Q: Dr.Crapo, I have a terrible mess going on in my mouth. I’m thirty-eight and every tooth needs a root canal and crown, or needs to be extracted, a bone graft then an implant and crown. That’s the report I got when I told my dentist I wanted to save my teeth. When he gave me the estimate, I fell off my chair. Seventy-five thousand dollars! I don’t have that kind of money – heck my parents and grandparents couldn’t get me that kind of dough. At first I was shocked – numb and dumbfounded but then I felt despair, frustration and anger. Not only are my teeth a mess, they look gross. I can’t smile, I feel self-conscious in conversation and I wonder if my breath is alienating my co-workers. I really don’t know what to do. I’ve got two dental plans with yearly limits of $1500 each. As you can see, $3000 wouldn’t come close. I could raise another three, but that’s a drop in the bucket. I’ve started to think about dentures, though it’s a great disappointment.
How would you go? What would you do?
A: There are at least two pluses you presently have. One is your age, the other is technology. Just over twenty years ago, great solutions such as root canal began to appear for situations such as yours and have only gotten better since the late eighties and early nineties. If you handle the situation carefully, you will be able to take care of pain and esthetics, and at a later date do something vastly better than dentures.
An option to help reduce cost would be to do the work in two phases. The first phase at the end of the year, and the second phase at the beginning of the following year. Any portion of your plan not used, goes into the ether (someone else’s pocket). If I were you, and my only option was removal of abscessing and broken down teeth with a denture, I’d choose an immediate denture for the top teeth (graft the sockets too if you can), that way I’d have something that would stay in place during the holidays and look good. I’d be able to use up my plan benefits for that year and not put myself into a fifteen year mortgage.
Taking care of the lower teeth would occur in the following year, but with a small difference. Because a lower denture is much less stable (it flops about) than an upper denture, I’d try to keep 2 or more teeth by root canaling them then having them shaved to stumps. These stumped off teeth act as strong pilings to support the lower denture during chewing. In less than two months, you’ll have a good looking, pain free situation. In the future, your grafted jaw bone would allow implants to be placed and bridges to replace your dentures.