Losing molars, how to decide?
October 1, 2019 11:05 PM Subscribe
Dentist wants to pull my remaining two molars on the top left side. Both teeth have old root canals and crowns, though the teeth to me seem sturdy with no looseness. But, I did go in to get a cavity filled by the gums in one of the molars. I am a little freaked out, and writing this question at 2am as I cannot sleep.
I went in to get a cavity filled in the back of a molar that already had a root canal and crown. I knew there was a cavity for several months before I went in, and I was also having trouble on the front side with a food trap or pocket that bothers me. In looking at the x-rays (and also comparing them to x-rays from a year ago), the dentist said there seemed to be an infection and some obvious bone loss in that area, possibly caused by a break in the root part of the tooth in one or both molars left on that side. He told me both teeth should come out.
It was unexpected and a shock. He doesn't know if there is enough bone to do an implant(s) though an option might be a bone graft and implants, and when I told him cost was an issue he said one option is to do nothing (leave a gaping hole on that side), or to get a flipper. I am already down to one large molar on the other side. Reader, I cried at the dentist. I turned 50 this year, I don't have much savings, my 10+ year relationship may be near its end. I've always been rather below average in appearance and worry the loss of these teeth will give a sunken look to my face, making me appear even older.
What I thought was a food pocket, that is very annoying and sometimes a bit painful, is where the infection from further up in the root is draining. He said the infection is not likely to clear on its own, that I could get a second opinion but I shouldn't wait too long, that the infection could spread, etc. At one point he conferred with another dentist, I think before he told me both teeth should come out.
Would you get a second opinion even though that might be another couple hundred bucks you don't have, if you're probably going to end up getting 2 teeth removed and having a plastic flipper indefinitely? I told him I wasn't ready to have 2 teeth out today but did get molds taken so they could make the flipper, and made an appointment to have the teeth out next week.
$300 for each extraction (seems high?) and about $550 for the flipper. (I have $1000 in dental insurance that will cover some of it). The office is in quite a nice neighborhood so probably isn't the cheapest. Do you have any similar experiences with these things? Do you have a flipper? Are you used to it and can tell me it is not the end of the world? I've always had teeth problems, many stemming from having the kind of braces when I was younger that are very bad for your teeth and softened a lot of the enamel. Thank you if you read this far. Teeth problems SUCK.
I went in to get a cavity filled in the back of a molar that already had a root canal and crown. I knew there was a cavity for several months before I went in, and I was also having trouble on the front side with a food trap or pocket that bothers me. In looking at the x-rays (and also comparing them to x-rays from a year ago), the dentist said there seemed to be an infection and some obvious bone loss in that area, possibly caused by a break in the root part of the tooth in one or both molars left on that side. He told me both teeth should come out.
It was unexpected and a shock. He doesn't know if there is enough bone to do an implant(s) though an option might be a bone graft and implants, and when I told him cost was an issue he said one option is to do nothing (leave a gaping hole on that side), or to get a flipper. I am already down to one large molar on the other side. Reader, I cried at the dentist. I turned 50 this year, I don't have much savings, my 10+ year relationship may be near its end. I've always been rather below average in appearance and worry the loss of these teeth will give a sunken look to my face, making me appear even older.
What I thought was a food pocket, that is very annoying and sometimes a bit painful, is where the infection from further up in the root is draining. He said the infection is not likely to clear on its own, that I could get a second opinion but I shouldn't wait too long, that the infection could spread, etc. At one point he conferred with another dentist, I think before he told me both teeth should come out.
Would you get a second opinion even though that might be another couple hundred bucks you don't have, if you're probably going to end up getting 2 teeth removed and having a plastic flipper indefinitely? I told him I wasn't ready to have 2 teeth out today but did get molds taken so they could make the flipper, and made an appointment to have the teeth out next week.
$300 for each extraction (seems high?) and about $550 for the flipper. (I have $1000 in dental insurance that will cover some of it). The office is in quite a nice neighborhood so probably isn't the cheapest. Do you have any similar experiences with these things? Do you have a flipper? Are you used to it and can tell me it is not the end of the world? I've always had teeth problems, many stemming from having the kind of braces when I was younger that are very bad for your teeth and softened a lot of the enamel. Thank you if you read this far. Teeth problems SUCK.
If there is a dental school in your area, that is a good way to get dental work done at a low cost.
Caveats: A dental student will do the work and sometimes they will screw it up and have to redo it-I had to have a filling redone. They will be new and won't usually have an air of reassuring professionalism. It takes a while even if they do it correctly-a faculty dentist will have to come around and sign off on the work.
