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Advanced cosmetic and general dentistry

Is This Tooth Worth Saving or Should I Get an Implant?

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I’m 77 and have a dilemma about whether to get a root canal or an extraction and implant. Over the past year, many of my old fillings have failed and need to be replaced. I recently had a crown placed on my upper second molar, and during the procedure, my dentist found a cavity and a crack in the upper first molar next to it. She recommends crowning that tooth, too.

I’m concerned about needing a root canal after going through the process of getting a crown. I’m not sure whether it’s better to wait or consider a root canal now rather than needing one later. When is it better to remove a tooth instead of restoring it with a crown and, if necessary, a root canal? Thanks. Jen from RI

 

Jen,

Replacing missing upper molars helps maintain a healthy bite. Without replacement, even at 77, the opposing lower molars can gradually move upward into the space. The changes can affect how teeth fit together. Even if the bite remains stable, chewing on only one side of your mouth can place extra stress on the remaining teeth. It makes sense to include a replacement plan whenever extraction is considered.

How Do Implants and Root Canals Compare?

Both dental implants and root canal therapy have strong success records. However, dental implants are predictable tooth replacement options. Root canal treatment is highly successful when performed by a specialist using current techniques.

While implants have an advantage in reliability and rarely fail, treating a failed implant is often considerably more complex than treating a failed root canal. A root canal and crown usually cost significantly less than an implant and crown.

What Are the Advantages of Each Treatment?

Understanding the strengths and limitations of each option can make the decision easier.

Dental Implant and Crown

  • Costs about 50% more than a root canal and crown
  • Requires at least three months of healing before the final crown is placed
  • Has an excellent long-term success rate
  • More complex to repair if the procedure fails

Root Canal and Crown

  • Usually, it’s the more affordable option
  • Can often be completed within several weeks
  • Preserves the tooth and surrounding bone
  • Carries a slight possibility of future failure that might require an implant

It Tooth Extraction Worth It to Prevent a Root Canal?

Although there is a small possibility that a crowned tooth could require a root canal later, preserving the tooth is a priority. A more conservative approach is to restore the tooth with a crown and address a root canal only if it becomes necessary in the future. Preserving natural teeth whenever possible generally provides the greatest long-term benefit.

The information you provided does not suggest that these teeth are at high risk of needing root canal treatment. There was no mention of increased sensitivity or other symptoms that would raise concern about the health of the dental pulp.

This blog is sponsored by Lowell cosmetic dentist Dr. Michael Szarek, who has advanced training in complex restorative dentistry, and where we are welcoming our new associate, Dr. Andrea Biondo.

 

Why Did My Dental Implant Bone Graft Fail Three Times?

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I’ve had the same dentist for the past seven years and had no reservations about her placing my dental implants. Several co-workers referred me to this dentist, and three of them had great success with implants from the dentist.

My case must have been unusual for her because she said I needed bone grafting before getting my first implant. After four months, my dentist attempted the implant but said she needed to remove it because the bone was too shallow. I’ve had three surgeries, and I still don’t have a dental implant. I have much respect for my dentist, but I must ask, would I have had a better experience if I had chosen a specialist? – Thanks. Bennie from Tampa

Bennie,

While dental implantology isn’t a formally recognized specialty, some dentists, oral surgeons, and periodontists have advanced training in this area.

Model of a dental implant, including the crown, abutment, and artificial root

After successful bone grafting and dental implant placement, a cosmetic dentist can attach a natural-looking crown

We understand your dentist’s intentions and potential experience with implants. However, bone grafting is a complex procedure that requires specific expertise. Your dentist may be relatively new to this aspect of implant dentistry. Remember, every professional, even the most skilled, has a learning curve when using new techniques.

It’s commendable that your dentist is being honest about the situation. A less ethical practitioner might have proceeded with the implant, potentially leading to complications down the line.

Your dentist’s transparency suggests a commitment to a positive outcome. Dental bridges and implants are viable options for a single tooth replacement, each with advantages and disadvantages. If you prefer a dental implant, consider asking your dentist for a referral to a periodontist (implant specialist), or oral surgeon for bone grafting and implant placement.

After the implant heals, your dentist can restore it with a natural-looking implant crown.

Lowell, Massachusetts, accredited cosmetic dentist Dr. Michael Szarek sponsors this post. Read how Dr. Szarek strives to give his patients the best dental care in Lowell.

Why Does My Temporary Bridge Make My Face and Jaw Hurt?

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I have had a dental bridge since 2017 that includes my lower right first premolar through my second molar. Although the bridge was still comfortable, my dentist recommended replacing it before I began to have problems. She took impressions of my mouth and placed a temporary bridge. I take ibuprofen every day because the bridge hurts. The entire left side of my mouth and jaw hurt. It hurts to speak and chew more than anything, and my gums are slightly swollen. My dentist took x-rays and said they looked okay. She cannot explain my pain. Of course, I am not allowing my dentist to order the final bridge because this temporary bridge hurts so badly. My dentist recommended an endodontist, but I do not have an appointment until early next month. Why would I suddenly need a root canal? Based on my description, why would a temporary bridge cause ongoing pain? Thank you. Kurt from NH

 

Kurt

Thank you for your question. One of our dentists would need to examine your bridge, teeth, and X-rays for an accurate diagnosis. However, we will explain three factors that might cause a temporary bridge to hurt.

