All I want for Christmas is my two front teeth
November 18, 2010 2:43 PM   Subscribe

My dentist just told me I need an immediate implant (he also discussed bridge and orthodontic retainer options with me, but I am told the tooth needs to be extracted pronto.) Should I be gathering second opinions/additional price quotes, or should I continue treating this as Urgent?

About 16 years ago, I had a face-plant accident which resulted, among other injuries, in an upper front tooth being bent well back. 11 years ago, I had a root canal on that tooth by my excellent previous dentist.

I moved to a new area a few years ago and have seen a new dentist for cleanings, and he has a very good local reputation, but I haven't even gotten a cavity filled here.

The other night, I bit into a piece of chocolate and heard an awful crunch. The tooth in question felt strangely wobbly and painful. I finally admitted to myself that it wasn't going to get better on its own and arranged to see my local dentist today. He tells me the tooth is laterally fractured (which makes perfect sense), and un-salvageable, and that it needs to be extracted, sooner rather than later, before it breaks.

The oral surgeon might be able to see me tomorrow or Monday, but I'm in the US, so next week is Thanksgiving week, and so I can't, say, schedule with another dentist for a second opinion and really hope to get the extraction/implant done before the town shuts down.

Should I be getting a second opinion and shopping around for oral surgeons? My dentist hand-waved that the implant would probably be between $3500-$3700 US. We can cover it but it hurts (my insurance will cover a fraction of it). I don't even really know how I'd shop for oral surgeons, given that most of my friends are also semi-transient in the area.

And, on a long shot, if anyone has opinions on oral surgeons in Bloomington, Indiana, I'd love to hear it.
posted by endless_forms to Health & Fitness (22 answers total) 1 user marked this as a favorite
I'm not an expert but when I had an implant implanted the extraction came first, then only later was the implant post installed. Why not get it pulled and then shop around? It sure sounds like that puppy's gotta come out.
posted by facetious at 2:48 PM on November 18, 2010 [1 favorite]

My wife had an implant and it took months to do. They have to take the tooth out, then measure, set a post, wait a few months for post to set, then put in "tooth".
She also had the tooth (lower, back/side) out for at least a year before deciding on getting the implant. So you might be able to get the tooth extracted, then shop around for an implant. I know you said it was in the front but you can ask your dentist what they were going to put there temporarily and have them do that while you shop.
FWIW we are in NJ and again she had a lower side tooth done and it was around $3000. Fron tooth might require more work.
posted by Busmick at 2:50 PM on November 18, 2010

I'd be baffled by the idea of an implant being anything urgent.

I've got an implant on my treatment plan. I'm one year, two months into the plan, with several more to go. The implant is the LAST THING we're doing.

You'll look a bit goofy, but no immediate need, I bet. And why implant and not bridge? Definitely shop around on this.
posted by Rendus at 2:53 PM on November 18, 2010

Oh. I sort of misread. One of those days.

Yeah, the extraction may be urgent (due to infection risk and so on). But the implant can likely happen any time in the near future - but you're not getting it in before Christmas. I've been working on getting a dental bridge that will work, going on 3 months now due to lab failures, etc. Implants take a lot to do.
posted by Rendus at 2:57 PM on November 18, 2010

I agree that the extraction may be urgent. The implant--could wait for a short time. The problem is, is that the longer you wait, the bone in that area will start to dissolve and the more likely you will need a bone graft to support the implant.
I would question the dentist about the risk of infection, if you were to go ahead and get the implant at the same time versus waiting a week and making sure there is no infection, I say this since your tooth is currently fractured and at a higher risk for infection.
posted by 6:1 at 3:06 PM on November 18, 2010

Nth-ing the "I am sure the dentist means the extraction is urgent, not the implant." Infections in the mouth are nothing to mess around with.
posted by Sidhedevil at 3:13 PM on November 18, 2010

An ex of mine in NYC was able to find a dentist to do an extraction/implant for (I think) $2000 or so. Just a possible price point for you to consider, and there was no urgency in her case. I seem to recall there was something a bit sketchy about what was worked out, though, so your mileage may vary.
posted by slide at 3:17 PM on November 18, 2010

Checked my old email - she paid $3000. My mistake.
posted by slide at 3:20 PM on November 18, 2010

Cost depends on where you live. I paid well over $3k, all said and done. YMMV
posted by 6:1 at 3:27 PM on November 18, 2010

Best answer: I'm not an expert but when I had an implant implanted the extraction came first, then only later was the implant post installed.

It's different for front teeth because it's cosmetic and less structural. Molars take a lot of abuse; typically those are extracted, followed by a later post, followed by a later implant.

Front teeth are treated differently.

