Extracting a tooth that's part of a bridge
 

I have a bridge over teeth #18, 19, 20. I've been told that tooth #18 (rear anchor tooth) is decaying and has to be removed. The gum surrounding the tooth is a bit sensitive and I experience mild discomfort at times.

My questions are as follows:

Can #18 (rear of the mouth, left side) be extracted without removing the entire bridge?

Can the bridge be cut while still in the mouth?

Can the bridge be cut in a way to preserve the crown over #20 (front anchor tooth) or would I need a new crown here? Does #19 have to be cut away leaving me with a 2 tooth gap?

Implants are expensive and not covered at all by my insurance. Can I get along with a 2 tooth gap in the back of my mouth?

Confused

Thanks

Hi poilj,

Ideally a bridge needs anchor teeth on both sides of the fake tooth/teeth for proper support and to help maintain healthy musculature the jaw alignment.

A bridge that has one anchor tooth, say #20, and one attached fake tooth, say #19, will put a lot of pressure on tooth #20 during chewing. This could eventually cause #20 to become fragile and mobile. Infection or fracture often occurs in the lone anchor tooth and eventually it needs to be removed. If #20 is already root canaled, it is already unhealthy and the added pressure of chewing would cause the problems I have stated.

It is not ideal to remove #18 tooth and leave the 3 unit bridge intact. The bridge would be referred to as a cantilever bridge. Meaning keeping #20 crown attached as the only anchor tooth to 19 pontic and 18 crown (pontic after extraction). The pressure with chewing would be extreme on #20 and you would not be able to clean effectively underneath 19 and 18. So food debris would become trapped leading to an infection.

If tooth #20 is healthy and you are to keep just that one tooth, then the bridge can be cut at the junctions between 19 and 20 and between 18 and 19. Leaving #20 crowned tooth to stand alone. The pontic #19 is discarded and #18 is extracted. This can all be done in the mouth without removing the bridge to cut it.

If the bridge/crown is loose on #20, then it is best to remove the entire bridge and diagnose the reason for the mobility of #20 and extract #18 at the same time. This extraction and cutting of the bridge appointment can be coordinated between your dentist and an oral surgeon if you want an oral surgeon to remove #18.

If you are going to an oral surgeon for the removal of #18, irrelevant of whether or not you are keeping the pontic attached to #20, then your general dentist can cut the bridge and let the oral surgeon remove #18. This is usually an appointment that is coordinated for you between the two offices.

I hope I have explained that okay. Any questions, just give a holler.

Bryanna

Thank you for taking the time to reply and for the valuable info. I'll keep my fingers crossed that all goes well.

Poilj,

Now that you have additional information, it is best to discuss your options with your dentist so you can make an informed decision. Leaving it up to the dentist to decide may or may not end up being what you really want or it can end up costing you more in the long run. It is usually best to know what the plan is as well as the proposed outcome before diving into it.

I wish you all the best.
Bryanna

Thank you Bryanna,

What do you think about seeking a second opinion from another dentist? I've been seeing my dentist for about 13 years now.

The tooth (#18) has a root canal and is not really bothersome aside from some sensitivity from the gum.

I'm trying not to go through the awful sensation of an extraction again.

To further complicate things, I've Colitis. Taking a 7-10 day course of antibiotics may wreck havoc on me.

Thanks again.

Poilj,

Irrelevant of your symptoms, root canaled tooth #18 is infected and it has been since it was root canaled, if not before that procedure. There are many reasons why all root canaled teeth are chronically infected. Perhaps the easiest for a lay person to understand has to do with the fact that each tooth contains hundreds upon hundreds of tiny microscopic canals called dentin tubules. These canals as well as some large canals contain nerve tissue. During a root canal procedure the only canals that are accessible are those few (depending on the tooth it is usually only 1-4) that are large enough to be seen and get an instrument into. This leaves hundreds ++ of canals untouched. During the procedure the vessels that feed the the tooth nutrition are cut rendering the tooth no blood, no nutrition, no circulation and non vital. The nerve tissue inside of all of the inaccessible tiny canals becomes necrotic and infected. The bacteria and infection will eventually spread beyond the tooth into the jaw bone and further. I will attach a diagram of the anatomy of a tooth to show you the dentin tubules.

