Q: Dr. Crapo: I was born in a small community – mostly rural I would say, where dental care was far from our location and our minds. Teeth were cared for as they became an emergency and sometimes not even then. I escaped pretty well through my childhood and didn’t have much problem or concern through adolescence. The problem was that it never occurred to me to habitually see the dentist and hygienist. I entered adulthood, then marriage and family life. In my late twenties, I began to have some dental problems. At first some large fillings, then came root canals and crowns. Over time I spent a lot of time in the dental chair. Lately my teeth are falling apart. I’ve lost three crowns and another is loose. I sought help and was told that I now needed implants. With that, I’ve done a fair amount of research and asked friends who have undergone that treatment. I need at least two implants. One to replace my lower left molar which abscessed three weeks ago and made my face swell. The other one is my upper right molar where another crown was lost and the decay is too bad to get a root canal and a new crown. I’ve actually got a loose crown in front of that molar on the upper right and the tooth behind it has also lost a crown and has deep decay. I think I need implants. I don’t want bridges because I want something that will last and not decay. Luckily, I don’t have pain since the abscess was treated with antibiotics but I’m told that won’t last long. So, if I get implants that will be it for those teeth, yes?
A: There are a number of important issues going on in your mouth. Two are very important and careful analysis and work must be done before any implants are placed. The first is rampant decay. The second is strain being placed on your teeth by a bad bite, bad reconstruction of your teeth, clenching, grinding or a combination of these factors.
Decay under a crown starts at the edge where the crown meets the tooth. Careful removal of plaque daily is a must. Over time this decay, if not caught early, can work its way under the crown through the tooth underneath and turn it to mush. At that point, a soft noodle will dislodge the crown.
A forceful bite that is not controlled through excellent reconstruction and other means, can put so much pressure on crown(s) that the cement holding the crown in place, begins to crack. Once that happens, leakage of bacterial laden saliva can begin the decay process.
It will be important to have a thorough analysis of your bite and decay. Once that is calculated a comprehensive plan will give you the best timing on replacing the problem teeth.