time to start learning the banjo?

June 3, 2008 3:26 PM

Should I keep fighting, or pull this tooth out?

I've been having problems for some time now with one of my teeth. Four years ago I had a root canal, fine. Three years later, I'm getting x-rays and the dentist is shocked to see how infected the tooth has become (I never felt a thing). I had to have this other type of root canal where they drill upwards into the tooth from your gums, which is about as fun as it sounds, followed up with a new crown. 6 months later I had follow-up x-rays and the dentist told me it was looking good. Fast forward 2 months to last week when I was again getting x-rays (new dentist, this time for orthodontics), and the dentist tells me the tooth still looks like it might be infected. We're giving it a few more months to see if anything changes.

If it turns out that there are still problems, I really just want to pull it out, for many reasons, starting with how insanely painful the last root canal was, coupled with my diminishing trust in anyone to be able to fix this. And in terms of cost, if I had pulled the tooth out at the first sign of trouble it would have cost me 100$, but instead I have now spent in the area of 4,000$ on this one tooth with the prospect of more to come.

But, everyone I talk to tells me this is a bad idea. I'm 27 and have been told that I'm "too young to start pulling out teeth". A dentist has also told me that pulling out a tooth compromises the adjacent teeth, creating problems down the road.

So I turn to you, Mefites: is saving your natural teeth as important as people say? Have you ever pulled a tooth and come to regret it? Is it actually that stupid to pull out a tooth when perhaps it could have been saved?

side notes: it's the second tooth from the back, not visible when I speak. I can't go back to the dentists that did the previous procedures because I live in a different country now.

posted by vodkaboots to health (11 comments total)

Pulling out one tooth and having a bridge done won't have significant impact -- but the more natural teeth you lose (without replacement with a tooth implant), the more bone mass in the jaw you'll lose. The reason why people with dentures have a somewhat sunken cheek look as they age is because of that jaw loss.

My father is a prime example. In the pictures of his youth, he has a rather strong jaw (thanks, Dad, I inherited it and it doesn't look as hot on females). After losing his teeth in his 40's and years of dentures, his chin has receded greatly. He has even commented on this himself -- "I used to have a jaw. What happened?"
posted by lleachie at 3:49 PM on June 3

I'm 30, and had a molar pulled last year. I do not miss it in the sense that I feel my life would be better if I still had it.
posted by Brocktoon at 4:29 PM on June 3

My wife lost a tooth as a result of a unsuccessful root canal. She got a post and a crown as opposed to a bridge. At some point pulling the tooth becomes the only option and you'll probably wish that you had done it sooner. The only major issue is cost - it was only partly covered by our dental insurance and ended up being a few thousand dollars. I don't think there was any mention of long-term issues really - it's just one tooth, it's nowhere as severe as having them all pulled for dentures. There's no reason to believe that your other teeth are in any danger is there? At any rate, several years down the road my wife's post & crown causes zero problems.
posted by GuyZero at 4:31 PM on June 3

Right now I have a missing back molar, pulled recently due to a failed root canal - it failed because of the original problem which was root resorption. Even after the r/c was done the resorption and accompanying infection would just not stop or go away and then the tooth cracked in half, right down to the bone (omg ouch, you have no idea). So the tooth had to come out and let me tell you, even though it's my back molar & my smile is still gorgeous, it's a huge annoyance & I can barely wait for the very expensive implant, it will be a joy to go broke paying for it! Because the molar is missing I have to chew slightly to the front of my mouth on that side so I've just given up chewing on that side, which makes eating not as much fun, plus it's worrisome to have just one side of my teeth doing all the work, that could lead to new dental probs, ugh!

Anyway, when you pull a tooth you are also making a decision about the tooth directly above/below it - the tooth above/below a pulled tooth effectively becomes a useless tooth, and it will start moving downwards to meet the missing tooth so as to not be useless, plus the teeth adjacent to the missing tooth will start to shift. None of that sounds good to me, I like my smile the way it is now, plus I'd like to chew properly, so that's why I'm going with the implant.

Soooo, It sounds like you have been to hell and back with this tooth, and I don't blame you for wanting to just pull it, but on the other hand, I also think it's worth trying to save your natural tooth. The dentist will have to tell you whether they think it's worth it or not, and you will have to trust his/her judgment, or get a second opinion. I don't understand all the second guessing of dentists, I have never had a dentist that seemed to be steering me wrong - they have all seemed very interested in doing the right thing, very interested in their profession and doing it well, or referring me to a specialist who can better take care of me. If you don't trust your dentist get another one. But keeping your natural teeth, or if unable to and getting implants, in order to maintain the health of the rest of your teeth is never a bad decision imo. Yes, stupid to not save a tooth that could be saved, or stupid to not replace a tooth that absolutely has to be pulled.
posted by zarah at 4:34 PM on June 3

Yank that sucker and buy yourself something nice.
posted by turgid dahlia at 4:45 PM on June 3

Why does your present dentist feel it 'might' be infected? Are there any symptoms ( pain, swelling, draining) or is he just going by the x-rays? If the tooth is asymptomatic (without symptoms), there's a good chance the x-rays are merely showing normal post operative scar tissue and it is not infected. Good luck!
posted by trinitrotoluene at 5:27 PM on June 3

Please don't spend too much more on this. There will be no difference in quality between a $1000 extraction and a $100 extraction. But yeah, stop sinking money into this losing battle yesterday.
posted by Meatbomb at 5:39 PM on June 3

Cheers guys, thanks for the advice. Trinitrotoluene, I'm hoping that's the case! I guess it takes awhile post-op for things to settle down.
posted by vodkaboots at 5:51 PM on June 3

If the tooth is in a place where when you smile no one can see it, then have it pulled. The reason is because it is going to keep costing you money.
posted by regularperson at 6:26 PM on June 3

I had a failed root canal pulled about 15 years ago, back molar. No problems at all and none of my other teeth have been affected, certainly no dropping down of the top tooth above it. It was such a huge relief to get it pulled after all the issues, I so do not regret it.
posted by yodelingisfun at 9:12 PM on June 3

A dentist has also told me that pulling out a tooth compromises the adjacent teeth, creating problems down the road.

Not exactly. If you remove a tooth and don't replace it, the adjacent teeth may start to move, as they are no longer restrained by their missing neighbour. As for losing jaw bone - this is just one tooth out of 32. If you lose multiple teeth, then you start worrying.

For reference, a few years ago I had a tooth removed, a residual baby tooth that had never fallen out. As it was visible (just at the corner of my mouth), I had an implant put in and couldn't be happier. The downside is that it costs - about £2500 pounds.

In any event, given that it just "looks" like it might be infected, there doesn't seem to be any rush. Seek a second opinion if desired and maybe wait until (and if) the tooth does flare up and you can have it pulled then.
posted by outlier at 2:16 AM on June 4