Something that you may not be aware of is how the health of our mouth and teeth affect the rest of our body, our digestion, our intestines, etc. According to Ancient Chinese Medicine, our teeth and organs share the same pathways for blood and bacteria to travel through, these are called meridians. It simply means that bacteria is more likely to spread from certain teeth to certain areas of the body without hesitation. Tooth #18 is on the same meridian as the large intestine along with a few other areas. I will attach 2 meridian charts both will be on the same page. One shows the tooth and organ correlation and the other shows the tooth and emotional health correlation. It is not unusual for people to have infected teeth along with intestinal disorders.

Regarding the options you have with the bridge....

#1) Tooth #18 irrelevant of symptoms is infected and very unhealthy. Usually the lack of symptoms with an infected tooth is an indicator that the infection is draining either out from under the gum and into your mouth, down into your digestive system. Or draining into the jaw bone into your circulatory system. So it's important to know that symptoms are not always evident of the extent of the problem.

#2) The bone health surrounding #18 is not going to be healthy and not an ideal place for a dental implant. It is also best to have an oral surgeon not a general dentist remove this tooth as the surgery needs to be very thorough to help eliminate the infection. It is important that the tooth, the periodontal ligament and all diseased tissue and bone be removed at the time of the extraction. It is ideal if you convey to the oral surgeon at a consultation appointment that you want that done to assure yourself and him that he knows you want a thorough extraction. Never assume it will automatically be done.

#3) If #20 is not root canaled, is healthy and the crown fits well, then there is a good chance that the bridge can be cut off between 19 and 20 leaving 20 alone.

#4) If you leave #19 attached to 20 you are risking the health of #20 due to the forces of chewing on it with that fake tooth attached. It will also be difficult to clean underneath 19. However, in some cases this can be a temporary solution.

#5) If you remove 18 and 19 you are left with no molars in that area. If you are missing teeth on your lower right side, you may be a candidate for a removable partial. You would have to discuss that with your dentist.

Regarding your intestinal disorder .... what are you doing to treat or cure the colitis? Do you take probiotic supplements? What type of food do you eat? Yes, antibiotics could be troublesome for you. However, the infection from tooth #18 is also troublesome and needs to be eradicated. People who have intestinal disorders usually find it helpful to supplement with a probiotic called Saccharomyces Boulardii before, during and after taking the antibiotic. This strain of probiotics does not interfere with the absorption of an antibiotic. I can offer you further information on that if you want.

Did you have a bad experience with a tooth extraction in the past? Was the extraction done by an oral surgeon or your dentist? Also, how is the health of the rest of your teeth? Do you have other root canaled teeth or periodontal disease?

Tooth and organ charts link:
Tooth-Organ Acumeridian Relationships

Dentin Tubules diagram
 

Dentin tubule diagram....

Thank you once again Bryanna for providing this wealth of information. I have to say that no doctor that I've seen has made a connection between my intestinal and dental health.

For my Colitis I take 4.8grams of Lialda and a probiotic (Florastor) as recommended by my GI. I've also made a conscious effort to eat healthier. My symptoms are under control. A colonoscopy in April showed marked improvement in the colon compared to Jan. 2015 when I was originally diagnosed.

My tooth #20 is sound (I saw my regular dentist today) and has not had a root canal. I do however have other teeth that have been root canaled. (it's a miracle I'm still alive)

Being a child in the 60's and 70's trips to the dentist were really painful and unpleasant. There would be times that 4-5 years would go by without seeing one. Only once I was in pain would I give in and see a dentist. By then it would be too late and a root canal and crown were needed. I've been much better about keeping up with appts since finding my current dentist (13 yrs) but I guess the damage has been done.

I have another bridge on the lower right side of my mouth (# 31, 30, 29). I don't know off-hand if any of those have a root canal.

My dentist today recommended an implant at #17 once the extraction of #18 is complete. He urged me to do the extraction soon for fear of an abscess developing.

My head is spinning right now.

Sorry, got my numbers mixed up. He recommended a implant at #19.

