Two dental puzzles...

I have two dental puzzles that different dentists have given me conflicting advice about. I suspect some combination of selling what they can do, not seeing the entire picture, CYA (Cover Your Ass), adherence to (dysfunctional) "standard practice", etc., etc.

I am looking to the best and most appropriate long-term solutions and NOT what is "standard (CYA) practice", in other words, what would YOU do if this was YOUR tooth, and NOT what you would recommend to a patient. As with most other people, my financial resources ARE limited, though I have crummy Delta Dental coverage and live near the Mexican border so I can get ordinary procedures performed inexpensively.


Puzzle #1: My lower right first molar is abscessed. It has apparently been so for a long time - looking bad on a 2-year-old X-ray. It has previously had a root canal and has a pin going into one of the roots - the one that looks the worst on a recent X-ray (with part of the tip of the root being eaten away), though all of the roots appear abscessed with darkened regions around them on the X-ray. At present, the tooth is firmly in place with no pain, though it did hurt a couple of weeks ago and had risen very slightly at that time.

My endodontist is ready to charge in and retreat the tooth, replace the pin, etc., (for ~$2k), but my Mexican dentist advises against this procedure because of a combination of low success rate and the risk of spreading infection even if retreatment is "successful" and an even greater risks if it is unsuccessful. Complicating this is the next tooth over on the upper is broken off (see Puzzle #2), so that with both of these teeth missing my chewing will be seriously impaired on my right side. Also, I now have no shortage of strange heartbeat anomalies, some of which are "understood" and are probably benign, while others have been a continuing mystery, which might be blamed on a dental infection.

Of course, the decision as to what to do is based on probabilities and costs. The costs are all too well known, but I really have no idea what the probabilities are. Can you help here?


Puzzle #2: Like just about everyone else I know, I have a couple of broken-off teeth, that for various reasons were not suitable for crowning without extreme (read that "expensive") measures (root canal, pins, buildup, etc.), that my meager budget just wouldn't support at that time. They are tightly in place and not super-erupted. My Mexican dentist advises me that my gums have since receded around them and they are now unrecoverable - and is drooling over the prospect of installing bridgework for ~$1,200 each, or better yet, implants for about double that price. Some of the adjacent teeth are NOT crowned but have been extensively and deeply amalgamed, so I suspect problems in crowning them to install a bridge. Also, one of the adjacent teeth is a good incisor that I would sure hate to lose to a crown.

What would seem reasonable to me (no, I am NOT a dentist, but I AM an engineer), would be to build up a rounded conical "nub" onto each of these broken teeth that would be high enough to engage the opposing tooth, but would NOT hang off to the sides to dislodge it from the tooth when biting down on something hard, so that no pins, etc., would be needed to secure it. In one case, the opposing tooth is an all-gold crown that would almost certainly be completely beyond any possibility of being damaged by this. This is somewhat reminiscent of the aboriginal tribes that chip the corners off of their teeth to look fierce, only in my case it would be built-up material instead of original tooth. This wouldn't look quite like original equipment, but these aren't front teeth. This wouldn't work quite as well as original equipment, but it would put these teeth back into at least partial service and hopefully preserve them for some decade in the future when some other solution might be more appropriate, e.g. when the adjacent teeth need crowns for other reasons, when my rich uncle dies and leaved me enough to install implants, etc. Certainly, this would be better than simply leaving them as they are to continue erupting, receding, etc.


I have had my fill of "professional advice"!! What I appear to need now are ideas, suggestions, thoughts, experiences, or ~$20K to use traditional methods if your piggy bank happens to be overflowing.

What do you think?

Thanks in advance for your thoughts.

Steve Richfie1d
.

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