But, I had thousands of dollars of dental work done for hundreds about ten years ago, and in the end the work was very good, and they didn't try to sell me on extra work like most dentists in private practice do. (One guy told me in 2012 that my implant needed to be torn out immediately; it's still going strong. Sorry about your boat payment, guy). If you are in a position where you have more time than money and you don't have dental anxiety, it can be a great option.
posted by Kwine at 6:17 AM on October 2, 2019 [6 favorites]
Caveats: A dental student will do the work and sometimes they will screw it up and have to redo it-I had to have a filling redone. They will be new and won't usually have an air of reassuring professionalism. It takes a while even if they do it correctly-a faculty dentist will have to come around and sign off on the work.
But, I had thousands of dollars of dental work done for hundreds about ten years ago, and in the end the work was very good, and they didn't try to sell me on extra work like most dentists in private practice do. (One guy told me in 2012 that my implant needed to be torn out immediately; it's still going strong. Sorry about your boat payment, guy). If you are in a position where you have more time than money and you don't have dental anxiety, it can be a great option.
posted by Kwine at 6:17 AM on October 2, 2019 [6 favorites]
I would agree about seeing an endodontist. If the teeth are in there solidly and the only concern is the infection, there are (not fun) procedures to go up in there and drill the infection out.
edit: but, the final consensus might be that the teeth need to come out.
posted by misanthropicsarah at 6:52 AM on October 2, 2019 [1 favorite]
edit: but, the final consensus might be that the teeth need to come out.
posted by misanthropicsarah at 6:52 AM on October 2, 2019 [1 favorite]
N'th getting your second opinion from an endodontist. If you ask for a referral, look for the best endodontist in the area; not the closest. There was only one in my city, but there was a great one in the next city over. I regret starting at the near place, and did not mind driving 40+ minutes to actually get my problem solved, and was able to keep my gold crown'ed molar (2+ years past my re-root canal and all's good so far).
posted by nobeagle at 7:28 AM on October 2, 2019 [1 favorite]
posted by nobeagle at 7:28 AM on October 2, 2019 [1 favorite]
I had to have a molar out in this exact situation earlier this year. It sucked, I'm still not happy with not having a tooth there. But once you've had the root canal once, and it fails and there's infection, apparently it's very hard to save the tooth, the failure rate on a redo is super high.
When I had the tooth out at the oral surgeon he asked if I intended on getting an implant (they do the bone graft at the time of the extraction) and I said yes to keep my options open. I do intend on saving up and getting the implant, even if it takes me a year or two.
So it's a three step process (this was not explained to me at the time so hopefully this is useful info):
1. Get the extraction and the bone graft (which is super simple and not painful, and cost me $595 (and my insurance only paid $70, argh).
2. After a few months, when the gum heals, get the socket work done (basically they put a threaded hole in the bone graft to receive the implant), $1900 was the quote I got.
3. Then the dentist basically makes the crown that goes into the socket. I don't know how much this costs. They cap the socket when it's created so this is also something you can do as you can afford it.
So I don't have an answer for you but hopefully this information can help you decide how to proceed.
posted by rabbitrabbit at 8:25 AM on October 2, 2019 [2 favorites]
When I had the tooth out at the oral surgeon he asked if I intended on getting an implant (they do the bone graft at the time of the extraction) and I said yes to keep my options open. I do intend on saving up and getting the implant, even if it takes me a year or two.
So it's a three step process (this was not explained to me at the time so hopefully this is useful info):
1. Get the extraction and the bone graft (which is super simple and not painful, and cost me $595 (and my insurance only paid $70, argh).
2. After a few months, when the gum heals, get the socket work done (basically they put a threaded hole in the bone graft to receive the implant), $1900 was the quote I got.
3. Then the dentist basically makes the crown that goes into the socket. I don't know how much this costs. They cap the socket when it's created so this is also something you can do as you can afford it.
So I don't have an answer for you but hopefully this information can help you decide how to proceed.
posted by rabbitrabbit at 8:25 AM on October 2, 2019 [2 favorites]
Best answer: Depending on your insurance and the area you live, the price for the extractions seems reasonable.
As a dentist, I have nothing against endodontists per se, I refer patients to them all the time; the the fact is that an endodontist will likely look for a solution that involves the services of an endodontist, and will possibly be more "heroic" about saving your tooth than your general dentist, who understands that in this day and age extraction and implant probably offers a more positive prognosis for the long term. It's an interesting conundrum these days from a treatment planning standpoint, but ultimately it requires a trusting relationship between the patient and the provider. If you want to save your tooth at all costs, that's one conversation; if you want the best long-term outcome, that may be another conversation.
Flippers are common, and only you can put a value on your ability to chew and the aesthetics of wearing one, but they are a low cost (relatively) and quick solution to tooth loss and can be very servicable while you budget for a more permanent fix.
posted by OHenryPacey at 8:38 AM on October 2, 2019 [4 favorites]
As a dentist, I have nothing against endodontists per se, I refer patients to them all the time; the the fact is that an endodontist will likely look for a solution that involves the services of an endodontist, and will possibly be more "heroic" about saving your tooth than your general dentist, who understands that in this day and age extraction and implant probably offers a more positive prognosis for the long term. It's an interesting conundrum these days from a treatment planning standpoint, but ultimately it requires a trusting relationship between the patient and the provider. If you want to save your tooth at all costs, that's one conversation; if you want the best long-term outcome, that may be another conversation.
