What's the best way to replace a missing tooth or teeth?
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OK, so you've lost a tooth. Whether it was lost due to gum disease, severe decay, or trauma, you're still stuck with the same problem...a missing tooth. Your dentist may have spent a couple of minutes explaining your options and now a staff member is standing over you asking you to decide how you want the tooth replaced. Obviously if there were an easy answer to the question I wouldn't feel the need to write this article.
The method you choose to replace a missing tooth depends on a number of different factors, all of which are nearly equal in importance. The factors to consider include cost, time, longevity, comfort, esthetics, convenience, and the effects of the treatment on the adjacent teeth and the rest of the mouth. You have the four basic options below, and remember we are speaking about replacing a single missing tooth here.
- Do not replace the tooth
- Removable partial denture
- Fixed bridge
- Dental implant
These options are listed in order of increasing desirability and not surprisingly also in order of increasing cost. Let's examine each choice in more detail.
Not Replacing a Tooth
Is it OK to not replace a single lost tooth? Yes! (Well the real answer is "It depends....") It is not the end of the world to lose a tooth, although there are consequences depending on the location of the lost tooth. If it is a wisdom tooth (what we refer to as the third molar) I would definitely say do not replace it. In fact, for wisdom teeth, I would say take the other three out as well! Few people have room in their jaws for the wisdom teeth and they are usually impacted or crowded. If your wisdom teeth did erupt properly and you do have space for them and lost one I would still say do not replace it. They are too far back in the mouth for accessibility to perform restorative procedures well. You will not percieve a loss of chewing ability, you will not see a defect in your smile, and you will not see any effect on your facial structure (like "sunken in" cheeks). If the tooth you have lost is the second molar, that is, the last tooth in the back (assuming there is no tooth behind it, i.e. the wisdom tooth), you could seriously consider not replacing it as well. Clinical studies indicate that even with all four of your second molars missing, you ability to chew food properly is not significanly altered. A lost second molar rarely effects your smile or facial structure and appearance. However you must be aware that the tooth that opposes the lost tooth may supererupt. That is, an upper tooth that does not have a lower tooth to chew against will migrate down until it finds something to stop it, and vice versa. This does not always happen, but your dentist can monitor for it at your semiannual check-ups. A supererupted tooth may not necessarily cause problems. Problems can be prevented or dealt with simply by your dentist. Like a lot of things, early detection leads to simple solutions. Any other lost tooth should be replaced as a loss of chewing abiltity will be noticed as well as a change in your appearance. If there are one or more teeth behind a lost tooth, drifting and tilting of these teeth usually occurs. This can lead to a number of serious complications that include developing bite problems and even loss of additional teeth. So if you have lost an important tooth, get it replaced! One of the three tooth replacement options below should suit you. All three of these options will provide the benefit of preventing tooth movement and maintaining your appearance.
The Removable Partial Denture
The most inexpensive tooth replacement option is the acrylic removable partial denture, AKA "the Flipper." One study in the Journal of Dental Research (J Dent Res.1996 Feb;75 Spec No:714-25) reported that one in five people aged 18 - 74 wear a removable partial denture of one sort or another. There are many varieties of removable partial dentures and they are made to replace from one to many missing teeth. The "Flipper" is most inexpensive type. However for replacing just one tooth, it is a lot of "hardware" in your mouth. That is, along with the artificial denture tooth that fills the gap in your smile, there is a plastic framework that covers all or a part of the roof of you mouth. This is necesary to keep the denture tooth in position and provide retention to keep the partial denture in your mouth. Additionally, flexible wire clasps are sometimes present to grab onto key teeth for additional retention of the partial denture. All of this material in your mouth is one of the drawbacks of this technique for tooth replacement. Because the denture tooth is not rigidly fixed in your mouth, the partial denture will always have some movement when chewing. Patient's often find this movement unsatisfactory. Sixty-five percent of partial denture wearers have some problem or complaint with it (J Dent Res. 1996 Feb;75 Spec No:714-2). Despite it's drawbacks, because of the much greater costs of the other tooth replacement options, the "Flipper" is a popular choice.
