Corrente

If you have "no place to go," come here!

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).

Thoughts?

AttachmentSize
teeth.jpeg262.22 KB
0
No votes yet

Comments

V. Arnold's picture
Submitted by V. Arnold on

Thais generally have their teeth pulled. My suggestion is to ask is it necessary? I don't like losing teeth. So I go the root canal/crown route.
My sister was here for a year and state side was told she needed a root canal/crown ($3,000) which she didn't have. Here, a very good dentist told her no root canal, just a crown (฿5,000). That's baht, not dollars. She went back to the states a year later with her tooth.
Cheers.

Submitted by lambert on

I feel that I'm getting good advice from my dentist (for example, there's been no hint of upselling) but at the same time I'm getting Thai advice, if you see what I'm saying. (I deliberately went to such a place, so I have no complaint.) So your comment is helpful. Sounds like second opinion time.

V. Arnold's picture
Submitted by V. Arnold on

Never a bad option (2nd opinion). There is a very good dental clinic at Mahidol University in Nakhon Pathom (about 30 minutes from Central Pink Lao).
I don't know where you are in BKK, so it might be 2 hours for you. I'm 80 k west of BKK and avoid it whenever possible ;) .
I did have my last wisdom tooth pulled just before coming here. I see no value in them; it's the rest I worry.
Cheers.

Jay's picture
Submitted by Jay on

No. Get that fucker pulled. It's useless. It'll be nothing but headaches and infections. There's no point getting a painful and expensive root canal, which may fail!, on a tooth like that. Its only function is to be painful and give you life threatening infections. That's like getting a root canal on your appendix. You made a mistake not pulling it years ago when you were younger and could heal much more easily. After a while you'll never miss it, and if it's been getting serially infected you'll be much better off.

quixote's picture
Submitted by quixote on

I was one of the people who warned about teeth shifting after an extraction. If you're talking about a non-functional, because unopposed, wisdom tooth, that's way way way less of a concern. Probably not a concern at all. (I am not an endodontist! :) ) Get the second opinion at the University dental clinic V.Arnold mentioned. It's worth the day trip to feel more sure of your decision.

(Prefacing again with "I am not an endodontist," my first thought on seeing the x-ray was, "Holy crap. That thing has to come out.")

V. Arnold's picture
Submitted by V. Arnold on

Yes, as a non medical person; I'm not about to offer medical/dental advice.
Just common sense and sympathy for dental pain. It's the worst.
And yes, unopposed is important as well.
Cheers

albrt's picture
Submitted by albrt on

Not a dentist, but I agree with Jay and the Thai folks - that tooth is useless. You are right to be concerned about overly aggressive tooth pulling and replacement in the US, but wisdom teeth are a different animal. They were designed for when people lost their molars in their twenties and died in their thirties. If the other teeth are good, movement probably just means the molars will be less crowded.

Submitted by lambert on

This all makes a lot of sense. As I say, I don't have trust issues with the Thai dentists, but I do want to make sure I understand all the parameters. Bottom line here seems to be that "useless" is exactly right, and when they say "hard to clean" they are saying, in a nice way, that infection and all sorts of other bad stuff is also a danger.

Jay's picture
Submitted by Jay on

You're afraid of dentists, dental pain, irreversible outcomes. I understand that. Getting older, I realize that dentistry presents choices between bad and worse, because we're sort of not meant to live much past about 40 years. One thing at anthropological digs that shows up again and again is rapid tooth loss => death, which usually starts occurring late thirties early forties. So yea modern dentistry! Another thing is that human jaws have been shortening, and aren't actually long enough for our Neanderthal-mandated number of teeth, which is why those wisdom teeth are so foolish. Looking at that X-ray I don't like the wisdom tooth's counterpart on the lower jaw either; it looks half impacted into the mandible with some abscess around the anterior, but at least the root isn't twisted around to accommodate it. And if it's not bothering you . . . I am not a dentist, but I play one on the inter tubes.

Submitted by lambert on

I don't know if you read my previous post, but one of the advantages of Thai dentistry is that they really try to avoid pain; it's a cultural imperative.

I focused on this one molar because it's what has to be done now, this trip; a cracked filling that I'm conscious of... There isn't a lot of upside to that. Suffice to say they don't like a lot the molar you mentioned either, and they don't like molars on the other side, and for the same reason: "Useless," and "hard to clean." And they're right! But they aren't cracked.

