Bryanna- Thoughts on broken tooth, rc, implant
 

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

I'm sorry for replying so late. Yes, I had major problems with the dentist, who called me a very pushy daughter, unrealistic and uninformed about teeth and root canals, someone trying to create trouble when none exists, and on and on. It was just horrible. So my mother plans to go to a new dentist. The worst part is my usually calm mother is really worried that she'll need extensive work.

Will let you know. Thanks! - Em

Just had to tell you this! You linked below to Dr. E in Calif. He was my dentist, and my mom may see him.

ETA: Bryanna, thanks very much for your thoughtful questions below. We're thinking about them. Great point....

Hi Emily,

I'm so sorry you are being treated so harshly. There is no reason for that. I think it is wise for your mom to see a new dentist, if for no other reason than your mom (and yourself) deserve to be treated more gently.

Your mom's age, her overall health and her dental needs to be factored into any treatment plan that is offered to her. I think it may be wise and helpful to discuss some things with your mom and determine her personal preferences of which should be conveyed to the new dentist to avoid another unpleasant experience.

1) Does your mom want dental treatment that is temporary or permanent? Meaning is she looking to patch up any problems or treat them without having to deal with them ever again?

2) Does your mom feel that her teeth are an important part of her overall health and want control over her options? Would she prefer to have treatment options and decide what she feels is best for her or is she more comfortable with relying on the dentist to choose for her?

It is important for the dentist to check the overall health of all of her teeth. This may require additional xrays of her entire mouth if her former dentist did not take them recently. It is also best to have all previous xrays sent to the new dentist before the appointment. Radio-graphic history can be very helpful. I cannot stress enough that it would not behoove her to skip having the xrays because without them, there is no way to know what is really going on below the gum line. The overall health of her teeth can help determine what will be the best option for her regarding her broken front tooth.

Once the health of her teeth is established and she is aware of any other problems... hopefully none ...... the dentist can offer her treatment options for that broken tooth and whatever else is going on.

I know this is upsetting for your mom and I'm sure she's getting concerned over the whole thing. It's important that she work with a dentist who is going to treat her and you more kindly. I hope this new dentist is that one!

Keep in mind that your mom has to make the choice that she feels is best for her. So even if you do not agree, please try to understand that she needs to be comfortable with her decision. Just be sure that you both understand completely what is being offered to you.

I'm here if you need to bounce ideas off of someone. If you prefer to talk privately then my dental email is bryanna007@gmail.com

Bryanna

Thanks, Bryanna! I replied a while ago, but posts aren't showing up too quickly. Assuming my mother sees the dentist in Calif, yes, her records and xrays will be sent. She knows new xrays are needed. If she sees someone else too, we still need past xrays sent. You are so right -- this is my mother's decision and she must be comfortable with it. I felt like the dentist was telling me: "just back off - she's old." My mom said she probably was!