearing in mind the possibility of success or otherwise of each of the options. If you are not sure then the referral to the endodontist for an initial consultation may help you make up your mind.
If you decide to have the tooth removed and wish to have an implant (artificial root an crown) it is best to ask the person placing the implant to remove the tooth.

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 06/09/2010 12:00 am
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Leaving a space in a dental arch should always be monitored.Without a tooth,there is no support for the surrounding bone and teeth left behind. Teeth do tend to try to infill and move if un-opposed, this subjects them to imbalanced and destructive forces.This has the potential to accelerate tooth loss in even young dentition.

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 06/09/2010 12:00 am
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You have put a lot of intelligent thought into your predicament and are in a dilemma as to two differing opinions. Both have merit-retreatment can be attempted,surgery has significant risks in this area which you need to be very aware of but the fact you can move /remove the crown is pointing to a relatively poor investment potential for this tooth as a long term bet.The dentist who did not offer retreatment as an option may have decided this already so it was not offered.If the tooth is extracted, you have options for the space-nothing,denture,bridge and finally not mentioned by either-an implant.The latter does not involve other teeth so removes your concern re involving them in a bridge.Decide soon to allow the area to recover.

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Posted by Dental Professional (Questions: 0, Answers: 1475)
Answered on 04/09/2010 12:00 am