Periodontics and saving a a broken tooth

Discussion in 'Periodontics' started by calex75, Nov 5, 2018.

  1. calex75

    calex75

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    Sorry for the lengthy post. Those who could be able to answer me may want to read 2 paragraphs and skip to the question at the end.

    I recently moved to a new country (Canada). Unfortunately, last Sunday a piece of the tooth #3 broke while eating a pie. This tooth had been filled with an amalgamate about 25 years ago.
    About 3-4mm of the enamel detached on the upmost cheek face (if you look at it, roots down). At one point the broken part completely detached and I could clearly see the amalgamate and something reddish below which made me freaked out. I quickly rinsed my mouth (water was not colored by blood) and put back in place the broken part of the tooth (the slight pain vanished within minutes. Miraculously, the broken piece held until I could have an appointment 3 days later on Wednesday.

    The dentist told me that the XRay showed the tooth died (probably from bacteria) and she had to extract it. I managed to keep all my teeth until now (47) in spite of my periodontics disease, and could not take it so I insisted for an alternative. She explained, that in a normal case she would have cleaned the root canal but in this case she couldn't due to my periodontics disease. - On this tooth I would say that somewhere between 50-80% of the bone was missing but the tooth was not loose and my periodontics disease has been stable for the last 5 years-. I started crying and begging for an alternative even temporary. She answered that the only other alternative would be to let me go without doing anything and risk an infection. But that I should not be sad to have it removed, she was going to introduce me with her boss who is extremely experienced and it was not an issue.
    I knew that if for any reason the detachable part would be gone missing I would suffer and would be in trouble so I felt I had no other choice than to trust her and accept.

    ACT II

    Two days later (last Friday), I met this “exceptional” dentist, and things started badly when he explained me that the best for me would be to have all my teeth pulled off and replaced with an implant. He finished : “Not now, rather in 5-10 years”. But continued : “However, the earlier, the better, one of my tooth was already missing” - I was shocked, never ever in France a dentist told me anything else than : we will do whatever it takes to save my teeth -. He then showed me an advertising with an old man saying how he was happy with his white weird looking implants. He continued and told me that for now he would do a $2000 bridge but I could also stay with a missing teeth. I enquired about the consequence of a bridge for the adjacent tooth (#2 and #4) and he reassured me they would be more solid than before because that would be a big tooth with 2 roots... which is better than one. I was not convinced and answered that 3 roots would be probably even better. And that’s a shame because her workmate had a hard time pulling my missing tooth off. It looks like it really did not want to be extracted. He nodded.
    I pretexted I had first to call my insurance and I would come back toward them.



    Back home I grew suspicious about this bridge. My guts were telling me that my tooth #2 and #4 wanted to be left alone (tooth 4 is loose and missing 60% of the bone). So I googled "periodontics disease and bridge". Horror, I can't find a single site not saying that a periodontics disease is a contraindication to a bridge. That my bone would deteriorate hence losing both tooth faster.

    How can this dentist ignore that (he would have a specialty in periodontics according to his resume [removed resume]). Would these dentists pull off my tooth thinking they would be able to pull off all my remaining teeth to sell me one of their fancy prothesis?

    Now I feel worse and worse. I barely can eat with my missing teeth. I feel that I was stupid to let her extract my tooth without even googling her name. She has 8 months of experience : [removed removed] .

    A question is going back and forth in my head. And I am looking for an answer. Did she do whatever she could to save my broken tooth? Is a periodontics disease really a contraindication to root canal cleaning?
    I also read that if do nothing, my bone is also going to deteriorate (due to the tooth no longer stimulating the bone). On which timeframe should I absolutely meet a periodontist and dentist.

    PS: if anyone has a trustful periodontics specialist and/or dentist to recommend on Vancouver, I need help.

    Edit : I removed the links to my dentists resume. Although I think they help understand the story. I don't know if the forum rules allow it.
     
    Last edited by a moderator: Nov 5, 2018
    calex75, Nov 5, 2018
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  2. calex75

    honestdoc Verified Dentist

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    Could you provide x-rays? Vancouver is a beautiful city with plenty of great dentists. You may ask your friends, acquaintances, coworkers, etc who they recommend. Unfortunately, more & more dentists are selling you work you may not need or not to your best interest.
     
    honestdoc, Nov 5, 2018
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  3. calex75

    calex75

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    I may have some xray tomorrow.