I've been gradually escalating the tasks that I give them; for example, cleaning, cosmetic, cavity, and now this -- likely, the extraction. But I'm not willing to have them more than one extraction done the first time. I want to proceed in the same way; test them, then give them more work. (For example, there are plenty of horror stories online, so what happens if I get infected from fixing a cavity? The obvious answer is to test them and wait a few days....)

Submitted by hipparchia on

anecdata, n=1, and yes I am biased, but still...

wisdom teeth - I'm a fan of getting those suckers yanked out (painlessly, of course). I had more than the regulation number, and an uneven number to boot. they were growing in all the wrong directions, crowding my other teeth, impossible to brush and floss well enough, and constantly getting infected. my life (and disposition) improved measurably after I got rid of them.

7. With an extraction, am I going to end up with a bad-looking jaw, like a toothless Mainer who lives in the woods?

even senior citizens are getting braces these days http://www.webmd.com/oral-health/features/straight-talk-about-braces-for... and you can even get invisible ones too, no matter what your "before" picture looks like http://www.invisalign.com/how-invisalign-works/braces-before-and-after

Submitted by hipparchia on

getting wisdom teeth removed now is a bigger ordeal than doing so in your teens or 20s and that should probably be the bigger factor in your decision on whether to keep the tooth or get it pulled. I mostly just mentioned the braces as a reminder that if you do decide to have it removed, you're not necessarily doomed to have an ugly and miserable old age. :)

Submitted by lambert on

I don't want to pull them all at once because pain, money, and trust issues. But I think that cracked one isn't long for this world, and that will give me a reading on the pain and trust issues.

Submitted by lambert on

A reader writes:

I saw the piece about your molar. I ignored one for twenty years. It fell out earlier this year, with absolutely no pain.

If pain does flare up, your best friend will be Peppermint oil. Root canal in a bottle. I can't tell you how much that stuff has helped on some nights. Apply directly to infected area using Q-tip or clean small paintbrush, but be careful with the fumes -- it can get very hard to breathe.

I always keep a bottle marked "Pure oil of Peppermint" near my chair at all times. It sets my mind to ease.

I wish that molar would fall out, but given the angle its at, I don't think it will.

wanderindiana's picture
Submitted by wanderindiana on

The angle it is at, it looks more like a wisdom tooth than a molar. It does not look like it ever had a proper bite, I.e., connection/meshing with a lower tooth.

That said, as someone missing a second molar on the upper left, and who has had multiple root canals and crowns, I don't think extraction of the tooth is going to cause any detrimental shifting or have adverse effect on your bite.

If you still have to decide, go for extraction. The molar I had extracted? It was a crown that over a root canal that somehow became infected about 8 years after the initial work was done. It was painful physically and fiscally, all that money spent on the fix down the dumper, plus the cost of the extraction.

Save yourself the money and the possible problems down the road. Yank it.

Submitted by lambert on

There really seems to be a consensus on this.

Incidentally, I remember the X-ray the corporate dentist took, and it was different. I wouldn't put it past those weasels to swap in a fake image as a sales tool! They were very aggressive.

The Infamous Oregon Lawhobbit's picture
Submitted by The Infamous Or... on

Re: the "toothless Maine look," I had four wisdom teeth pulled courtesy of an Army dentist. "They're coming in perfectly," he said, "But they're not going to come in far enough and you're in for a lot of infections because they've broken the gumline." I was 22.

Thirty plus years later, there is a very small noticeable "migration" of the back four teeth. Dentist confirmed it was due to the lack of wisdom teeth, but they don't seem to have moved much - I have a larger gap on the lower incisors, for instance.

Of course, YMMV given genetics, bone structure, dentist-involvement, and so on.

wanderindiana's picture
Submitted by wanderindiana on

I had four wisdom teeth pulled when I was 21.

Last x-ray set I had done, first one I'd seen in many, many years, dentist shows me I have four more wisdom teeth -- I grew a second set, which supposedly happens to 1-3% of people.

Not sure what I'll do about that development.

Submitted by lambert on

It really sounds like that's another worry to cross off my list, especially since Hipparchia has a plan B of braces.

But it also says a lot about the quality of Maine dental care, as well as rural poverty (many say even worse than urban poverty) that I see this, and put it on my list of (over-) concerns.