Q: Dr. Crapo: Last week I went to the dentist because I had a bad ache in my upper right, last molar. When he looked at it he said it had a lot of decay and should be pulled. Four months ago, he pulled my lower right molar, second from the back, because it had lots of decay. I told him I didn’t want another tooth pulled because it felt like I was losing all my molars. Yesterday I saw another dentist, who said the tooth could be saved. He also noticed I had a dry mouth and asked if I was nervous or if I had been taking medication for high blood pressure, cholesterol, etc. I said high blood pressure, but I hadn’t associated it with the dryness in my mouth. He said it could be the reason why I was getting more decay. No one had said that before. He said as long as I’m on these meds decay would be a problem. He also said that my upper right molar could be saved but didn’t recommend it, because I might spend a lot of money only to have decay set in. I don’t know what to do. It feels like I’m just going to lose all my teeth. I’m depressed, what should I do?
A: First of all, dry mouth and resultant decay can be managed effectively. Your doctor should be aware of the class of drugs you’re taking and try something as effective that doesn’t decrease salivary output. Unfortunately, this is not well-researched and he may have to go to several studies to find an answer.
Dry mouth is managed by removing all decay (fillings etc.). Fluoride trays are then made specifically for your mouth; they deliver fluoride to the teeth. It kills bacteria, strengthens the enamel and stops sensitivity. In addition, rinses, lozenges and chewing gum with saliva stimulating action, create the needed saliva to neutralize acids. Seeing the hygienist quarterly, helps in prevention and management of the problem.
You were right to not have the tooth out. If you had, your molar function would be gone on that side, but here’s an idea. Have the dentist remove the nerve on the ailing back tooth – put an implant where the molar was extracted four months ago. If after four or five months of managing your dry mouth you’re successful, have the top back tooth fixed. If you can’t manage to prevent further breakdown, have the tooth out. You can function very well with only one set of molars, your natural top tooth against the new implant crown (which can’t decay).
Implants are the last resort of managing dry mouth, but when necessary they’re a great blessing.