Dead front teeth because of overbite/misaligned teeth?

December 18, 2023 2:12 PM

Went for a regular exam and my dentist told me I've potentially had some dead teeth for a while - I have questions..

So I went in for a regular dentist exam today expecting things to be fine, the last time I went in about 6 months ago I got the all-clear. I ended up seeing a different dentist than my usual one at this office - this time, the dentist pointed out that I had no visible nerve on both my top lateral incisors in the xray, and asked if I knew those teeth were dead. ????

This is the first time I've heard anything about those teeth being dead, and I've been going to this dental office for about 6 years (I asked how long these teeth have been dead, and they looked back at xrays from last year and said they looked dead in those xrays too.) The dentist didn't seem to think anything needed to be done about the dead teeth, but said she thought the cause was trauma from my misaligned bite to the top teeth, and that doing invisalign might prevent further damage. Several questions:

1. Is it normal for my dentist to not seem inclined to do anything about the dead teeth? I know it's not necessarily an emergency but generally I thought dead teeth need to be root canaled etc.

2. Is it normal for this dental office not to have told me about these dead teeth for at least a year, possibly much longer?? lol

3. This dental office does a lot of invisalign, and generally asks me whether I want to do invisalign every time I go in - I have some crowding on my bottom teeth and an overbite, but I did have braces as a kid and at least visually I don't think the misalignment looks that severe. Previously they've warned me about potential cavities on the overcrowded teeth which i thought was about the extent of the danger here, not nerve damage/tooth loss. Is this potentially some sort of strange upsell?

Just want to check in with other (hopefully more dentally knowledgeable) people about whether this all seems normal and whether I should get a second opinion.

Thank you!

posted by limnerent to Health & Fitness (11 answers total)

1. Your regular dentist would have or should have mentioned this if they assessed that those teeth were dead.

2. It's not up the dentist's office to tell you about this. It's up to the dentist.

3. Doesn't seem like an upsell to me. What did this dentist suggest for next steps?

If were in your situation I'd make an appt to see my regular dentist and ask them what's up.
posted by ThatCanadianGirl at 3:32 PM on December 18, 2023

Hmm. I’m not sure about this. Pure anecdote, but I had a dead baby tooth (I knocked it on the monkeybars) and the tooth literally turned gray/dark purple within a few months of dying. I’m not sure if this is how it works for adult teeth but I’d do some googling.
posted by samthemander at 3:47 PM on December 18, 2023 [2 favorites]

1. I had a dead tooth for many years. I recently decided to do a root canal on it because it started to turn more noticeably yellow and I wanted to internally bleach it. It was fine to not do a root canal on it while it was dead, since there was no infection.
posted by watermelon at 3:53 PM on December 18, 2023

I've had dead front teeth for over 30 years from a bicycle accident when i was young.

They used a cold swab on my teeth to find out which are dead - couldn't feel it on several in front. Knock on wood, thats the only difference it has made to me. Cant feel cold, otherwise they seem fine and the dentist hasn't said anything.
posted by TheAdamist at 4:07 PM on December 18, 2023

I've had a dead tooth for many, many years from a childhood accident. Successive dentists didn't seem to notice/never mentioned it until 5 years ago when a dentist x-rayed it. Since then, other dentists have also noticed it, also took an x-ray, and then stopped worrying about it.
posted by mkdirusername at 4:12 PM on December 18, 2023

I have a dead front tooth from a childhood accident. Had a root canal about 6 years after it died and have had it bonded multiple times because it's very dark now - and most recently had it internally bleached. Are your dead teeth discolored?
posted by leslies at 4:18 PM on December 18, 2023

the dentist pointed out that I had no visible nerve...


I'm a doctor.

Nerve tissue doesn't show up on X-ray.

(
posted by BadgerDoctor at 5:35 PM on December 18, 2023 [10 favorites]

Here's a cautionary tale about dead teeth. I was kicked in the face by cranky mare I was training over twenty years ago. Got lucky then, but the trauma eventually caught up to me, and just prior to covid, my dentist said that one of my front teeth had died, but no big deal. There was no recommendation about treatment.

During covid, I didn't see a dentist at all, and immediately after, I had several other health issues that caused me to put off seeing anyone. So forward to nearly 2 years later after the diagnosis, and I now have a raging abscess and will need a root canal, but since it didn't hurt, I could wait a couple months till they could book me in. No antibiotics given. By the time I got in, I had a fistula just starting to erupt. The doc does the root canal, and by the way, the two teeth next to it are also dead and will have to be taken care of by an endodontist. Endo does another root canal that immediately fails, and those two teeth end up pulled. Still no antibiotics. The root canal on the original tooth fails and ends up pulled also.

