Re: Difficult Root Canal versus Extraction (Back Molar)

VoidBox wrote:

Hi again.

I posted here about a week or two ago with a pain in my lower back molar. Some of you (Joel, StovePipe, Steven and, I believe I recall - though is post is not on Google - W_B) correctly diagnosed this as needing root canal treatment. However, I now have a follow-on dilemma for which any advice would be very much appreciated.

(Original post, but you probably don't need to read it:

http://groups.google.co.uk/groups?hl=en&lr=&threadm=d2qqts%24fqb%241%40newsg3.svr.pol.co.uk&rnum=2&prev=/groups%3Fq%3Dvoidbox%26hl%3Den%26lr%3D%26selm%3Dd2qqts%2524fqb%25241%2540newsg3.svr.pol.co.uk%26rnum%3D2 )

When I saw my dentist he took some x-rays and confirmed that the tooth probably needed root canal treatment. He then referred me to a specialist. I had the initial consultation today.

The endodontist inspected the x-rays, had a close look and advised me that the tooth would be problematic to treat. The decay had started at the back (where the wisdom tooth was impacting and as such it would be difficult to ensure that the tooth was sealed). It would also be relatively difficult to operate on. He said that the probability of success was probably about 80%. He also thought that it might need an amalgam filling as it would need to be strong (although he did mention the possibility of crowning it). The other option worth considering, he said, would be extraction (as my other teeth are in reasonably good condition he thought this wouldn't impair me too much).

I now need to make a decision as to what to do. I'll go back to consult with my regular dentist as well, but ultimately I've got to make the choice. I've tried to write down what I think are the advantages are of each approach. It'd be a great help if anyone here can tell me which of these I should really worry about and which are mistaken or trivial. Also, is there anything I've missed? I've kept cost out of it: the root canal will cost more, but I'm prepared to pay to do what's best for my health in the long run.

REASONS FOR ROOT CANAL
- extraction is final (can try root canal then extraction but not vice versa)
- extraction would probably require me to take some time off work to recover
- extraction risks dry socket complications
- extraction might result in other teeth (particularly top teeth) repositioning adversely
- uncertainty over long-term viability of other back molar (tooth suffered similar decay - x-rays show no immediate need for root canal, but decay is quite deep).

REASONS FOR EXTRACTION
- root canal is uncomfortable surgery (not too worried about pain, but keeping mouth open for so long may be a struggle)
- root canal might require an amalgam filing to be successful
- root canal would require several x-rays
- if the tooth will likely have to be extracted sometime maybe it's better to do it when I'm younger (I'm in my early thirties)

TIA,

Sam



This seems like paralysis by analysis.
The way I would play it is if the tooth is restorable and the tooth is treatable by endodontia and if the periodontal status is good I would save the tooth. If there is a high probability of failure of the individual tooth I'd extract and plan on having an implant. There is no mathematical formula to make the best decision--in the final analysis it is a professional judgement whether the root canal is likely to succeed, and your decision that you can live with it.

Good luck,
Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001
.

Relevant Pages

  • Re: Dentist damages an unrelated tooth - now what?
    ... office, I noticed that the 2nd molar was sharp, and on further examination it appears that part of the filling is missing and possibly a small part has been chipped off of the rear of the 2nd molar. ... If this is a massive old amalgam you must understand that the tooth is probably fragile and would have been a maintenance problem whether the wisdom tooth were extracted or not. ... Under the circumstances, a minor chip on the next tooth might be considered a normal risk of the extraction, while a major fracture leading to the loss of the second molar would not. ... There has been much commentary here about the stress of dentistry, obnoxious patients, etc. ...
    (sci.med.dentistry)
  • Re: Difficult Root Canal versus Extraction (Back Molar)
    ... > I posted here about a week or two ago with a pain in my lower back molar. ... > When I saw my dentist he took some x-rays and confirmed that the tooth ... > the tooth would be problematic to treat. ... > option worth considering, he said, would be extraction (as my other teeth ...
    (sci.med.dentistry)
  • Difficult Root Canal versus Extraction (Back Molar)
    ... I posted here about a week or two ago with a pain in my lower back molar. ... When I saw my dentist he took some x-rays and confirmed that the tooth ... option worth considering, he said, would be extraction (as my other teeth ...
    (sci.med.dentistry)
  • Re: Tooth Extraction went badly - advice needed!
    ... Your dentist should have proceeded with a surgical extraction is he/she ... Because wisdom teeth can be quite tricky and this one was also ... dentist will tell you how easy or difficult each tooth will be to ... causing me any pain everyone just says to me "why did you take it out ...
    (sci.med.dentistry)
  • Re: Tooth Extraction went badly - advice needed!
    ... Your dentist should have proceeded with a surgical extraction is he/she ... Because wisdom teeth can be quite tricky and this one was also ... dentist will tell you how easy or difficult each tooth will be to ... causing me any pain everyone just says to me "why did you take it out ...
    (sci.med.dentistry)