Do I REALLY Need to Replace This Dental Bridge?

I have a dental bridge on my lower right to replace a lost tooth. I initially thought about getting a dental implant but my dentist suggested the bridge would be less expensive. Now he is saying the one of the teeth holding the bridge is broken and I need to replace the entire unit. If I have no pain and no symptoms, do I really need to replace this? Is there another option?

Jeremy

Dear Jeremy,

You’ve brought up one of the many benefits of dental implants over a dental bridge. If an adjacent tooth to the replacement is damaged it has no impact on the dental implant. With a bridge, that is not the case. The only reason I can think of that he steered you toward a bridge instead is that he doesn’t have dental implant training and did not want you going somewhere else.

That being said, I am a bit sceptical of your dentist’s diagnosis here. You have no pain. If a tooth was broken, you would be very likely to have some pain, especially when you bite down. Generally, the solution to a broken or fractured tooth that can be saved is a dental crown, so why is this one suddenly damaged when it already has that protection. Plus, replacing the bridge would only be necessary if the tooth had to be extracted, which means you would now need a longer bridge. That is another crown on a healthy tooth, with even more strain on it.

I would not consider this a dental emergency especially since you do not have any symptoms. My recommendation is for you to get a second opinion before following through with this. Don’t tell Dentist B who Dentist A is or what he said. They may know each other and you don’t want Dentist B feeling pressured to not contradict his pal. Instead, just go and say, I am seeking a second opinion on the lower right side of my mouth. If he asks you what the previous diagnosis was or who the dentist was, just explain you don’t want to prejudice his diagnosis in any way and just want a blind second opinion. He or she should not have a problem with that.

This blog is brought to you by Moline Dentist Dr. Thomas Goebel.

Antibiotics for Tooth Infections

I have a toothache that has me so distracted I am having a hard time getting any work done. I am in the middle of a huge merger and DO NOT have time to see a dentist. I do have a doctor that will write me a prescription for just about anything. I just need to tell him what type of meds I need. Can you help me with that?

B.W.

Dear B.W.,

First, I’m just going to say what your doctor is doing is not only against medical ethics but super dangerous. While I am sure that it is handy to have a doctor willing to do that, I do worry. That being said, an antibiotic will not solve your problem. Instead, it will just be a temporary reprieve. Once the antibiotics run out, your tooth infection will come back with a vengeance.

The only way that you can stop a tooth infection is by having a dentist physically go in and remove the infected pulp. This is because a tooth infection kills the tooth and there is no longer blood flow to the tooth, which means the antibiotic will have no effect on the root of the infection.

You have two choices in truly dealing with a tooth infection. The first is to have a root canal treatment where the dentist goes in and removes the infected pulp. From there you are generally given a dental crown. The good news is that this saves your tooth. It is always better to have as much natural tooth structure as possible.

The second option is if the tooth cannot be saved and the decay and infection have gotten too far. When that happens, the tooth has to be extracted and you will need to replace the tooth. If that happens, I recommend you get a dental implant to replace it. That is the closest to having a healthy natural tooth in your mouth again.

I know you are short on time, but if you let this spread, it can turn from a dental emergency to a medical one. Think about how close your jaw is to your brain and heart. People still die from tooth infections because they allow the infection to spread. I know you are busy, but I really do not want you to put this off. You could call the dentist and ask him to prescribe you an antibiotic, but it will only buy you a short period of time.

This blog is brought to you by Moline Dentist Dr. Thomas Goebel.

How Long Can I Delay Root Canal or Tooth Removal?

A crown on my upper left first molar broke. My dentist said that the tooth had died, and if he could not remove all the decay, he would refer me to an oral surgeon to remove the tooth. Then, he would place a dental bridge. I asked my dentist to refer me to an endodontist, and I have an appointment in two weeks. I read online that a dental implant is better than a bridge. Is there any reason I should have the tooth removed right away? How long can I wait before this becomes a bigger problem? – Thank you. Selina from Allegheny, PA

Selina,

Thank you for your question. Dr. Goebel would need to examine your teeth and x-rays. But we can offer some insight.

Removing vs. Saving a Tooth

If a tooth is healthy enough to save and will not negatively affect your oral health, it is best to save it. Although dental implants are a highly effective tooth replacement, healthy natural teeth are better. We recommend that you keep your appointment with the endodontist (root canal specialist) for a second opinion.