Flippers are common, and only you can put a value on your ability to chew and the aesthetics of wearing one, but they are a low cost (relatively) and quick solution to tooth loss and can be very servicable while you budget for a more permanent fix.
posted by OHenryPacey at 8:38 AM on October 2, 2019 [4 favorites]
I've been thru this, down to the not having a ton of money to throw at the problem. I had to get one of my front teeth extracted, and did get a flipper for that. And various molars along the way. I had periodontal disease, and did get cleanings, but due to lack of insurance at times, couldn't really keep up with them.
Ended up eventually getting top dentures, and keeping most of my bottom teeth, with a lot of molars removed on the bottom. I have an appliance for the bottom, but it's extremely painful and uncomfortable, and the dentist who did the dentures refused to replace it, and since I've moved away from that area, will be seeking a new on come January, when our insurance re-ups again.
My husband has had a few back molars removed, nothing too visible, and they said it wasn't worth trying to replace them with implants, etc.
We found a good dentist earlier this year, and he's going back for a cleaning soon, and I'll be going for cleaning of my remaining teeth and to discuss doing a new bottom appliance. My top denture fits fine, I wear it mostly going out, and it gives me a lot of confidence. I was very resistant to any talk of dentures, but finally had to admit it was too far gone to keep yanking teeth there and there (but we had the $$ to do the co-pay).
$300, well, it depends on your area, I've had some that were $150, but that was a while ago, and some as high as $200. Think the flipper did cost a bit, but insurance covered a lot of it. That was a temporary solution for me, as I said, I eventually just got the dentures done, and it was an adjustment, but I'm cool with it now. No more worrying about infection or an emergency extraction. I have also cried at the thought of extractions, and getting a 2nd opinion often wasn't an option, as it would have eaten into my insurance coverage and pocketbook, for co-pays and sometimes straight out-of-pocket.
My Mom had a bridge, and one of my brothers also has some sort of bridge. But he could afford it, and I could not and it wasn't feasible for me.
posted by Marie Mon Dieu at 9:55 AM on October 2, 2019 [1 favorite]
Ended up eventually getting top dentures, and keeping most of my bottom teeth, with a lot of molars removed on the bottom. I have an appliance for the bottom, but it's extremely painful and uncomfortable, and the dentist who did the dentures refused to replace it, and since I've moved away from that area, will be seeking a new on come January, when our insurance re-ups again.
My husband has had a few back molars removed, nothing too visible, and they said it wasn't worth trying to replace them with implants, etc.
We found a good dentist earlier this year, and he's going back for a cleaning soon, and I'll be going for cleaning of my remaining teeth and to discuss doing a new bottom appliance. My top denture fits fine, I wear it mostly going out, and it gives me a lot of confidence. I was very resistant to any talk of dentures, but finally had to admit it was too far gone to keep yanking teeth there and there (but we had the $$ to do the co-pay).
$300, well, it depends on your area, I've had some that were $150, but that was a while ago, and some as high as $200. Think the flipper did cost a bit, but insurance covered a lot of it. That was a temporary solution for me, as I said, I eventually just got the dentures done, and it was an adjustment, but I'm cool with it now. No more worrying about infection or an emergency extraction. I have also cried at the thought of extractions, and getting a 2nd opinion often wasn't an option, as it would have eaten into my insurance coverage and pocketbook, for co-pays and sometimes straight out-of-pocket.
My Mom had a bridge, and one of my brothers also has some sort of bridge. But he could afford it, and I could not and it wasn't feasible for me.
posted by Marie Mon Dieu at 9:55 AM on October 2, 2019 [1 favorite]
Response by poster: UPDATE: I got a second opinion from an endodontist. It was almost $400 (and some of that will be covered, and I also know I am lucky I was able to get that). I don't regret it because the loss of teeth is permanent and I would always wonder. I have scheduled the extractions after having discussed it at length (and then some) with a variety of people. It is not the end of the world! For reals.
Any future people reading this answer are welcome to MeMail me if you want to hear more about it. ALSO! If you have old root canals/crowns, they do not last forever and make sure to get them checked regularly. (At least one of the teeth in question had a root canal more than 20 years ago. I think 15 yrs is the expected life of a crown.)
posted by Glinn at 11:46 AM on October 29, 2019
Any future people reading this answer are welcome to MeMail me if you want to hear more about it. ALSO! If you have old root canals/crowns, they do not last forever and make sure to get them checked regularly. (At least one of the teeth in question had a root canal more than 20 years ago. I think 15 yrs is the expected life of a crown.)
posted by Glinn at 11:46 AM on October 29, 2019
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