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Old 01-03-2015, 11:41 AM #1
jimkh jimkh is offline
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Default Extraction of maxillary cuspid

I have been to the dentist for a second xray and this one showed a dark hazy round shadow around the apex of the tooth. (upper canine)

My options are to extract or do root canal treatment. I have read that root canal involves the use of bleach and this is necessary to disinfect the canal. This is a major deterrent for me and has forced me to consider extraction as the only option. But this has bad consequences too.

Is the extraction of this tooth easily done even though it is the longest tooth in the mouth?

If I leave the space, will my teeth shift and cause biting problems?

is there no alternative to the strong bleach they use during root canal?
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Old 01-03-2015, 09:21 PM #2
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Hi Jim,

Is this the same tooth we spoke about previously?

Root canal therapy always includes using a harsh and toxic disinfectant. They are called intracanal medicament's. The idea is to kill the nerves and bacteria that come in contact with the chemical. If it's not bleach then it's formocresol or copious amounts of hydrogen peroxide. All of which are very toxic when used in this way, especially if the irrigation is pushed through the apex and goes beyond the root of the tooth into the bone. I know that sounds awful but you like to be well informed and if I don't tell you and something happens, you will be even more upset.

Removing an upper canine can be a bit complicated because the canines are located in the oval area of the arch and are considered the cornerstone of the arch. They kind of hold the arch in an oval or round shape. Leaving that space empty will cause teeth to shift. So it should be replaced with either a 3 unit bridge, an implant or a partial denture.

If you opt to have it extracted, please see an oral surgeon not a general dentist for that procedure.

Bryanna





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Originally Posted by jimkh View Post
I have been to the dentist for a second xray and this one showed a dark hazy round shadow around the apex of the tooth. (upper canine)

My options are to extract or do root canal treatment. I have read that root canal involves the use of bleach and this is necessary to disinfect the canal. This is a major deterrent for me and has forced me to consider extraction as the only option. But this has bad consequences too.

Is the extraction of this tooth easily done even though it is the longest tooth in the mouth?

If I leave the space, will my teeth shift and cause biting problems?

is there no alternative to the strong bleach they use during root canal?
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 01-04-2015, 09:35 AM #3
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yes this is the same tooth which i spoke about previously. But you can see this is a terrible dilemma for me.

I dont want to replace the gap if i extract it because that will involve a fair amount work and will likely be more expensive that the root canal. However as you mention the root canal uses harsh chemicals which is unacceptable to me.

How much of a shift will occur if the gap is left? my teeth are already not perfectly straight so would it matter much?

can the amount of shift be accurately guessed or is it impossible to say?
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Old 01-04-2015, 09:38 AM #4
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There is one other question though. There is no question now that the tooth is dead but the mystery is that there were no holes in the tooth and non trauma to it that i can remember. So how did it get infected and die in the first place?

My dentist says it could be due to tooth grinding.

Also can the canine tooth be removed normally or not? is it a surgical procedure or a normal extraction?
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Old 01-04-2015, 11:39 AM #5
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Jim,

Okay, I thought so.

Yes, you are in a difficult predicament as there is no easy fix to this problem. I cannot tell you how much or how little your teeth will shift if you do not put something in the place of the canine. This canine is one side of the cornerstone of the upper arch which means when it is not present, the curvature of the arch changes. This causes an unnatural movement with the other teeth. What can happen is the upper teeth will move which will throw off the alignment of the bite to the bottom teeth. This movement could result in damage and eventual loss of other teeth as the bite will not be coming together properly.

The main reason for replacing this tooth is to put something in its place to hold the curvature of the arch. You may be a candidate for what is called a Nesbit. This is a small, one tooth, removable appliance. It is designed to hold the space open, as if the tooth were still there, to prevent shifting of the teeth. But it has to be worn every day or teeth will move and the appliance will not fit. A Nesbit is also worn for esthetic reasons so you do not have a space when you talk or smile. However, this appliance is not meant to leave in when you eat or sleep as it is small and can become dislodged when chewing or sleeping which could be choking hazard. Not all dentists are comfortable suggesting Nesbits because of the choking hazard. But many people have and many people do really well with them. One of our members here, Ginny has a 2 tooth Nesbit and she has remarked many times how happy she is with it.

