Q: I had a tooth root canaled about fifteen years ago and it’s been fine. A crown was made at about the same time. I’ve been good for all this time but then about the end of March when we were all on “lockdown” the tooth began to bother badly! I could tell which one it was every time I swallowed. If I pushed on it, it hurt. How can that be I thought there’s no nerve?
I called my dentist and he wasn’t in so I finally got someone who would get me some antibiotics. It’s calmed down but what’s up? Am I going to lose this tooth and if I do, what should I do about it? The teeth behind and in front have crowns and they’re fine but if that tooth comes out what happens?
I was told I could get an implant or a bridge but then if I get a bridge won’t that mean the teeth on either side of the gap will lose their perfectly good crowns? I’ve never had a missing tooth since I was a kid. What are my options?
A: First of all, the pain you suffered maybe one of several conditions. First, the root canal may have some microscopic unfilled canals that are now harbouring bacteria. That bacterial challenge has over powered your immune system and there fore you have an abscess. If this is the case the tooth can be retreated or a surgical procedure can be done to eliminate the problem.
The second possibility is the root of the tooth is cracked, and is infected so you’re experiencing pain. In this case, the tooth will be lost. A cracked tooth cannot be made whole. You have several tooth replacement choices. Today one would say an immediate implant could be placed at the time of tooth removal. This is a good option, however if too much bone has been destroyed by infection the extraction site should be grafted and an implant placed four to six months later.
If you choose a bridge, bone grafting is also important so bone resorption (bone dissolution over time) does not leave a gap under the bridged tooth. Yes, the crowns would have to be sacrificed. Your last option is to do nothing but that leads to many other problems besides not being able to chew properly on that side. All things being equal, the implant is your best option if the tooth is lost.