Poilj,

Conventional doctors and dentists do not generally discuss the correlation between the mouth and the rest of the body. Holistic and Biological dentists as well as Integrative and Functional Medicine practitioners do discuss the correlation. All practitioners have learned about the mouth and body connection. But unless they have sought further education beyond their basic schooling, like the Integrative and Functional Medicine practitioners, they don't delve into that important connection as they should.

Glad to hear that your intestinal health has improved!

Bryanna

One final question if you don't mind Bryanna. You have been such a terrific help.

My general dentist suggested an implant at #19 in order to close the upcoming gap somewhat, leaving #18 vacant.

#20 is a sound tooth not root canaled.

What do you think?

Poilj,

Regarding your question about placement of the dental implant to replace tooth #19 ....

There are some significant issues to consider or address before placing any dental implant simply because of the fact that it is a foreign material, usually titanium or zirconium, which can be rejected at the site or contribute to poor oral or physical health of the recipient. Things to consider:

1) The overall health of your mouth irrelevant of where the dental implant is proposed to be placed. Any chronic area of infection or inflammation compromises oral health. Root canaled teeth, periodontal disease, poor oral hygiene, ill fitting restorations/crowns/partial dentures are areas of concern for infection and inflammation.

2) The overall health of the patient. Smoker, alcohol drinker, poor eating habits, and many medications compromise a persons health. Acute or long term inflammatory disorders or infections of the digestive tract or elsewhere compromise the health of the immune system. Any of these issues can prevent, slow down, or even cause a rejection of the implant.

3) The jaw bone at the site where the implant is to be placed as well as the surrounding bone or teeth should be healthy. If there are or were neighboring teeth that were infected or root canaled, the health of the bone in the area of the proposed implant may be compromised. The jaw bone must also be sufficient in height, width and thickness to hold the implant.

4) The dental history with tooth #19 is important. If it had been root canaled and the infection had spread to the bone prior to it being extracted, then the bone may not be ideally healthy as it can be difficult for the surgeon to eradicate the bacteria completely from the bone from a root canaled tooth.
If #19 were periodontally involved and there was moderate bone loss due to the infection, then the amount of bone will be compromised and it's health in question.
If #19 had been extracted more than a year ago, bone loss has occurred with each passing year. Depending on the circumstances, the existing ridge may be too flat to hold a bone graft prior to the implant. Bone grafting is done to help encourage new bone to grow and to help stabilize the dental implant. However, the graft cannot do those things if the bony ridge is inadequate or not healthy. The graft would either be rejected or just sit on top of the existing ridge without much, if any retention.

It is important to consult with an oral surgeon. Make sure he knows your full medical and dental history as well as any medications that you take, even decongestants or other OTC meds. He should know the history of tooth #18 and tooth #19. He should take a panoramic xray and possibly single xrays to view all of your teeth, especially those that are root canaled. Of course, unless there is a blatant abscess with any teeth, he will likely dismiss the chronic bacterial infection in your other root canaled teeth.

Depending on what the oral surgeon finds and recommends to you then you can decide whether or not to proceed with the dental implant. He may suggest to remove #18 and place the implant in #19 site at the same visit. On one hand this is usually done in one oral surgery. On the other hand since #18 is root canaled, it may be wise to extract #18, let it heal for 3 months and then place the implant in the #19 site providing it is a good recipient site.

Many times in my professional experience and even with people who have written in here, the surgeon convinces the patient to "get it all done" and do both procedures in the one appointment. In an ideal situation where there was no concern about root canaled or infected teeth, this could work out great. But anytime you had or have infection, the post op complications can be worse than if it had been done separately.

I know this is not an easy thing to deal with or think about. It is best if you consult with at least one if not two oral surgeons about the things I have informed you about here. It is not wise to let your general dentist extract #18 or place the implant in #19 site as he more than likely has very limited experience with surgical cases like yours.

Bryanna

Thank you once more for your help.

Just an FYI tooth #19 was extracted possibly 35 yrs ago and the bridge covering 18-19-20 is probably 32/33 yrs old. Probably the only thing the dentists did right by me yrs ago. As I said earlier the dental visits I had early in life were brutal at times. it scared me away for years