I Just Didn’t Want to Lose That Tooth!
Question: Dr. Crapo: About a year ago I lost my upper left back tooth to decay. Both myself and the dentist were surprised, because I really work at my dental hygiene and to find decay under a crown that had travelled into the nerve and into the bone, was a surprise. I’ve had a lot of dental work and it is in very good shape, so my dentist couldn’t figure out why it had happened. He did his best to save the tooth because I didn’t want to lose it, but when he got the existing crown off and started to investigate whether it could be saved he found that the decay had eaten right through the roots. I was very disappointed because it was my favorite side to chew on and I especially like to eat my harder things back on those teeth. When everything healed I asked if I could have an implant and a new crown, so I could have my good chewing side back. I’ve learned to chew on my right side but I really miss that tooth. The problem, my dentist says, is there’s not enough bone to put the implant in. He said my sinus was large meaning it encroached on the bone in that area, so I only had about ¼ of an inch of bone and I need ¾ of an inch. Am I stuck without a tooth? What do you think caused the decay?
Answer: With good dental hygiene and good dental work, it’s hard to say what allowed the bacteria to get a hold and then do the job so completely that you lost the tooth. The best theory is micro-leakage exacerbated by the chewing forces and perhaps grinding of teeth that you weren’t aware of. When teeth, fillings and crowns are overworked, cracking in the teeth and gapping at the edges of fillings and crowns can cause an ingress of bacteria as the filling or cement holding the crown on, begins to crack. Bacteria can easily be “sucked in and set up home”. In this case, everything worked to their benefit to multiply quickly when they got inside, protected from your cleaning efforts. No one is to blame; it just happens that way sometimes.
As for your tooth that is missing – fortunately advances in implant placement has developed some wonderful techniques where one may prepare the hole for the implant, enlarge a space under the sinus membrane, then add bone so that when the implant is then inserted, it is completely covered with bone which becomes solid around the implant. About six months after implant placement, you can have a crown. Done well, it works perfectly.
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This article was originally featured in the Victoria Times Colonist on November 8, 2015.