The Fixed Bridge
The fixed bridge, or what we refer to as a fixed partial denture, is the next tooth replacement option we'll discuss. A fixed bridge requires preparing, that is cutting down, the teeth on either side of the missing tooth. This is not terribly conservative treatment. Tooth preparation of the adjacent teeth is irreversible and involves the removal of quite a bit of tooth structure. See the photo on right. I know it may seem a bit barbaric, but for the longest time it was the only way to provide a fixed, non-removable replacement tooth. Providing this service well is technically demanding and will require all of your dentist's skill. A well made fixed bridge can look natural, function well, and potentially last a lifetime. However, 75% of fixed bridges fail within 7 years. The fixed bridge is at least three teeth connected together with the false tooth (the replacement tooth) in the middle. Because the teeth are connected, you cannot pop dental floss between them. Instead you must thread the floss through underneath where the teeth are connected or use a special small brush to get under the connectors. People tend to neglect to perform this inconvenient extra step in their oral hygiene routine. This contributes to the relative high rate of failure. Also, the extra stress on the teeth supporting the fixed bridge can lead to mechanical breakdown and thus adds to the failure rate. The fixed bridge is still the treatment of choice for many patients.
The Dental Implant
The dental implant can be the best method for replacing a missing tooth in most cases. It involves surgically placing a titanium artificial root (the implant) into the space that the root of the lost tooth occupied. A crown is then connected to the implant. See diagram to the right. One benefit of this tooth replacement method is that the adjacent teeth are left unaltered. The dental implant and its crown are a free-standing self-supporting total tooth replacement. That is, the root of the tooth as well as the crown of the tooth are replaced and the new tooth does not rely on the adjacent teeth for support. Clinical studies show that unaltered teeth adjacent to an implant have a much better long-term prognosis than teeth supporting a fixed bridge. Because the dental implant is not connected to the adjacent teeth it can be flossed and maintained exactly as you would your natural teeth. Modern dental implants have been in use since the late 1950's and research & development have improved the technology to now be one of the most successul forms of treatment in dentistry today. The cost of the single tooth dental implant can be nearly the same as that of the fixed bridge depending on the circumstances. Finally, the dental implant has the same chance to last a lifetime as one of your natural teeth. Look for my next article explaining using dental implants for replacing single missing teeth in more detail.
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I had a root canal on tooth #30. Sadly, the filling cracked and then fell out completely. The tooth was cracked and lost to decay. I am having it pulled in a couple of days. I think my best option is to just live without the tooth. (There's not much money for anything else anyway and it's not visible when I smile.) I'd like another opinion though. Any thoughts?
I am now 21 years old, I lost one front tooth, (molar). The tooth affected broke into two 7 years ago, the other part is still in my jaw, I've been feeling pains around the surrounding gum a periodically. I am thinking of replacing it, please what's the best option and how much will it cost,
thanks
In regards to my previous post. I looked it up and it's avulsed tooth 23 and loose 24
Thanks,
I had a traumatic dental injury the other day while playing hockey. A stick came across my face slicing my chin and avulsing my lower tooth. Number 9 I believe and 8 was loose. I had the tooth sitting in water and after about 30-35 min got ahold of a dentist and was told to put the tooth back in the whole. I did this immediately and then about 30 min later was in the dr office getting the teeth splinted. A couple days later I talked to a friend who is a dentist and he said I should start a root canal treatment and start antibiotics. So I did this, now I am supposed to wait 2-3 weeks for evaluation. My question and concern is this: what are the realistic chances of my tooth/teeth surviving? My gum also had a laceration where the tooth came out so right now the tooth that was out the gum is lower then normal. I have been stressed out about this all week.
I know it's a wait and see if the tooth reattached to the gum or not but how many cases have been successful in this type of situation.
Thanks,
Justin
Alb Emmanuel,
I'll need a little more informationto answer your question. How old are you? Which tooth or teeth did you lose? How long ago did you lose it/them?
- Dr. Appleton
I lost my when i was 7 years ago. Since then it has not been replaced, please what do you advise me to do in this case.
James,
You are welcome! Your situation is truly unusual And thanks for the kind words!