How Long Can You Wait Before a Root Canal?

You did not mention if your tooth hurts, but the specialist will need to check for the extent of the infection. Without treatment, infection will continue to spread. So, the condition of your teeth and your oral health will continue to decline without root canal treatment.

Also, if the tooth requires removal, leaving the space without a dental implant will allow other teeth to drift into the area. Tooth misalignment can lead to other issues like jaw pain or the need for orthodontic treatment.

Get a Second Opinion

Your dentist seems uncomfortable replacing your tooth with a dental implant and crown. Even if your dentist would refer you to an oral surgeon for implant placement, we are concerned about his experience with implant crowns and crowns in general. After your appointment with the root canal specialist, we recommend scheduling an appointment with an experienced dentist to discuss your options after root canal treatment or extraction.

 

Moline, Illinois dentist, Dr. Thomas Goebel, sponsors this post.

Dental Implant Delayed Due to a Sinus Infection

Can you tell me why my dentist can’t clear my sinus infection after tooth extraction? This issue prevents me from getting a dental implant. After removing my upper left tooth, my dentist prescribed clindamycin antibiotics for a week, but the infection isn’t gone. I finished the antibiotics, but I still feel pressure in my face and nose. I have tried nose spray and decongestant. Before I call the office back, can you give me an idea of what my dentist should recommend?

Also, if his recommendation does not match yours, should I ask for another round of clindamycin? Is this a routine problem that my dentist should have known about? I am afraid it will not heal, and I cannot get an implant. Thank you. Jeremiah from Columbia, SC

Jeremiah,

Dr. Goebel would need to examine your tooth and review your x-ray for an accurate diagnosis. But from your description, your dentist is not negligent.

Upper molar tooth roots are often located close to the sinus. So, when your dentist removes a tooth, the sinus can rupture. Sometimes only a thin membrane separates tooth roots and the sinus.

A dentist may treat the issue with these steps:

• Close the perforation
• Use a surgical gelatin sponge or bone grafting if you need a dental implant
• Stich the opening closed
• Prescribed antibiotics if you have an infection

After finishing antibiotics, contact your dentist if the infection does not clear. Although you may need another course of antibiotics, your dentist may need to switch you from clindamycin. Sometimes bacteria become antibiotic resistant.

Afterward, if the infection persists, your dentist may need to refer you to an otolaryngologist (or ear, nose, and throat specialist). The specialist will coordinate your care with your dentist to ensure the infection is gone before dental implant surgery.

You can expect about four months of bone graft healing before you get a dental implant. And after implant surgery, it takes three to four months for your jawbone and implant to fuse. Then, your dentist can complete the implant with a dental crown.

Cosmetic dentist Thomas J. Goebel, DDS of Moline, Illinois, sponsors this post.

What is this weird sensation I feel with my new dental crown?

I have a new crown but feel a strange sensation in it. After I received the crown in mid-July, I returned to my dentist about the problem. My dentist said he could re-cement the crown or make a new one. I thought that it was better to choose a new crown. The new crown was ready in early August, but my bite still did not feel right. The tooth is not painful, but it feels strange. Am I going to need another new crown? I am beginning to wonder if this is an issue with the crown or if the crown preparation somehow damaged my tooth. Thanks for your help and advice. Darren from Idaho

Darren,

When a dentist places your crown correctly, it should feel like a healthy natural tooth. You not notice that you have a crown. Sometimes, even bite adjustments are not enough to resolve the discomfort because the problem lies beneath the crown.

Uncomfortable New Dental Crown

If discomfort in your crown lingers, get a second opinion, and ask for an x-ray. Sometimes, decay beneath a crown can cause lingering discomfort. If the problem tooth previously had root canal treatment, you would not feel pain or have a toothache. Your symptoms might be vague and difficult to describe.

What Causes Tooth Decay Beneath Crowns?

Tooth decay beneath a crown can occur in these instances:

• Bacteria or plaque gets trapped beneath the crown
• Root canal failure
• Lingering decay or infection that a dentist covers with a crown

Depending on the condition of your tooth and how much tooth structure is left, the second opinion dentist may recommend

• Adjusting the crown
• Remaking the crown
• Extraction, replacing the tooth with a dental implant, a new implant crown

After retreatment, your tooth and bite should be comfortable.

 

Thomas J. Goebel, DDS, of Moline, IL, sponsors this post.