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.

Hi Sandy,

My statement .... there may be more to it than just the extraction.... meant there could be some sinus involvement and/or quite a bit of bone loss in that area. Whatever is there, the oral surgeon will take care of when he removes the teeth. This does not necessarily mean that you will have more pain or any complications post operatively. The most important health issue right now is getting those teeth removed.

I think you should reconsider removing #5 also and here's why. Teeth #3 and 4 have been chronically ill for a long time (that is indicated by the long term pathology on the radiographs that your dentist said hadn't changed) and the bacteria from them has spread. Also, a multi unit bridge is difficult to clean properly especially when there is bone loss, so all of the teeth associated with this old bridge are going to share similar problems.

If your goal is to get rid of the problems, then think twice about leaving anything in there that is now in guarded condition.

In other cases where there is a well fitting, fairly new mutli unit bridge.... sometimes the bridge can be separated with a drill in between the tooth that is coming out and the tooth that is remaining. The remaining tooth would still have the crown on it. However, I really doubt that your situation is in this category.

Root canaled teeth can be very brittle, but depending on how much bone loss there is, they may come out fairly easily. If you are very anxious about this surgery, then by all means ask the surgeon what your options you have for either having oral (valium) or IV sedation. The oral surgeon is not going to refuse to do the extraction.... he will help you.

Bryanna

This surgeon took a tooth out 20 years ago and also #11 last year for which I was had IV sedation so yup, they do that with no problem. One last question..if I do keeo 5 and he cuts it off, the side will still be exposed to air. I know I would need a new crown but how do they seal the side close to tooth 4, that's now been cut into with the drill? My own dentist will be on vacation for 2 weeks so does the oral surgeon make sure that the patient's tooth is sealed before they leave? I can't imagine them leaving it open to air.

I'll see what he says about 5. As you know, it's more visible and if I can keep it without health repercussions, I'd like to.

I hate to bog you down with another question but rather than make a new post...tooth 31 stands alone now. 30 and 29 are gone for years. 31 is very sensitive to cold lately and I don't want a root canal. Especially after getting the top teeth out, why would I even need 31...it would not contribute to the functionality of my mouth, chewing. So here is my question. Unfortunately (see why I am upset, argh), tooth 32 is horizontally impacted. On some x-rays, it looks like it is touching 31. I asked my dentist is removing 31 could stir up trouble on 32. I should have had my wisdoms out when I was young and I know the problems that can occur now at my age (62). Would it be better to just leave 31 and deal with the sensitivity forever? I can't see doing that! I am so scared of this. parasthesia, dry socket. Bryanna, I can't sleep over this. I feel like getting this all done the same day but maybe too much at one time. Anyway, have you seen a scenario like this on 31 and 32 where they can remove 31 and leave 32 undisturbed? Or does taking 31 out give the surgeon easier access to 32 and may as well get it out? Gosh, this is a lot of questions, I'm sorry, I just am so nervous. Thanks a million.

Hi Sandy,

Firstly, I am only too happy to help you! Ask me anything you want

Your question about leaving #5 which is part of the 3 unit bridge....
Most conventional bridges are made by soldering individual crowns together to form one long bridge. Which means each tooth has a separate crown on it that covers each tooth in it's entirety. So generally it is not a problem to drill in between 2 of the crowns, separating them. If this is how your bridge was made, then tooth #5 will have a complete crown on it with no exposed sides.

However, older bridgework was sometimes done a little differently, especially if there was moderate periodontal disease. Instead of each tooth having a separate crown on it, the bridge may have been fabricated as one piece but made to looks like it has 3 separate crowns. The dentist or surgeon can tell you which type of bridge you have.

Another issue with your particular bridge is.... the three teeth were originally bridged (splinted) together because none of those teeth were stable enough to be on their own. So any one of them standing alone without support from another tooth/teeth is not going to work. The integrity of each of those teeth has been compromised for a very long time by periodontal disease, bone loss and infection. So holding on to any one of them will be short lived which means an additional surgery to remove it. This is something to discuss with the oral surgeon and be mindful of what the long term outcome will be of your current dental care. I think the last thing you want is to be readdressing any of this anytime in the near future.

With regard to tooth #31 and the impacted wisdom tooth #32....
You are correct in that once the upper right teeth are removed, #31 will have nothing to chew against therefore you won't be using it. Even if #31 were healthy, once the above teeth are gone, nature will cause this tooth to super erupt. This means that it will slowly remove itself from the bone because it has nothing to hold it down. The problem with this condition is that deep pockets between the tooth and the gum will develop and trap bacteria as it erupts. This will also cause bacteria to migrate to that wisdom tooth. The only way to hold it down is to wear an upper partial denture.

Yes, I have seen hundreds+ cases very similar if not identical to yours. Most of them resulted in a fine outcome! Others had some complications but eventually worked out ok. I think you should discuss removing #31 with the oral surgeon and ask him what would be involved in removing #32 as well. It may or may not be a total bony impaction and yes it may be more accessible while removing #31. The least amount of times you have to have surgery the better so it may be wise to remove the both of them. It probably would be a good idea to do the upper arch first and then a second surgery to do the bottom.

Sandy, I have had patients 10+ years older than you dealing with these same issues. You are still young enough yet to have a healthy smile. Perhaps once the ill teeth are removed, you can repair any others that have problems and then have partial dentures made to replace the missing teeth to give you a more stable bite. A prosthodontist may be someone to consult also as they are a dentist who has extensive experience in making comfortable partial dentures.

I know this is all alot to think about.... but you know you have to do something sooner than later.... keep moving forward and trust your intuition... because it is guiding you in the right direction.

I peek in here often... so please never hesitate to ask me anything. ok?

Bryanna

Hi Bryanna, what an informative reply. Thank you! I went today for the consultation and am going to have this done next week. I didn't ask about #5 being ok to keep or not but will when I go. I imagine he would have told me if it weren't. I have to say that even though he is more expensive than others, just about every dentist refers to him and I trust him a lot. He did say he will remove 31 and gave me an explanation about why he doesn't feel 32 needs to come out. But here's the bad part. I showed him an x-ray of tooth 17. A year ago he saw a Panorex and said I could live with it...took a wait and see approach but now he said there is root resorption (not of the adjoing tooth, just the wisdom itself). I see it on the x-ray, it looks jagged at the end and is horizontally impacted. He would not do this all at the same time but at some point he feels it's prudent to remove it. I was feeling so ok with next week's appointment but this is really bugging me out. He said the stuff I knew about parasthesia but he also said it could be pretty painful and swollen for a week. I didn't want to hear this now but he is just being honest. Have you seen cases where people are my age and do well with this? I know it depends on his skill (which he has) and the position of my nerves, etc. but I am just so terrified of being in excruciating pain. Can you give me any encouraging words about this (nothing scary?) Thanks.