- Dr. Appleton
Hi Doc!
i just wanted to thank you for your extensive answer. It is such a nice thing you are doing here, taking your valuable time and answering people's questions here. I appreciate it and want you to know that your answers are helpful. My dentist talked about a similar course of action like you wrote. He doesnt want to start an intrusive action to bring out the second molar, he said, lets keep an eye on it, keep it very clean, it may get infected again now and then, but may also turn out good without any external action. but i still cant get my head around it that i dont have my second molars come out till now. on the left side its not even visible, the row ends at my number 6 the first molar. and in the full mouth x-ray we saw i dont have my lower wisdom teeth only the upper ones. but they dont present any problems right now. well thank you again for your time, and i wish you successful treatments!
Shane K,
First I recommend you begin by making sure you have excellent oral hygiene. That is, make sure you brush your teeth with a good fluoridated toothpaste twice each day, floss your teeth properly after brushing before bedtime, and rinse with a good antiseptic mouth-rinse, such as Listerine. Follow the instructions on the mouth-rinse label. You should be able to get good oral hygiene instructions from any of the major toothpaste manufacturers, like Crest and Colgate on the internet. If the NHS cannot provide you with the service your need then your only other solution is a private dentist. The right private dentist will earn your confidence and quell your fears of dental treatment. He or she will take the time to present a few different treatment options to you and explain them thoroughly. They will use anesthetic techniques that are painless and maintain your comfort throughout your treatment. Unfortunately they cannot do this for free. I am in Louisiana and I am not that familiar with the NHS or health care in general in the United Kingdom. There is a prosthodontist in London who received his specialty training at the same time I did. His name is Dr. Myles Dakin. I have not spoken with him in years and I do not have his contact information but surely he can be found in the telephone directory. His practice may be too far away from you or the cost may be prohibitive for you but perhaps he could refer you to someone in your area who could care for you. Another avenue would be through a charitable organization, like a church. Many churches here, including the Catholic Church, offer dental clinics or have members who are sympathetic and offer their services for free or at a discount or permit small monthly payments, etc. If you are fortunate to find a dentist who will work with you, make sure you are an ideal patient. That is, you arrive early for your appointments, you never fail to keep an appointment, and you follow the dentist's recommendations faithfully. We dentists enjoy helping people and it is particularly rewarding when the patient is a "good patient." Let me know how it goes, and good luck!
- Dr. Appleton
James,
The number 7 is the second molar. The wisdom tooth being the third, or last, molar. The second molar usually erupts through the gums and into the mouth at the age of 12 years. It is not normal for the second molar to erupt at age 30. It is, however, not that unusual for people to be born without one or more of their wisdom teeth. I can only guess that perhaps your second molar was impacted and something about your mouth has changed to permit it to erupt. Another possibility is that the second molar is impacted and you have suffered some gum and/or bone loss around the first molar that has left the impacted second molar closer to the surface. When a tooth just breaks through the gums it creates an opening that connect your mouth to the space within the gums that surrounds the crown of the tooth. This space around the partially erupted crown of a tooth can get infected and become red, swollen, and painful. This impacted tooth may erupt into its proper position and all will be well. Just keep the area clean and well-irrigated with a good mouthwash, like Listerine. It is also quite likely that the tooth will never erupt fully and will be a recurring painful problem for you. I would get a consultation with an orthodontist to see if he can expose part of the second molar and then use braces to pull it up and into place. If he does not feel this is possible then give the tooth as much time as you can stand. If it does not erupt and you keep getting infections then see an oral surgeon and have the tooth extracted. I cannot give you your best advice over the internet. You need to see a dentist you trust and ask a lot of questions. I'd need to see a radiograph of the area to better diagnose you problem. Only your dentist can make an accurate diagnosis. Talk to him or her about your options. Let me know how it goes, and good luck!