I'm waiting for an appliance to be finished Jan 15. Implants were not really an option. I feel horribly self-conscious walking around with three missing front teeth. Plus, I had heart surgery (MAZE and LLAC) in July, and my surgeon was PISSED that the dentist and endo were so cavalier about a jaw infection. I never had any jaw pain, but looking back, I'm sure the infection played a part in my general ill health and my feeling miserable all the time.

I now have a new dentist.

Please find the best dentist you can and talk about options and outcomes. I spent money on two failed root canals that the dentist *afterwards* told me he knew might have questionable results. He also strongly pushed for implants, and my new dentist says that's not the best idea, and he has reasons.
posted by BlueHorse at 8:21 PM on December 18, 2023 [8 favorites]

Selling invisalign pays the bills.

I think this is all pretty normal. The new dentist doesn't know your history and actually reviewed your situation. That's pretty great. The only thing your previous dentist missed was noting in your file what your situation with your top lateral incisors. I've had dentists that would only note down actual problems, and so because these teeth are NOT actually causing you problems, they didn't get noted. Or it was noted - but year and years ago, and I've totally had and then forgotten conversations about my teeth over such time spans. And the new dentist doesn't have time to dig through all that.

I'm not a dentist. I've just spent lots of quality time with them. I find it helps to generally expect less of dentists than I do of doctors or other medical providers. Less science, less effort, and less actual medicine. More teeth whitening. I'm not saying that dentistry is just mouth chiropractice, but the primary reason it's separate from other medicine is money.

The assessment dentists typically use for nerve damage (like a dead tooth) is the cold test. They blast a swab with compressed gas and hold the frozen blob against your tooth, and if you have no reaction then you likely have no nerve. It's not a finely calibrated test, but again, low expectations.

An X-ray can show bone density loss - which a dentist could see and infer nerve damage as the likely cause. The new dentist is guessing, a dr might call it a hypothesis, but regardless it's a professional opinion so I expect it's likely a very good guess. You might be asking yourself why a dental office doesn't posses the necessary gear to perform what seems like a direct assessment of a key part of your mouth. That gear is both expensive, and worse, needs a trained operator. And the existing dental methods are good enough for most scenarios to either come up with a solution or send you off to a specialist. At least the specialist will have the money all the diagnostic equipment, so be thankful that course of treatment does not appear to be your future- that can be a serious bill.

The new dentist is a second opinion, and they understood your situation an opportunity for an upsell to 'prevent further damage'. Your previous dentist understood your teeth aren't bothering you, and there are other options for mitigating damage, like a night guard. I asked my current dental practice to put in my record to avoid upselling me, and generally they are reasonably good at honoring that request.

I've had great misfortune with some of my teeth - and I try to remember that at each step the general approach was to take the least invasive approach with the knowledge we had at the time. All medicine is imperfect, and I've found dentistry to be slightly less so.
posted by zenon at 8:03 AM on December 19, 2023

Unless the dentist in question did a pulp vitality test they probably can't definitively say that the teeth in question are dead. Abscessed teeth are known to be dead by certain signs that show up on xrays, but it doesn't sound like your dentist is saying you have an abscessed tooth.
What your dentist might be saying is that the pulp chamber, where the blood vessels and nerve tissue are found, isn't visible (there are a number of reasons for this) which is not necessarily problematic.
With all respect to badgerdoctor, physicians don't know jack about dental anatomy and should stay in their lane. I've been doing this for 3 decades and have seen more problems exacerbated by (ER) physicians than i can recount. Having a patient recount what a dentist has put into layman's terms is understandable to a dentist, as it should be.
posted by OHenryPacey at 8:46 AM on December 19, 2023 [2 favorites]

To further answer the rest of your questions: having lateral incisors with narrow of calcified pulp chambers won't have an impact on an ortho plan, so it was likely just an awkward opening to discuss ortho, which yes, they are selling in light of your lower crowding and so forth.
Laterals also seldom show up on routine bite-wing xrays (the 4 images taken periodically at check-ups), but they do show up on panoramic xrays or full series xrays, which are taken every 5-7 years or if a problem is suspected. it may be that the laterals look different than they did the last time they were imaged some time ago.
A second opinion is not a bad idea, but at this point it might as well be an orthodontist if you really are considering ortho, or an endodontist if you're worried about needing a root canal.
posted by OHenryPacey at 9:02 AM on December 19, 2023 [2 favorites]