Regarding the root canal... yes, the medicaments used during the procedure are toxic, but so is a non vital tooth. All teeth require vitality to be healthy. There is nothing healthy about a dead tooth. I know you are a thinker and you delve into all of the details, so that is why I am reaffirming these facts with you as I would assume they would be important to you.

Here is what a nesbit looks like.... http://www.onnikdentallab.com/valplast-nesbit/

Bryanna




QUOTE=jimkh;1116235]yes this is the same tooth which i spoke about previously. But you can see this is a terrible dilemma for me.

I dont want to replace the gap if i extract it because that will involve a fair amount work and will likely be more expensive that the root canal. However as you mention the root canal uses harsh chemicals which is unacceptable to me.

How much of a shift will occur if the gap is left? my teeth are already not perfectly straight so would it matter much?

can the amount of shift be accurately guessed or is it impossible to say?[/QUOTE]
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***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***

Last edited by Bryanna; 01-04-2015 at 12:01 PM.
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Old 01-04-2015, 11:51 AM #6
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Jim,

Correct, the tooth is infected.

Teeth become infected for a number of reasons. Here are some them:

1) Decay which can occur on the exterior or interior of the tooth.

2) Recession along the gum line exposing the sensitive root area to hot and cold temperatures over a period of time can cause enough trauma to the tooth to render it infected.

3) Recurrent decay underneath a previous filling.

4) Grinding or clenching your teeth on a habitual basis. The force put on the teeth during bruxism causes trauma to the live, nutrient rich periodontal ligament that cradles and attaches the tooth to the bone. From the chronic trauma, the ligament becomes inflamed, bacteria moves in and infection develops.

5) A misaligned bite can cause repetitive trauma to those teeth that are being over worked while chewing. This can cause the nerves to die inside of those overworked teeth and infection moves in.

6) Unresolved gum disease can allow enough bacteria to get in underneath the gum line eventually infecting the tooth.

7) If an adjacent tooth is non vital, has a root canal or has a periodontal problem, the bacteria from that tooth will travel to the surrounding teeth which can result in infection of the other teeth.

All tooth extractions are surgical. Some require an incision while others don't. Some require the tooth to be sectioned in pieces while others don't. But all extractions are a surgical procedure. Removing the canine is a bit tricky because the surgeon has to take great care during the removal so as to not disturb too much of the surrounding bone. The idea is to remove the tooth and all diseased tissue while leaving as much bone intact as possible. That is why I recommend an oral surgeon do the extraction.

Bryanna


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Originally Posted by jimkh View Post
There is one other question though. There is no question now that the tooth is dead but the mystery is that there were no holes in the tooth and non trauma to it that i can remember. So how did it get infected and die in the first place?

My dentist says it could be due to tooth grinding.

Also can the canine tooth be removed normally or not? is it a surgical procedure or a normal extraction?
__________________
Bryanna

***I have been in the dental profession for 4 decades. I am an educator and Certified Dental Assistant extensively experienced in chair side assisting and dental radiography. The information that I provide here is my opinion based on my education and professional experience. It is not meant to be taken as medical advice.***
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Old 01-04-2015, 06:27 PM #7
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you say that you cannot tell me how much or little the teeth will move. (I expect there will be be some movement.) But then you go onto talk about the worse case scenario of further tooth loss which may or may not happen. Even if it does, we all lose our teeth in the end. Often with age, other illnesses affect us and eventually we all die. The loss of a tooth is horrible but if you look at the whole picture it is actually not the end of the world.

And what about the positive side which you didnt mention? Perhaps tooth movement is a good thing? People pay a heck of a lot of money to move their teeth into alignment. If my teeth move into the right position, it would be an advantage which i get for free.
As I mentioned, my teeth are already not exactly straight. They are crowded and the tooth next to the dead tooth is already under the adjacent tooth. Chances are this tooth will move towards the gap (should i get the extraction) rather than away from it. This would be a good thing would it not...
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Old 01-04-2015, 06:30 PM #8
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i thought you held the belief that the bone also has to be scraped clean after the extraction? and now you say the bone shouldnt be disturbed. Biological dentists recommend scraping the bone but it is not something usually done.
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Old 01-04-2015, 06:34 PM #9
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how much is a partial single tooth denture anyway?
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Old 01-04-2015, 09:30 PM #10
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Jim,

I have been in dentistry as a dental technician since 1979 and have seen no more than 1 handful of root canals be problematic...some involved trauma such as accidents.

I had one done on #30 in 1982 and it is still there with never any complications.

Bud
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