Yes on a second opinion, to do your due diligence, and then likely, go with it. It's a lot of money, but it sounds necessary on several different levels.
posted by A Terrible Llama at 3:28 PM on November 18, 2010

I'm in consultation right now to get some non-urgent implants, and my dentist said that at times, he is able to do both the extraction and the implant on the same visit. That probably won't work for me, as I need a bone graft, but it's possible; he says he won't know until the day of the surgery. $35-3700 sounds about right.
posted by quadrilaterals at 3:30 PM on November 18, 2010

I can't, say, schedule with another dentist for a second opinion and really hope to get the extraction/implant done before the town shuts down.

Sorry, I missed this. I would ask about antibiotics to handle ongoing pain through the holidays; it can get infected. That would allow minor stalling for time. The other thing is to call around like crazy to other dentists to get a quick look.

If you can't, and if they can set you up with an implant on the fly--myself, I would do it. I'm not a dentist, but I'm a veteran of dental crises. Teeth are worth every penny. Never cheap out on teeth, is my philosophy. I'm sorry that's so lousy but I don't think anyone other than a dentist, and one who's looking at the x-rays, can tell you definitively what to do.
posted by A Terrible Llama at 3:33 PM on November 18, 2010

Response by poster: I appreciate all the thoughtful answers; you've given me good questions to ask the oral surgeon.

A Terrible Llama, I completely agree about choosing to spend money on teeth. One of the reasons I asked the question was to get some balance to my own instinct to bite the bullet and get it done ASAP!

To answer a couple other questions --

My understanding from my dentist was that the extraction and post would be done at the same time, with a temp crown, and the permanent crown would have to wait several months. Now I know to ask more questions about necessary timing.

A bridge would involve compromising the teeth to both sides. If this were a back molar, I might go that route, but I'm willing to go the extra distance for an upper central incisor.
posted by endless_forms at 3:49 PM on November 18, 2010

I had almost the same thing happen to me, down to the fact that my tooth broke when I was eating chocolate! Anyway, I got it all done right away, the extraction and the post put in. I had a retainer-like thing with a tooth on it that I had to use for a few months while my gums healed, then I had the final crown put it. Now it all looks great and my gums are super healthy. Yay!

Anyway, implants are expensive, so if I were you I'd start asking everyone you know in Bloomington if they know anyone who got an implant there. You'll probably be surprised how many people have. I hope someone has a good recommendation for you. If not, I'd go with the person your dentist recommends and start on the path soon, since it can take a long time and the sooner you start, the sooner you'll finish.
posted by shesbookish at 4:52 PM on November 18, 2010

If the extraction and post can be done at the same time, it means you need no bone grafts (because it takes 6 months or so for the grafts to heal). If you need no bone grafts, it can't be all that urgent. I'm sitting here typing this on pain killers and antibiotics having had 2 extractions and bone grafts today. These are for back teeth. It's been a month since I had my front tooth extracted (and bone grafts put in). The prices quoted for implants often don't include the price of the crown itself so make sure you know exactly what is being covered. $3000 including the crown in NYC (where I am) is an excellent price but would be high if the crown isn't included.

By all means shop around. And make sure you have a copy of your x-rays to show the next dentist you ask. They're usually digital these days (mine were sent to me in email!) If they're not digital, your dentist may not have the latest equipment. I got several quotes but didn't take the cheapest, but the one who explained things the best and had the best equipment. (and was recommended in previous AskMe's.)
posted by Obscure Reference at 5:43 PM on November 18, 2010

I would do it all at once if they give you the option. The extraction is supposed to be the most painful part (which was kind of surprising to me, you know, since the other part involves screwing a post into your face bones). I didn't have the choice because I needed bone grafting, and now I'm dreading having the additional procedure to get the implant done. If it's infected, then don't wait, because you might lose bone and then need a bone graft after all, but if it's not truly urgent, then shop around.
posted by elpea at 7:13 PM on November 18, 2010

Is there a local dental college near by? Maybe at IU? They might be able to give you a second opinion without having to spend too much.

It sounds like you might need to have your tooth pulled right away. I did have a dentist scam me into thinking I had a tooth fracture and was relieved when I got a second opinion. If your dentist is legit they won't mind if you get a second opinion either.
posted by turtlefu at 8:27 PM on November 18, 2010

Response by poster: Update:

"Calling around like crazy" as per A Terrible Llama, I managed to score a cancellation appointment at another dentist this morning. She confirmed the need for an extraction and recommended an implant. On the other hand, she told me that the main urgency is my discomfort; while infection is a concern, it's not a concern over the next week, and I have time to consult with a couple of oral surgeons.

This is a big relief, because in the pool of five friends I went out with last night, one had had a bad experience with the OS I'd been directed to -- she told me he tried to pressure her into unnecessary extractions & implants. So I now have a second referral and am going to make the most of my consults before scheduling surgery.

