Q: Dear Dr. Crapo: Almost 50 years ago while expecting my second child, I was travelling with my husband. His business took us all over western Canada and the U.S. We ended up one day in a small town and went out to lunch. During my meal, I bit down hard on a crusty piece of bread and heard a crack. It sounded like an explosion in my mouth. I knew right away something was wrong. I excused myself and went to the washroom to spit out the contents of my mouth. Once rinsed, I explored my mouth to find I’d broken, quite badly, my second to last molar on my lower right side.
Fortunately, or not, we found a dentist in this town. He took one look, froze me up and pulled the tooth. Since that time, I’ve just learned to deal with no tooth there. However lately, the tooth behind the extraction area is wearing significantly and the tooth in front of the extraction area has started to decay.
Though it has been fifty years, I’ve only changed fillings when it’s been necessary but now it looks like I need crowns on both teeth, so it was suggested that a bridge would be a good way to go. I’ve been told that in those years that the tooth that was hitting the extracted one has descended down, so if I do a bridge the top tooth must get cut back to put it in it’s original position. I’m told it will need to be crowned. I should have acted sooner but it hasn’t hurt and I’ve gotten by just fine, but now what to do.
A: You’ve got at least three options. The option we would ideally suggest is to put an implant in the space and then crown the other teeth (two on the bottom on either side of the implant and the one above, so your bite is even). Another option is to bridge the two lower teeth so they are protected, the decay is eliminated and you have greater chewing ability. Of course, the upper tooth would also have to be crowned. Both of these options require a good analysis before proceeding, to make the best result.
The last option is to simply crown the lower teeth and leave the space. This is not the best option but in the short run it is the simplest – and you are used to the space.
Option one is the best because it can be cleaned and maintained better than a bridge. It is better than option three because it provides greater chewing function and prevents further bite changes.