Hi Bryanna: thanks for sharing your experience and knowledge. You've been a huge help the last few years...

My mother, who is 83, recently bit into pie crust and the tooth next to her right front tooth broke off at the gum line. She visits her dentist yearly, and is in good health. We went to the dentist, who said that because my mom's upper four teeth were capped years ago, the best option is to have an endodontist do a root canal on that tooth -- then begin the implant procedure. I know why root canals are a huge NO, but the dentist (who disagrees about rc's - so what else is new) said the other alternative -- a bridge -- isn't feasible, because the surrounding capped teeth won't hold a bridge. I asked why the remaining tooth/root can't be pulled and she said to just trust her.

Bryanna, could you explain 1) why the rest of the tooth can't just be pulled, all healed, then implant done? I know i'm not understanding a step... 2) do you know any other alternative to an implant?

While a front tooth is affected and there's a very visible gap at the moment,
this seems like a lot of dental work and a lot of dollars. Most imp, I'm not comfortable with the root canal step. Thanks for any light you can shed. - Emily

Hi Emily,

Thank you for the kind words.

Could you please clarify this statement for me?

<<We went to the dentist, who said that because my mom's upper four teeth were capped years ago, the best option is to have an endodontist do a root canal on that tooth -- then begin the implant procedure. >>

Why root canal the tooth, then extract it and then do the implant? If I am understanding that correctly, that makes absolutely no sense. So I would definitely not go that route.

It sounds to me like your mom's other top front teeth and the surrounding bone may be compromised, meaning not real healthy since they won't hold a bridge. She does not have to have symptoms with her teeth for there to be a problem. If the bone is not real good in the area of the broken tooth, meaning it's not healthy and/or she has bone loss, then it won't hold an implant. So if that is the case, then her replacement options for this tooth may be very limited.

The one thing that concerns me is doing the implant on a woman of her age. Does she have any chronic health conditions... related to her heart, high blood pressure, artery problems, kidneys, lungs or have diabetes or history of heart attack or stroke... any heart surgeries?? Does she take medications... blood thinners or other?

Without xrays I can only assume what her dental status is based on your description. If you could post xrays here that might be helpful. Her least invasive option would be to remove the root tip and have a partial denture made. This may not be the ideal replacement option and she may not be able to leave it in when she eats as it would be mainly used for esthetic reasons and to prevent the adjacent teeth from shifting towards the open space. The advantage to the partial is that as she looses her other upper front teeth, which is possible given the age of those crowns and any one of them could break off like this one did, she could have teeth added to the partial as they were removed.

Your thoughts on this??
Bryanna

Thanks! So implants require removal of entire tooth -- that's what bothered me. I wasn't getting the need for a root canal at all. We'll ask that dentist what she's thinking. She did say implant post might be able to be inserted soon after root canal. ?!?! I should have been much more alert that day.

My mom's caps/crowns (don't know age) were mostly for aesthetic reasons as my mom did a lot of public speaking, much on camera, until a few yrs ago. Much of her social life is going to luncheons, but this is just 1 tooth. Thx for mentioning possible fate of other teeth; we have to consider that.

No chronic health conditions, no heart attacks, just a knee replacement 19+ yrs ago. No prescription meds, only OTC calcium, vit D3. Yet any surgery at my mother's age worries me. I watched my father, grandoarents and father-in-law all greatly decline btw ages 83 to 86, most after one or two minor surgeries. Will try to get xrays too.

Thx!!

Emily,

I have a feeling that your dentist was talking about putting a post in the root of the tooth after the root canal was done. A post is not a dental implant.

A dental implant replaces an extracted tooth. A post is put in a tooth that has little tooth structure left. But a root canal has to be done before the post can be put in because the root canal deadens the tooth.

Root canals are never a healthy option as the tooth will then be chronically infected because the nerve tissue inside of the tiny canals cannot be cleaned out and that nerve tissue becomes necrotic and infected. I do not advocate root canal therapy because of the chronic infection and risk of systemic infection.

With that said, what is concerning me also is the health of her other upper teeth. Generally when a crowned tooth breaks off at the gum line it is due to decay that developed underneath the crown. Because the dentist said her other teeth were not healthy enough to hold a bridge, it makes me wonder if the xrays showed similar issues on her other front teeth. Did the dentist elaborate on that statement?

Yes, the xrays may be helpful if you could post them.

Bryanna

Hi Bryanna - i think you're right about the dentist referring to using a post. I did hear the words post and implant, but what you wrote above must be what she meant. We can't reach her until her office reopens tues or wed.

I agree 100 percent about root canals. My mother said she just wants a tooth at this point and does not want a denture -- but agrees she must consider the health of her other front teeth. I'm trying to convince her why a root canal is asking for trouble...

Question: Isn't bone loss a given when people reach their 80s? I would think the less invasive the procedure, the better.

Thanks!

Hi Emily,

Yes, most people in their 80's have bone loss in general. But depending on the health of their teeth, gums and health in general, they do not necessarily have to have extensive bone loss just because they are old

I am concerned that her other upper teeth may not be so healthy which would mean that she could develop one tooth problem after another. So in my opinion, she really needs to have a thorough look at the health of all of her teeth, which includes a full mouth series of xrays (18-20 of them) so that a decision can be made that will prevent her from having those problems.

If her dentist is hesitant or not upfront with answering questions or wanting to explore the whole picture, or just wants you guys to take her word for it... please seek another dentist.

Bryanna