- Dr. Appleton
bitrex,
The short answer is "yes". Just make sure the surgeon who places your implant also gives you detailed information regarding the implant. Specifically you will want the following data:
- Implant surgeon's name, address, and phone number
- Tooth number (the location where the implant was placed)
- Date implant was surgically placed
- Implant manufacturer, implant model, implant diameter, implant length
- Implant lot number
- Implant manufacturer contact information
This should be sufficient information for any dentist experienced in implant dentistry to make a crown that attaches to the implant. Many implant surgeons will give you the implant components necessary for fabrication of the implant crown that you can then give to the dentist who will make the implant crown. Both aspects of implant dentistry, the surgical placement of the implant and the creation of the crown that will be placed onto the implant are equally important in the success of the treatment. The exact angle of the implant, the depth it is placed, its rotational orientation, all details can effect the final outcome that is the implant crown. Optimal outcomes in implant dentistry usually come from an experienced team who plan your case together and who communicate well with one another. So I have to ask, why are you planning to have your implant placed in one country and the implant crown placed in another? If it is circumstances beyond your control then remember to get the implant details. If possible, select the dentist who will be making the crown and ask him to communicate with the implant surgeon so they will be working together to effect the best possible result. If you are considering having your work done in two different places to save money, then be very careful. A crown placed on a dental implant is very different that a crown placed on a natural tooth. Remember, in dentistry, you usually get what you pay for. Just make sure you are working with dental professionals that you trust and with whom you are comfortable. Print this comment out and read it a couple of times. Read the entire article above. If your dental treatment is particularly complex, consider getting a consultation with a prosthodontist. We specialize in solving complex dental problems and making beautiful crowns. We also specialize in working closely with other dental professionals to provide optimal solutions for patients. Let me know how it goes, and good luck!
- Dr. Richard
Lisa,
So as I understand it you just had your upper right first molar extracted Tuesday. The first molars are very important. You are awfully young to have lost such an important tooth. It is very unlikely that your second and third molars will not move nicely into place. In fact they will almost always just tilt forward like trees falling in the woods. Thus leaving a problem with deep bunched up gum tissue in front of them and probably causing a bite problem as the back side stick up to interfere with your bite. It is not too early to treat the area. We used to wait months for the bony socket to fully heal and remodel before proceeding with treatment. Nowadays we prefer to proceed immediately. Find a good oral surgeon and speak with him or her about grafting the extraction socket immediately and possibly even placing a dental implant immediately. Eighty percent of bone loss after extraction occurs within the first 8 weeks. If you can't get the implant right away due to cost, then at least consider the bone grafting procedure, also known as socket preservation. See if the surgeon can use a bone graft that is resistant to resorption so you can buy some time until you can afford an implant. Regardless of what you do, seriously consider getting an interim removable partial denture, the "flipper" made or some other device like an orthodontic retainer that will preserve the space and keep your other molars from drifting and tilting out of place. Read the entire article above so you can understand your options. Your best option is a dental implant and do it right away if you can. Different surgeons have different ideas regarding grafting and implants. Find someone who keeps up with the research or has recent training. They will tend to be most familiar with newer trends & techniques. Let me know how it goes, and good luck!
- Dr. Appleton
Jim,
If you do not have a tooth behind the missing tooth that can be used to support a fixed bridge, it is not recommended to get a bridge. This kind of bridge is cantilevered into space to replace the missing tooth. While it is quite possible to make a cantilevered bridge, they have a very high rate of failure. The cantilever acts like a wrench and can exert a lot of force on the teeth to which it is connected. There are a few isolated instances where a cantilevered bridge can work well, but replacing a molar is not one of them. Your only two choices are a removable partial denture or a dental implant. Read the entire article above and arm yourself with information. Find a highly recommended dentist or a prosthodontist and ask lots of questions. Let me know how it goes, and good luck!
- Dr. Appleton
hi i need help i have a lot of bad teeth that are going down in to the gum top and bottom i was hit in the face with a bat 4 years ago i want implants but have not got the money to pay for them i dont like going to the dentist as i have always had a fear of them i am 24 and it looks really bad i think nhs dentist are like butchers and i think its getting worse i wake up with blood in my mouth every day is there any where i can get this done without the cost or where is the cheapest place to have this done can you email me @ shane-22222@hotmail.co.uk many thanks
Hi Dr. Appleton,
i hope you could give some advice. Today i was at the dentist, since i had significant pain on my lower right jaw, and thought oh finally my wisdom tooth is coming out. - i am 30 btw- so then after the x-ray and stuff, the dentist gave the news, no its a not a wisdom tooth issue, he says the gums have a bit inflammation but no biggie, and he gave me some antiseptic mouthwash, follow a week if doesnt get better come by again. then i asked but what is the thing that i can feel with my finger that is coming out of my gums? he smiles and says its your number 7!! i am like what! on the left side it is not even there nothing to see, and he sent down i dont have my wisdom teeth only the upper two. I just wanted to check with you, that my number 7 is coming out sooo late? is it normal?
thanks in advance doc
I would be very grateful if you could answer a perhaps unusual question for me. My dental situation is far too complicated to go into and would be irrelevant to everyone else.