Why Would a Temporary Bridge Hurt?

Diagram of a dental bridge

Dental bridge

A temporary bridge can hurt because your teeth are sensitive after preparation, irritated by bacteria, or the bridge is not optimal.

  • Sensitive teeth after preparation – Placing a bridge requires shaving down teeth on the sides and top so the bridge ends will fit over them. Teeth prepared for a bridge can ache and be sensitive to cold and hot temperatures, food, and drinks. Removing a bridge and preparing teeth for a new one are traumatic events.
  • Irritation from bacteria – If a dentist finds decay beneath a dental bridge or its components, bacteria could have infected and irritated your teeth.
  • Bridge position – A bridge that does not fit well can affect your bite. When you eat, the opposite teeth (upper or lower) can hit the bridge teeth harder than usual and make them ache. You can feel jaw or neck pain and get headaches, too.

Referring You to a Root Canal Specialist

When a dentist cannot identify the cause of your pain, they may refer you to a root canal specialist (endodontist). The endodontist will examine your teeth, possibly x-ray them, and test their sensitivity.

Although some dentists delay making the permanent bridge, others place it with temporary cement. It gives the dentist time to observe your teeth and see if the sensitivity resolves. An X-ray will show whether the tissue inside the tooth is infected or died and requires root canal treatment. Prompt care can help preserve the tooth, preventing the spread of an infection or the need for a dental implant.

Lowell, Massachusetts, accredited cosmetic dentist Dr. Michael Szarek sponsors this post.

Why Do I Have Radiating Tooth Pain with No Cavity?

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I have radiating pain in my tooth, but no sign of a cavity exists. I think the worst and am concerned about needing an extraction and dental implant. What else could be causing the problem? Thanks. Gavin K.

 

Gavin – Thank you for contacting Dr. Szarek’s office.

Although you may not see signs of a cavity, the pulp of your tooth may be infected. Cavities or decay begin outside a tooth, but internal root absorption destroys tissue inside a tooth.

What Can Cause Tooth Pain Without a Cavity?

Conditions that can cause tooth pain without a cavity include the following:

  • A fractured tooth can cause persistent tooth pain. A dentist will use a bright light to reveal if your tooth is fractured.
  • Inflamed tissue. The tissue surrounding your tooth may be strained. The pain and inflammation in the tissue can transfer to your tooth.
  • Jaw pain. Facial pain, such as pain in your jaw muscles, can refer to your teeth.
  • Sinus problems can refer dull, aching, or throbbing pain in your teeth.
  • Headaches. Migraine and cluster headaches can refer to deep pain in teeth.
  • Cardiovascular problems. Heart problems can refer pain in the shoulder, neck, and even the jaw and cause pain in your teeth.
  • Nerve pain. Specific neurological issues can cause you to feel pain in your face, teeth, or gums.
Model of a dental implant, including the crown, abutment, and artificial root

Prompt care for tooth pain can decrease the need for removal and a dental implant

Schedule an examination from your dentist for an examination and x-rays. Call a dentist for an appointment. Your dentist will determine if your tooth is causing discomfort. Early detection can prevent the need for tooth removal and a dental implant.

Your dentist may refer you to a primary care doctor and perhaps to a neurological for further tests to identify and treat the cause.

Lowell, Massachusetts, accredited cosmetic dentist Dr. Michael Szarek sponsors this post.

My Tooth Broke at the Gumline and the Repair Is Unresolved

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Five months ago, my left front tooth broke at the gumline. Although my dentist said he would do an extraction and bridge, he did a root canal on the tooth instead of the extraction. My insurance company will not pay for the bridge because I have other missing teeth and one that requires extraction, so really, a bridge will not work. My dentist said he would give me a refund if I signed a waiver to agree that he is not responsible if I have problems with the tooth that broke at the gumline. I am wearing a poor-fitting partial flipper and waiting for a solution for the damaged tooth. My dentist wants me to pay for the flipper without telling me about the final solution. I do not think it is fair to ask me to sign a waiver. Should I accept the loss and go into debt for a dental implant? – Thank you. Tyrone  from Kansas City

Tyrone,

Your dentist is responsible for starting work that he cannot complete and switching treatment options on you without proper notice. We recommend that you not make any decisions before switching to another dentist. Do not sign a release.

Getting a Refund from Your Dentist

Picture of dental iimplant parts separate and put together

A dental implant can replace a tooth broken at the gumline

You can get a refund from your dentist by contacting these professionals or organizations for help:

  • A lawyer – Consult with a lawyer to understand your options for getting a refund and compensation for your discomfort. Get copies of your dental records before the consultation.
  • A cosmetic dentist – Look for a dentist with advanced cosmetic dentistry training—preferably accredited—to conduct a thorough exam and take x-rays to determine how to restore your teeth. The new dentist will likely be willing to confirm that your dentist’s work on your teeth was faulty. A dental implant is a reliable way to replace your missing teeth. Talk with your new dentist about payment plans or financing to make treatment affordable.
  • Your dental insurance company – Report the issue to your insurance company if it is involved. Your dentist should not receive payment for the care you did not receive.
  • The state dental board – Report the issue. Although your dentist may not receive a reprimand, reporting the problem can help prevent other patients from having a nightmare experience with your dentist.

 

Best wishes for a progressive and thorough resolution.

Lowell, Massachusetts, accredited cosmetic dentist Dr. Michael Szarek sponsors this post