Hi Kriss,

I'm a dental assistant for over 30 yrs and I will offer you information to hopefully help you to discuss your treatment options with your dentist. You may be a bit alarmed at some of the things that I am going to share with you, but my intention is to help you become better informed so you can make decisions that you feel are in your best interest.

It is common knowledge amongst the dental profession that all teeth that have been root canaled are in a compromised state right from the beginning. This is due to the actual root canal procedure itself which removes the nerves within the tooth leaving the tooth vulnerable to infection due to the lack of nutrients or vitality. Like any organ in the body, teeth included, vitality is necessary for it to be healthy because without it, infection and "proliferation" of bacteria are inevitable. Loss of vitality also creates a continual breakdown of the structure of the tooth as well as the surrounding bone making the tooth vulnerable to fracture and the bone susceptible to necrosis.

Just so you are aware.... it is common to see the post that was put into a root canaled tooth actually perforate through the tooth into the jaw bone and/or cause a fracture in the tooth because of the continual deterioration of the tooth. Sometimes the perforation occurs while putting the post in... other times the post wears a hole through the side or end of the tooth.

With regard to symptoms of something going on........ Our immune system works very hard to deal with this chronic condition and in doing so we usually don't notice visible or obvious symptoms until the problem has progressed beyond the tooth. In any case involving root canaled teeth, the most effective way to treat the ongoing problem is to remove the source of the problem which is the tooth. Any other expensive and painful efforts to "retain" the deteriorating tooth will only further compromise the health of the surrounding bone, gum and other teeth. Another big issue in "retaining" a non vital tooth is the growing concern that the bacteria will cause a systemic infection elsewhere in the body and once again, symptoms of that may not appear at the onset.

Dental implants are a wise option for the replacement of some teeth. However, you should be informed that implants have a sketchy prognosis or lower success rate when they are replacing root canaled teeth and/or are placed in the bone next to an existing root canaled tooth. This all stems back to what I explained above about the chronic deterioration of the root canaled tooth and how the bacteria from the tooth proliferates into the bone causing it too to become unhealthy. Depending on the individual case, caution is also used when placing bone grafts in areas that had root canaled teeth for the same reasons.

This is one of those situations that unfortunately has a tragic history and will continually need to be readdressed so long as the teeth are present. The other option would be to remove the 4 root canaled teeth and replace them with a permanent bridge. Depending on the health of the teeth adjacent to the root canaled ones, the bridge would expand as far as one or two teeth over on both sides.... meaning a 6-8 unit bridge to include 1-2 anchor teeth on both sides. The other option would be a removable partial denture to replace the 4 root canaled teeth and any other teeth that you might be missing in the arch.

I'm sorry to be the one to tell you all of this..... but perhaps you can consult with your new dentist again and express your long term goals with him and then go over the different options. Anything you do is going to be expensive. However, keep in mind that it will be most expensive if you have to keep readdressing the same issues.

Please let us know if you have any other questions...... or thoughts about this.

Bryanna