What I've been wondering is if it's possible to have the surgical implantation procedure done separately from the crown. "Separately" here meaning in some other country. Basically, can one have the surgery done here and the making it pretty done elsewhere?
hi doctor,
i have 2nd molar on my right side and all of my wisdom teeth are taken out...could i get a bridge on the molar without another tooth to the right of it?
Dear Dr Appleton,
I had to have my UR6 molar taken out on tuesday, I had it root treated about 10 years ago and it had subsequently fractured. Becuase my mouth is small, the gap is not very visible. I would just like to know what my best option would be in your opinion. My UR8 wisdom tooth hasn't erupted yet, is it possible for my UR7 and UR8 teeth to move in and close the gap so I won't have to do anything? Or will this have complications on my other teeth?
As Im only 22 I don't want to get a denture and as my adjacent teeth are healthy I don't want a bridge either.
The dentist I spoke to said I would have to wait nearly 6 months for my bone to repair before I think about getting an implant or doing any kind of restoration to the gap. Is this true? Or should I be doing something asap before my gum heals?
Thanks for you help!
Khadija,
Yes, you should still be able to have orthodontictreatment (braces). Get a consultation with an orthodontist righ away. He or she can advise you if there are better alternativesfor closing your spaces between your teeth. They will advise you whether your problem can be solved with orthodontictreatment alone or if some restorative dentistry will need to be performed along with or after your orthodontictreatment. If you will not be seeing an orthodontist soon the see your dentist about maintainingthe space for your lost molar. Otherwise you will most likely suffer from tilting and drifting of the teeth on that side of your mouth. This could interfere or prolong your desired orthodontictreatment later on. Read the entire article above and make sure you understand the part about teeth drifting and tilting into open spaces. Don't wait. See an orthodontist now. Let me know how it goes, and good luck!
- Dr. Appleton
i have lost all my back teeth on the bottom and one near front on top and i am very depressed about this.
Hello Dr. Appleton,
I am 21 and I have lost my molar tooth which is the 2nd one after the wisdom tooth. In my case I have a little spaces between few of my front top and bottom teeth. I am not sure what I can do about the spacing since they mostly require braces. I am not worried about replacing my molar since it's far back and no one can actually see. My question is if will i still be able to got braces or invisalign if i want them to fix my spacing. What do you recommend is a better option?
Joey,
It sounds like you lost your lower left first molar. (The wisdom tooth is also known as the third molar.) Don't worry. The loss of this tooth will not affect the outward appearance of your face. Read the entire article above. The second molar will likely tilt and drift forward into the space of your recently extracted first molar. I would highly recommend having an implant placed within the next 8 weeks while all the bone is still present. If this is too expensive then see about having bone grafting done in the socket left by the extracted tooth. Some materials, like a xenograft
I had to remove my molar #36 tooth as dentists call it because at first I did a root canal but then the dentist noticed it was fractured. So I had it removed just yesterday by a dental surgeon because I have long roots and now I have a space between the last tooth and the one before #36 which is the 3rd tooth after the Wisdom tooth. I don't have wisdom teeth, they were removed when I was a kid. My question is, would the space affect my appearance as far as sunken anything or would it cause shifting of the other teeth? Should I get the expensive tooth implant? Is it okay to leave it without the tooth? THank you.
Sonia,
My apologies, but I can only respond to comments in English. If someone will translate for you I'll be happy to reply!
