Extract tooth from under a bridge?Good idea?
 

Hi -
my dentist has x-rayed my upper bridge and has said that one of the three teeth supporting the bridge (its a four tooth bridge) has split and is infected. He proposes to cut the split tooth across and then extract the lower part of the tooth + root while leaving the bridge in place (and the top part of the split tooth would remain in the bridge). From ignorance (!) this sounds rather radical to me - I would appreciate any advice as to whether this is really feasible and, if so, is it a good idea??
Many thanks for any advice on this.

Hi David99,

I am in the dental field and can offer you some information here. If you don't mind, I have a few questions which will help clarify your situation and in return allow me to give you the information you are seeking.

I assume by your description of the bridge that there are 3 anchor teeth and one fake tooth replacing a previously extracted tooth. If so, what tooth is missing and which teeth are the anchor teeth? Why was the bridge made with 3 anchor teeth and not two? Were the anchor teeth compromised in some way making them weak to begin with? Do you have periodontal disease and/or bone loss? Are these anchor teeth root canaled?

Thanks....
Bryanna

Hi - many thanks for taking the trouble to advise me on this - I'm really grateful.
To answer your questions: Going from the back upper left of my mouth, the two back teeth of the bridge are anchors, then there is a gap and then there is another anchor tooth. Unfortunately, I'm not absolutely sure why the bridge was made with 3 anchor teeth, but, from memory, it was because the dentist who put it in (some years ago) thought that the anchor tooth that is now split (no.2 from the back, next to the gap) was weak and so went for a 'belt & braces' solution. As far as I'm aware, I don't have periodontal disease and I don't think there is any bone loss (although my present dentist said that if I just leave the bridge as it is, because its infected (but draining straight out) there will be bone loss down the road). I think the anchor tooth has been root canaled.
Again, I'm really grateful for any advice/insight you can give on the proposed procedure which I understand will take about 45 mins. I suppose also (from ignorance!), I'm not sure how it is possible to extract the bottom half of the tooth while leaving the bridge in place. Many thanks, David

Hi David,

You described it perfectly, thank you!

I am going to say that you most likely did or do have periodontal problems because this is how they use to do bridges when the teeth were unstable....meaning unhealthy.

In general the cement used to adhere bridgework and crowns has a life span of about 5-10 yrs and that is only if the site was perfectly clean and dry when the restorations were cemented on. The reason for that large difference in the span is due to the type of cement that was used and/or anatomical factors which can cause a bridge or crown to fail. Most people go way beyond the life of the cement before they have the work redone. Sometimes the bridge or crowns become loose, other times they just move slightly allowing bacteria to get in underneath them and cause the teeth to decay.

Extracting a tooth from under the bridge is beyond tricky as you can imagine. But yes, it can be done. Is it ideal, no. It is also not usually recommended unless the patient is reluctant to have a new bridge made. I am deeply concerned that this dentist even mentioned keeping this tooth knowing full well that although it is draining it is a chronic long term infection..... draining where?? Into your sinuses, your brain ...into your digestive system... into your blood stream?? He should have informed you of all of this and not just made it sound like it's not big deal to just leave it.

Keep in mind that one of two or perhaps both of these things has happened... the cement gave out a long time ago and there is bacteria seeping in underneath the bridge which means all of the teeth are being compromised .... the tooth in question has been a brewing problem for how many years which means the bone surrounding this tooth is unhealthy.

I think your problem is not just related to this one tooth and you will endure this procedure only to find that you have other problems associated with this bridge that are currently brewing but either undiagnosed or not mentioned to you in any detail.

I think you are most fixed on how the procedure can be done rather than how big of a problem you may have and how it can affect your overall health. Not your fault for thinking this way.... after all your dentist has only informed you part way and you are here seeking more information :)

Hope this information helps clarify some issues for you... either discuss these things with your dentist or consider seeking a different opinion. Your case is not unusual... it is just a question of you becoming informed of the extent of the problem and seeking the best care in dealing with it.

Bryanna







I

Hi Bryanna - I'm really grateful for your very thoughtful and informative advice on this - from what you have said, it would seem that the sensible way forward would be to replace the bridge now rather than undergo a v tricky procedure which may not resolve anything and indeed could lead to worse issues down the road. I think that perhaps my dentist (who is attached to a local dental teaching hospital just outside London) sees performing an extraction from under a bridge as a 'challenge' which no doubt he could then discuss with his students (don't worry about the patient!) anyway, I shall now discuss a replacement bridge with him and, if necessary, get a second opinion (or change dentists!) Again, many thanks for your kind advice on this - I'm most grateful - (oh, and have a great weekend, wherever you are!)(I'll keep you posted on developments).

Hi David,

Yes, yes and yes!!! That is exactly what I am saying :)

Sensible would be the ideal path to take with this dental problem. Please understand that when this bridge is removed... there may <or may not> be a can of worms underneath there :/ If there is, then remain "sensible" about the treatment options that are presented to you and keep in mind the risks of retaining teeth that are not healthy. To remove that tooth but then place a new bridge on other compromised teeth will not alter your current situation very much or for very long. Ask about all of the options.

You are most likely correct in your assumption with the dentist finding this extraction a challenge and bragging about it to his students. But I agree with you... let's not forget about the patient!

Thank you for being so open minded about your dental problem and to my no nonsense manner of giving you the information. It's been a pleasure communicating with you. BTW.... I live in the US in the state of New Jersey!! Long way from London ;))

Yes, please keep us posted.
Bryanna

Hi Bryanna - Frank Sinatra, the Sopranos, and now great dental advice - much to thank New Jersey for!!

Update - thanks again!
 

Hi Bryanna -
a somewhat belated update to the issues I had with my bridge - I thought you'd like further confirmation of how valuable your advice is.
After your advice on the forum, I consulted another dentist who referred me to one of the top endodontists in the UK based in Harley St, London - he confirmed your opinion entirely! ie, that the whole bridge should be removed etc, and the causes of the infection etc dealt with before moving on to eg any new crown/implants etc and (as you also advised) not to proceed with the procedure recommended by my (previous)dentist.
So many thanks again, and although it is a rather crude measure of the worth of your advice, you might like to know that the Harley St endodontist charges around $500/hour just for a consultation!

Hi David99!!

Thanks so much for updating us and confirming that I really do provide factual information here! Means a lot to me to have that acknowledged and by an Endodontist of all people!!! How ironic is that?? :)

So what dentistry have you had done since we last heard from you??

Yes, I am well aware what "experts" or "consultants" charge for their professional advice. As you can imagine it requires a great deal of my time to answer the questions on this forum ... however there is no monetary compensation given to me. I volunteer my time and I do this in addition to working, going to school, family.... etc. I try to be here as often as I can and answer as many inquires as possible but sometimes I just run out of time.

When you get a chance.... fill us in on your dental journey since last year!

Take care!