    I was right, again :), she admitted my tooth could be saved when I announced I was done with them :
    "[...] Thanks to Ms Bxxxxx, I now know how dentistery was practiced in the middle age, but I don't need a dentist who has not the skills to fix a stupid broken tooth. Neither do my kids.

    Best,
    "
    She has too much ethic to listen to her patient, that's why she extracted my tooth:
    "[...]The only other option to attempt to save that tooth would have been to do a root canal and put a crown on the tooth (which would cost upwards of $2500). Because there was also so much bone loss in that area and the prognosis was so poor, it would have been unethical for Dr. Bxxxxx to attempt this.
    [...]
    I believe Dr. Kxxxx did give you some options on Friday to put something there so you can eat normally
    [...]"

    But her boss could only convince me that the only possible option was to keep my tooth and its bone. - A bridge : I doubt my #4 teeth could support it. It is so loose...
    - Nothing : her boss told me that I could stay like that but I don't believe him. My teeth 2 and 4 are going to be extremely vulnerable to efforts perpendicular to their roots.
    Conclusion : there was no other option than crowning my broken tooth. Keeping it would continue to stimulate my bone, provide some longitudinal support to my #2 and #4, divide the pressure on the other teeth.

    Am I wrong? I really hope they were right to extract this tooth. Whatever they say it sounds like lies and does not make sense to me...
     
    calex75, Nov 6, 2018
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  4. calex75

    calex75

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    Here, the xray of my teeth.
    What do you think about extracting it?
    - Would it be YES.
    - No WAY
    - Or not sure?

    And more importantly, which option do I have now? What would be the deadline to have an appointment in order to keep all the possible options? 2 weeks, 2 months? 2 years?

    Thank you,
     

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    calex75, Nov 7, 2018
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  5. calex75

    honestdoc Verified Dentist

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    You had mentioned #3 (UR side) broke. The x-rays show UL side so maybe it is flipped wrong? I would never do a bridge 2-4 because of inadequate bone especially #4 being mobile. If #3 has no pain, no swelling, no mobility, leave it and restore it with a conservative filling on the fractured area.

    There was a periodontist that presented a case similar to yours. The patient was able to keep her teeth with meticulous home care and frequent hygiene recalls for over 10 years. All to often dentists and specialists want to sell you expensive treatment in an expensive city like Vancouver BC. Find a dentist/periodontist that share in your best interest of wanting to keep your teeth as long as possible. You will know if the provider is right for you.
     
    honestdoc, Nov 8, 2018
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  6. calex75

    calex75

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    Thanks a lot for your answer Honestdoc,
    Sorry, I miss-read https://en.wikipedia.org/wiki/Universal_Numbering_System.
    The broken tooth, which was extracted,was rather #14. The #13 is mobile.
    Actually :
    - Although I was not feeling any pain. If I attempted to chew something it would be very painful. Then the pain would vanish within minutes
    - The first time I saw her, she told me she saw some blood so she was suspecting the tooth died;
    - 2 days latter she did the XRay above and told me the absence of a "white cloud" in the bone bellow the broken tooth, confirmed the tooth was dead so she extracted it;
    - A few days latter when I cancelled my appointments, she wrote : "The only other option to attempt to save that tooth would have been to do a root canal and put a crown on the tooth (which would cost upwards of $2500). Because there was also so much bone loss in that area and the prognosis was so poor, it would have been unethical for Dr. Bxxxxx to attempt this."

    Would you have done that?
    Now that my tooth is extracted, what would you do?


    Thanks,
     
    calex75, Nov 9, 2018
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  7. calex75

    honestdoc Verified Dentist

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    I am very conservative and many other dentists would disagree with me. My thoughts are...we can always do a root canal, extract, crown, drill, fill, etc as needed basis. We can never undo dental work.

    Unfortunately, you do have a lot of bone loss and the longevity of your teeth is questionable. I would never restore your teeth with questionable periodontal condition. I would leave it alone for now...no bridge, no root canal, no implant. I would establish stability in your gums and bone first by deep cleaning (scaling/root planing), frequent recalls like every 3 months to establish stable gum attachments (probing). Once your gums are stable...no bleeding, no deep pockets, reassess how you are functioning in that area. Do you need an implant, partial denture, or leave a space? I would never do a bridge there.
     
    honestdoc, Nov 9, 2018
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  8. calex75

    calex75

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    You're right, I wish my tooth could be put back where it was but this can't be undone...
    Anyway, thanks a lot for your time and advice. At least none is going to sacrifice my other teeth with a bridge.
     
    calex75, Nov 10, 2018
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