Common Household Remedies Request
At the risk of turning Corrente into a medical crotchets site, here's an X-Ray of the molar that's a candidate for extraction, emphasizing that word "candidate":
The molar in question has a history: The cracked filling was done by the horrible corporate dental mill that wanted to extract all my wisdom teeth, even though I wasn't feeling any pain, way back eight years ago when I worked in the cube and had insurance. Fortunately in retrospect, at least in my mind, I decided against what looked like a pointless procedure; gawd knows what they would have done to me in surgery if they could't handle a filling.
Anyhow, the filling cracked right after I came up to Maine, in 2006 -- suddently, a chunk of it came off in my mouth -- but from that time to this, I've had no pain at all. Occasionally I get some sort of infection that makes its way up my Eustachian tubes, but I kill it off by swilling red wine for an evening, swirling the wine round my mouth like a wine taster. Otherwise, no pain, no swelling, no feel of an abscess on my gums. A tooth geek told me to Google "necrotic molar" and this (leaving out some medical articles I can't make sense of) is what I came up with:
Question: I have an upper rear molar that's necrotic; my dentist wants to do a root canal, just recently drilled a cavity & filled with temporary filling. My experience with root canals are they end up capped then fall out when that weakened; can I just have a permanent filling without the root canal? I'm willing to take the chance; the tooth has been " for quite a while and I don't see the necessity for root canal work.dead"
Answer: The conventional wisdom is that a non-vital tooth will require root canal therapy, because it will invariably develop overt infection. While this is generally true, I have witnessed not a few teeth that were conspicuously non-vital (as determined either by electrical pulp testing or x-ray examination) that did not develop conspicuous infection over a period of many years. However, the neglect of the non-vital condition was not by my choice, but due to the patient's refusal to implement a course of treatment that I recommended. Although these events may seem to represent good judgment on the patient's part in retrospect, it really just means the the patient gambled and won. In the majority of cases, though, maintenance of an untreated non-vital tooth is an invitation to an acute pain event, and one that usually occurs at an inopportune time.
So, I got lucky about something, at least!
Readers, I'm really not asking anybody to diagnose the problems my molar, remotely, from an iPad photo of just one X-Ray. But I'd like to understand the parameters, and whatever additional parameters I need to find out about. I'm assuming that my choices are either extraction, or a root canal.
1. I'm assuming the molar is necrotic -- if for no other reason than that "necrotic" is a really great word -- because it fits the facts. "Maybe the nerve died," as another friend said when I mentioned the curious lack of pain.
2. The molar isn't much good for chewing; look at the angle of it. ("Useless" is what the Thai dentist called it; that, and "hard to clean," which is true. They're really offended by it, and they're right!)
3. My understanding of a root canal ("endontic therapy") is that the inside of the tooth is drilled out, and then the tooth is filled up. It's as if a plaster wall got dinged, so I get a putty knife and cut away the damaged plaster, and then spackle it. But in the same way that spackling won't help if there's structural damage to the plaster, like the lath behind it is damaged, a root canal won't work if the tooth's structure is bad. Which is why the deep cavity and what look like small roots are worrisome; perhaps the molar's structure is unsound.
4. All other things being equal, a root canal seems preferable. Though it's more expensive, I can afford it, as long as I'm here (though not at home).
5. With an extraction, there's 3 or 4 days of swelling, so it's probably not a good idea to schedule a visa run during that time. (I have to cross the border and come back in to Thailand after I've been here 60 days.)
6. With an extraction, my teeth are going to start moving around, slowly, tectonically, but still moving. That worries me, if only because never having had braces, I think of teeth as being solidly fixed in position. It just feels to me like there's no upside to having my teeth moving around.
7. With an extraction, am I going to end up with a bad-looking jaw, like a toothless Mainer who lives in the woods?
8. What about the tooth below this molar? Presumably, it can stay; there's nothing wrong with it, and since this molar is so out of alignment, it's not biting down on the tooth below, or on anything else, for that matter.
9. My current dentist has been deft and pain-free with routine fillings. But they're going to have to outsource an extraction or a root canal. However, it seems just as reasonable for them to quality a practitioner, a for me to do it.
So, those are my questions about my necrotic molar. I know for some of you who have had real medical issues, this probably seems trivial, even whiny, but I've been very lucky not to be involved in the medical system for many years; this is really the biggest actual decision I've ever had to make (touch wood).