Re: Two dental puzzles...

George wrote:

Thanks for your comments. I have some subsequent questions:

It's hard to tell without looking at them; if you could post xrays of
the teeth in question it would be a great help.

I don't think we are allowed to post attachments, but I have a scanner that is supposed to be able to scan slides. I'll see if I can get it to work on the X-rays and email them to you if I am successful.

Puzzle 1: It all depends on how badly you want to save that tooth. Ask
your endodontist to eyeball what the approximate chance of success
would be in his opinion, considering all the complicating factors. You
need to know not only if the root canal has a good chance of working,
but also how easy it would be to restore the tooth to it former shape
and function afterwards. Then you can weight this info with how much
it's going to cost you and how desperate you are for keeping that tooth
and take a decision.

Another factor that has my great interest is the effects of infection on my heart and other organs. I already have a variety of heart beat anomalies, some of which would seem to be consistent with some sort of infection, e.g. if I eat a bunch of sugar, then maybe 12 hours later (when my immune system has had a chance to be depressed by the sugar) I experience some atrial fibrillation. Of course there are other potential explanations, but there may be some major risks in "screwing around" with this, especially in my case.

On a related note, a decade or so ago I attended a lecture where the speaker was recommending extracting ALL infected teeth! His explanation was that it was ever so easy for residual infection to escape detection, and in the process do long-term damage throughout the body. While this sounds a bit extreme to me, extracting teeth where simple root canals have failed seems more reasonable. Do you have any thoughts on this?

Puzzle 2: It's not going to work. You will not gain anything and you
might end up with more damage. Back teeth have that flat shape for a
reason, they are designed to crush food.

These are both small top teeth - one just behind my left incisor, and the other is on the opposite side one tooth further back. In short, these are both small single-rooted teeth. My goal here was not so much to improve mastication, but rather to simply preserve the teeth and gums for possible rehabilitation sometime in the distant future when their neighbors have been lost, must be crowned, etc.

What you want to do is give
them an unnatural shape and an unnatural function.

Yes - an unnatural shape but the only function is to preserve them indefinitely into the future.

If these teeth are
truly unrestorable as you've said,

Not COMPLETELY unrestorable - one dentist gave me a $4K estimate for each with no guarantees. They aren't worth that when I still have most of my other teeth, but this situation could be VERY different in another 20 years. However, if I simply leave them as they are, they will probably either decay away or erupt in that time. Both still have their roots. What I am looking for is really a in-mouth STORAGE plan.

there is no patch-up material that
will stay there for the long term and even if it did the design you
have in mind would not improve your masticatory ability. On the
contrary, a poor design might lead to problems like food impaction
threatening the wellbeing of adjacent teeth.

The obvious question then is: "What would a good design look like?" Any thoughts?

This all brings up my primary beef with "modern" dentistry. Their goals are NOT my goals! My goal is to live a long life and eventually die with enough teeth to still chew fairly efficiently, whereas "modern" dentistry seeks to provide a 20 year solution (way too short) that looks pretty (when I don't). My most recent "failure" died 15 years after heroic efforts to save it. I suspect that most dentists would consider that a success, but that is just another tooth that I won't be dying with. Most dentists won't even fill a wisdom tooth, despite these being very effective anchors when 2nd molars are lost sometime in the future.

To accomplish this very long term goal, I suspect that in-mouth "storage" of severely damaged teeth would be an effective tool. This would certainly be better than pulling and bridging them given the limited life expectancies of bridges and crowned teeth. Also, there are good bridging situations (e.g. where the adjacent teeth must be crowned) and poor bridging situations (e.g. where the adjacent teeth are still sound). Why not simply wait for the right situation? Also, the optimal restoration of often a function of what is happening with adjacent teeth, and this could radically change in the future.

At the rate that I am now going, I will probably need a bunch of implants in another 20 years or so. However, I would like to put that off for as long as possible. Who knows, maybe I will be planted tomorrow with my present teeth! I would much rather enrich my kids than enrich my dentist.

Thanks again for your comments.

Steve Richfie1d
.

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