Re: Two dental puzzles...

George,

Thanks for taking your valuable time to help me, an obvious newbie.

The speaker was probably a "biological" dentist relying on the focal
infection theory that was discredited 70 years ago. If a RCT has
failed, extraction of the tooth is certainly a viable option, but
retreatment may also work. I wouldn't worry much about distant
locations in the body becoming affected by infected teeth.

In my net browsing, there are plenty of sites that relate other problems, especially heart problems, to dental infection. Of course, this could be as you said based on long discredited information.

To put this another way: there are people who have chronic ear
infections or chronic problems with their sinuses, but noone has ever
recommended they remove their ears or sinuses.

But, tooth roots are very different in two important ways:
1. They provide a protected site for infection to prosper indefinitely.
2. Teeth are MUCH easier to remove, and removing them doesn't significantly disable or disfigure the patient.

I see your goal here: it is to preserve some structure remaining in
order to restore in the future. I don't know exactly how badly damaged
these teeth are.

They are broken off at the gum line. One had a crown and buildup that broke off and destroyed its margin on the way out. There isn't enough room to cut a new margin.

The other one just behind my top left incisor had an amalgam filling and then lost its outer cusp - the inner cusp is still there. There is still plenty of surface area left on this one and I would think that it would be a reasonable candidate for a bonded onlay, but so far no dentist has wanted to attempt this somewhat unusual repair. When asked why, they explain that they are afraid of breaking off the remaining cusp and destroying the tooth. This doesn't seem quite logical to me, since by abandoning the tooth without repair, they are in effect sacrificing the tooth (and indirectly the opposing tooth) to avoid taking a gamble with it. This goes back to our differing goals as mentioned earlier.

If most of the crown portion has been lost and it's
only the root that is remaining, you could have any current decay
removed,

There is no significant decay.

root canal treatment if needed,

The roots seem to be OK.

and then the top portion of
the tooth sealed with a material like glass ionomer to protect against
further decay.

This is new to me (oops, I am showing my vast ignorance). Can you tell me a little about glass ionomer? What is it generally used for? Can other materials, e.g. as might be used to build up a tooth, be placed on it, or would it have to first be removed?

This will not do anything to restore shape or function,
but it could maintain the root there for a long time. Maintaining the
root would preserve bone levels, which would be beneficial if you
decided to restore with implants in the future. But all this depends on
the individual teeth.

Remember, we may be talking decades here. Wouldn't the tooth still erupt over time, and wouldn't gums eventually recede from non-use? Also, the opposing teeth are threatened by having nothing to bump up against.

How about something that pushes when biting while limiting force, e.g. a thin elastomer sandwich bonded between a hard surface and the tooth? Of course, a simple buildup that would have to be replaced every year or so would also seem to be an option.

Perhaps a simple do-it-yourself blob of marine epoxy applied as needed? There is some stuff that remains slightly flexible that I could envision working quite well if you don't mind blue teeth (obviously an engineer's and not a dentist's point of view). The laptop computer that I am writing this on was smashed and broken, and I glued the pieces back together with this stuff! Its slight flexibility allows it to give rather than break under high stress, e.g. under screw heads at points of attachment.

Any thoughts?

Thanks again for your patience and help.

Steve Richfie1d
.

Relevant Pages

  • Re: root-canal + crown follow-up - s.m.d.
    ... despite a root canal, sometimes infections can occur in areas of the root ... this that make us all realize that the tooth really is a biological space, ... Surprisingly it's composed of little tiny tubules, ... tubules and they remain in there causing infection and eventually they ...
    (sci.med.dentistry)
  • Strange and persistent symptoms
    ... I have a long saga of adjacent teeth needing to be extracted ... but the tooth continued to ... It felt like a minor infection, ... In addition to the expense of 5 root canals, ...
    (sci.med.dentistry)
  • Re: Two dental puzzles...
    ... speaker was recommending extracting ALL infected teeth! ... sounds a bit extreme to me, extracting teeth where simple root canals ... infection theory that was discredited 70 years ago. ... This will not do anything to restore shape or function, ...
    (sci.med.dentistry)
  • Considering an implant to replace #10 (long)
    ... I lost my adult #10 tooth to root absorption after ... whole visible area of the tooth turned pink and then black. ... My parents and I discussed having an implant or bridge ... I had my teeth cleaned last week, ...
    (sci.med.dentistry)
  • Re: Two dental puzzles...
    ... Mexican dentistry that I've observed is extremely poor. ... this was YOUR tooth, and NOT what you would recommend to a patient. ... looks the worst on a recent X-ray (with part of the tip of the root being ... broken-off teeth, that for various reasons were not suitable for crowning ...
    (sci.med.dentistry)
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