Followup Question: what should I be asking the OS at the consult? The second dentist recommended getting impressions and pictures before the extraction (something my first dentist didn't mention), for instance.

THANK YOU for all your comments. Y'all helped me look at this more rationally.
posted by endless_forms at 6:54 AM on November 19, 2010

The person who makes the crown (and/or the flipper) will need the impressions. They may not have been mentioned because they're done as a matter of course. Questions I would ask? What's the big emergency? What happens if you wait? (I've asked things like this and was told that they can't answer because they don't know how fast bone loss, or whatever, takes place. In effect, they wanted to avoid the worst case scenario, not predict the actual future, but the worst case may be extremely unlikely.) Ask why prices differ. (Sometimes it's where their office is--the high rent districts charge more. Other times it's the type of titanium the use for the screw socket--there seem to be different grades.) One OS I saw insisted that an x-ray didn't show enough and made me fork over $400 for a cat scan. The person I went with, ultimately thought the x-rays were just fine. In the end, I wanted someone who I trusted and who I felt was empathic with me. That is, I wanted to feel like they understood that I found the whole process daunting and scary and, rather than use that as a way to manipulate me, tried to reassure and inform me.
posted by Obscure Reference at 6:47 AM on November 20, 2010

Response by poster: I wanted to reiterate my thanks to everyone who answered, as well as give an update for the benefit of anyone using this thread for information in the future.

I wound up consulting with two oral surgeons -- OS A, who I'd been referred to by my dentist, and OS B, who I'd been referred to by the second-opinion dentist.

OS B was perfectly normal. He was pleasant, said much the same things the dentists had about my options and what he recommended, and gave me a verbal quote of ~$2000, and noted that IV sedation would be more money, but available if I wanted it.

OS A -- who I'd been warned about by my friend -- turned out to be as pushy as she said. He also made me very physically uncomfortable, such that I was VERY glad I'd consulted with OS B already. OS A also was asking $3000 for his side of the deal. That was without IV sedation, which he said would cost $600 if he used it, but he doesn't because it's expensive and invasive relative to Halcion. (Fair enough. But I actually didn't want to be using an amnesiac around this guy.)

I ended up using OS B and my original dentist. I was very nervous about this, particularly because I knew my dentist and OS A were buddies. I also thought that there might have been advantages to using two offices which were used to working together. It turned out fine, though, and my dentist never made me feel uncomfortable about my choice. Scheduling between the two offices was a pain in the patooshie, especially because the choice of what kind of temp (crown or partial denture) I would have factored into it, and the dentist and the OS had different initial opinions about what was the better choice. That process did require some patience and being willing to be a bit forward and entitled (sensu Malcolm Gladwell) .

I did develop infection; I wish I'd filled the antibiotic prescription OS B gave me ahead of time, instead of needing to wait for the next day. There seem to have been no complications from the infection, though.

I had the extraction and implant done under IV sedation yesterday, 3 weeks after the fracture. A couple hours later I went over to my dentist, and he put on the temporary crown. (Pro: less risk of various soft tissue damage than a partial denture. Con: biting using it before the implant heals can wreck the implant. ) I'll get the permanent crown in a few months. I feel fine!

The final cost at OS B (does not include crowns) was $2500. That included IV anesthesia at ~$300 (half what the other guy cited.) I'm expecting the permanent crown to come to about $1000, and the total cost of the entire business to land at about $3500 (noting that I could have chosen a cheaper analgesic for the surgery.) If I understand my dental insurance correctly, I'll end up using my full $500 benefit this year.

OS B called me at home yesterday evening to check in and see how I was and how the crown installation had gone. I really appreciated that.

I spend a lot of time grateful to have the abundance of resources (time, health, money, social context and technology) to get this corrected. I'm also grateful to MetaFilter for giving me practical advice while I was panicking and confused.

Lessons learned:

1) it wasn't exactly an emergency, but getting on things immediately was really necessary given that the holiday made everything take twice as long as it would otherwise.

2) I wish I'd filled the antibiotic scrip when I got it, instead of waiting for the infection to show up.

3) Get a second opinion!

4) technology is amazing.

I'm marking this as resolved, but FBAEW.
posted by endless_forms at 11:01 AM on December 8, 2010

Congratulations on your new tooth!
posted by A Terrible Llama at 11:44 AM on December 8, 2010

I've been starting on antibiotics a day before the work begins so that I and my blood stream get a jump on preventing infection.
posted by Obscure Reference at 11:24 AM on December 9, 2010

« Older Fastest way to burn multiple clips directly from...   |   Who makes Yelpstick? Newer »
This thread is closed to new comments.