Hi cricketticket,
This xray, prior to the recent filling, shows the area of decay clearer than the other one, but you still need a periapical xray. The periapical will show the tooth in it's entirety. Meaning the entire root system and the bone beyond the tooth are necessary to see for 2 reasons. One, to see if there is an infection at the root of the tooth. Two, to have a full view of the anatomy of the entire tooth if you are considering rct or an extraction. It is not wise to guess what the root structure is or not know if there is infection beyond the tooth. Both dentists should have taken periapical xrays.
The size of this cavity appears quite large which means it has been brewing for a long time. The longer a cavity is brewing, the more chance of the bacteria spreading beyond the tooth. So I would suggest to get the periapical xray done.
If you choose to retain this tooth, you would need to have a root canal because the decay is very close if not already into the pulpal chamber. If it has not reached the pulp, the drilling to remove the decay will definitely inflame and cut into the pulpal chamber because it's that close. Once the pulp is involved the only 2 treatment choices are to root canal or extractiion.
If you do the root canal, it will also need a full coverage crown. If you decide to extract it, you may be a candidate for an immediate implant. Both treatment options are similar in cost.
It's important that you know a root canal does not render the tooth healthy again. The procedure is a temporary measure to "retain" an unhealthy tooth for an uncertain amount of time. The tooth will continue to be infected and inflamed because there is no access or means of getting into the hundreds of microscopic canals which will harbor the infected, toxic nerve tissue. Eventually the tooth becomes overwhelmed with bacteria and looks for a way to drain. This can lead to bone infection, bone loss and neurological pain.
To extract the tooth means to get rid of the cause of the infection, which is the tooth. If the bone is healthy, you may be a good candidate for a dental implant.
I would suggest that if you decide to do the extraction and implant, consult with an oral surgeon. Unless your general dentist has extensive education and experience in tooth extractions, most of them don't, it is best to have it done by an oral surgeon.
Your general dentist would be the one to place the crown portion over the top of the dental implant about 6 months after the implant surgery.
Regarding tooth #13 ... a periapical xray is also necessary and for the same reasons as I mentioned above for #18. Yes, #13 should be re evaluated for distal decay or burnout.
I am going to post a diagram of the anatomy of a tooth to show you all the hundreds of microscopic canals to give you an idea of just how loaded the tooth will be with bacteria after the root canal was done. These canals are shown in tan and marked dentin tubules.
I hope this information is helpful to you.
Bryanna
Quote:
Originally Posted by cricketticket
Hi Bryanna,
I appreciate your response. I do not have a Periapical xray of that tooth. I do have the Bitewing x ray from Oct. and have attached it to this thread.
I was really surprised in Oct. when the dentist told me I only needed a patch and not a crown. Dentist #2 has indicated that the decay is clear on the Oct. xray and cannot explain why dentist #1 patched it. I was also told that between Oct. to Jan. the decay has significantly increased.
What would your be recommendation at this point? Should I request a Periapical xray to assess the situation further? Do I request the dentist to open it up to see if the tooth is salvageable without RCT or extraction? My fear about this is even if I could get by now with just a crown sometime in the near future I could have problems due to very little tooth structure protecting the nerve.
For tooth #13 dentist#1 indicated that it is ok for now but that it should be closely watched. I did not have dentist #2 assess this tooth. Perhaps I will ask for his opinion next time I visit the office.
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