I have tooth 3, 4 and 5 covered by one long one piece crown. It's been there for about 30 years. It looks like 3 teeth but it's one piece. If one tooth has to be extracted, how do they do this? Do they remove the whole piece, drill it off? Then what would I have to do? Replace both crowns with new ones? Or do they file it and smooth it some kind of way? I am asking because #5 aches when I put my tongue on the outside of the tooth, moreso in the middle of the night than any other time. It will be OK for weeks, then it will happen again. Doesn't seem like an abscess and nothing shows on x-ray, may be sinuses but I am at the point where I just want it out. I am nervous about the long crown thing, how they do it. Any feedback would be great.

Hi sandy,

It sounds like you have a 3 unit bridge. That means that there are 3 crowns fused together and permanently cemented onto one or more of those teeth. I assume tooth #5 is present because you said it sometimes hurts. Are teeth # 3 and 4 also present or has one of them been extracted in the past?

Bryanna

3 and 4 are old silver point root canals and 5 is not root canaled. I just went to my dentist for a consultation and he wants me to see the oral surgeon. he said if we remove the bridge, the teeth may be shot by now and not worth redoing the crowns. He also said that they wouldn't just redo the crowns, they'd redo the root canals (if possible).

I don't want them redone with gutta percha. They are old silver points now and my inclination is to just get rid of these teeth, at least 3 and 4 anyway. he told me to not be so quick to opt for extraction but I am so tired of this. I put my tongue on the outside of all 3 and it hurts. Then it goes away for a few weeks and comes back, mostly in the middle of the night or when I wake up. It may still be my sinuses and not the teeth at all but nobody knows for sure.

He also said that even if these were extracted, my pain might persist, if it's caused by something else (sinus, neurological). I am really upset today because this morning I had a consultation with a new dentist for a second opinion and he told me what I have is being his scope and I need to see a good prosthodontist. he made me feel like every corner of my mouth is a mess. I then went to my own dentist who knows my mouth and x-rays for years and sees no change. I have my x-rays and the shadows are exactly the same as years ago. I just don't know where to turn anymore but there is no way I want redos or apicos.

Hi Sandy,

Oh boy.... I definitely hear your concern and disappointment. I knew if you saw a new dentist that you would be given a very different diagnosis than what you have been given by your former dentist.

I'm sorry that you have ended up with so many dental problems. Your new dentist was correct in telling you the truth about the condition of your teeth and although it's not what you wanted to hear.... it's pretty much what your intuition has been telling you for awhile.

Your original dentist may be a nice guy and someone you have trusted for a long time...... and you are right he certainly does know your teeth but he has been neglectful in that he has just continued to watch things deteriorate. He is not telling you the truth to say that things have not gotten worse over the years..... you can tell just by touching your teeth that things have worsened. I'm not saying he has done anything in a malicious manner... he's probably done what he thinks you would want him to do rather than offer you options that may have been more aggressive or expensive. I'm just telling you what typically happens with so many people.

With regard to that 3 unit bridge.... the only time 3 or more teeth are bridged together (with no missing teeth being replaced) is because there has been a severe deterioration in the bone level holding the teeth in the jaw. The deterioration is from periodontal disease and/or root canal treatment. Right from the get go... this is not a stable or healthy dental situation. Most of the time, these teeth should have been removed and not root canaled or splinted together in the first place. The only purpose in doing this type of thing is to "hang on" to teeth that are in guarded condition. So you can imagine how things have progressed in all of the years that the bridge has been on there. One reason that the area has not swelled up and that the pain comes and goes is because there has to be an opening someplace around the margins of the bridge and/or an opening into the sinuses that periodically allows the bacteria to escape acting like a pressure release. Your dentist, all of them, knows this is what is going on. However, some dentists do not treat this until the pressure release is sealed off and the area becomes swollen. Does that mean it's ok to leave it this way.... no.

About silver points in root canaled teeth..... silver points corrode which causes additional bacteria to develop. The reason gutta percha started to be used was because it is a rubberized material that can soak up a chemical (like formaldehye) and then be melted into the large canals. Supposedly this material filled the large canals better than the silver points. No material can fill all of the canals because there are too many that are not able to be seen.

Extracting those teeth will remove the original culprit of the problem. However, because the condition of the teeth and the bone has not been healthy for a long time, there may be more to it than just removing these teeth. An oral surgeon would be the one to see next.

I know this is very worrisome..... I counsel people with your exact problem every day. I can only provide you with the facts and encourage you to think in terms of your health first, teeth second.

Sandy, I feel terrible for you and others in the same predicament. I'm so sorry.

Bryanna

He did tell me to see the oral surgeon so I will call tomorrow. I am wondering what you mean by "more to it than just removing these teeth". Maybe I don't want to know :-( I just want an end to my intermittent pain and hope that the extraction solves the problem. Thanks so much for your help and soothing words as always.

Bryanna, I forgot to ask you this. In your practice, what does the oral surgeon do when someone has the long crown I describe? If 3 and 4 are extracted and I keep 5 for some reason, how do they cover it up after they do the extraction. Do they put a temporary crown on it? Also, is it harder to remove a root canaled tooth than one that isn't? I am so scared of them drilling off this piece and the whole thing...I always dreaded something going wrong and the prospect is making me so anxious. I don't think I want to be awake for this. Can the oral surgeon refuse to do this extraction? I am scared of nobody helping me.