- Dr. Appleton
Rey lanja kodaka emi ardham avuta ledu ra
Martha,
There are a number of different classes of antibiotics and allergy to all of them would be unusual. The safe thing to do would be to see your physician and get tested to see if you are truly allergic to penicillin and clindamycin or if your rash was a result of something else. Regardless of the dental implant issue, it is important to know if you are allergic to any antibiotics and it is important to know which antibiotics are safe for you. It would be prudent to get this information about yourself as soon as you can so see your physician. You should replace your tooth #27 as soon as reasonably possible after you have resolved your antibiotics issue. This tooth is an important part of the dental arch and helps to keep your bite correct. Replacing this tooth will help prevent your other teeth from moving. Replacing this tooth with a dental implant will preserve the bone that used to surround the root of the tooth that was removed. Read the entire article above. See your physician about your reaction to antibiotics. Get the dental implant. It will help take the stress of the surrounding teeth and this is good for you since your have short roots. Let me know how it goes, and good luck!
-Dr. Appleton
I received the following email a couple of days ago from Cindy. I thought everyone could benefit from her question and the answer that follows.
"Dear Dr. Appleton,
I stumbled upon your blog after learning that I need to have my lower second molar on the right side removed due to decay and infection -- yes I have learned my lesson! I also need to have both upper and lower wisdom teeth removed on that side. Now, I have had 4 of my premolars (I think) removed for braces when I was younger -- two upper and two lower, so I will be left with just one premolar and one chewing first molar on my right side after the infected second has been removed.
Now, I am still in grad school (even tho I'm 32) so I can't afford an implant yet, and I have read different contrasting opinions regarding whether a second molar needs to be replaced. The thing that worries me is that since I don't have all my premolars, how would it affect my chewing? I don't think it'll be noticeable as it's in the back and I have a small mouth...it's just very upsetting. If you can give me any suggestion I would greatly appreciate it. Thank you so much! Best, Cindy"
Cindy,
Read the entire article above, especially the section regarding not replacing a tooth. You will probably not notice much loss of chewing ability. You will still have enough posterior teeth to chew fine. If after some time you feel you need or want your second molar back, then you can seek out an oral surgeon and have an implant placed. If you want to hedge your bets and keep the implant option more readily available, have socket preservation performed along with the extraction of the second molar. Then if you decide in the future you want the implant, the site will be ready to receive it. Don't stress out, just get the hopeless second molar out. Let me know how it goes, and good luck!
- Dr. Appleton
Christal,
Loosing all of your molars is a pretty serious situation. However the aftermath can be dealt with. We'll divide the aftermath into two categories, the immediate aftermath (the postoperative recovery period) and the long-term aftermath (or the permanent results of having lost the teeth). The postoperative recovery period can be minimized first by using a highly skilled oral & maxillofacial surgeon. He or she will remove the teeth in the most non-traumatic fashion and then close the wound in the most ideal manner possible to promote healing. Second, by following the surgeons postoperative instructions faithfully, including any medications he or she prescribes, you will shorten your recovery period and make it a much more comfortable experience. As for the long-term recovery, read my article above to get information about your tooth replacement options. The first molars, that is the ones closest to the front of your mouth, are the last teeth that show in your smile. The loss of your upper first molars will probably negatively impact your smile to some degree. Your options will be limited to removable partial dentures or dental implants. I would recommend you ask for socket preservation procedures and/or guided bone regeneration, at least in all four first molar sites. This will minimize the impact of the resulting socket left behind once the first molars are removed and reduce bone loss. This will also create ideal sites for the later placement of dental implants for replacing the first molars. Most people do not need to replace the second molars to achieve a beautiful smile and to be able to chew food properly, but the first molars are important. When people are dissatisfied with their teeth when they smile, they do tend to smile differently. It is not automatic or unconscious. They tend to consciously reduce how wide they smile. The is usually obvious to the onlooker and it usually gives the person the appearance of being less happy. This can eventually lead to the person actually being less happy. Regarding tooth #19 (the lower left first molar), root canal treated teeth can last a lifetime. Molars that have received root canal treatment must soon be restored with a full-coverage restoration, such as a crown. Root canal treated posterior teeth, like molars, are at a much higher risk of catastrophic fracture and thus need the protection of a crown or similar restoration. For molars, a root canal is not the end of treatment, the molar will need a core buildup to replace the tooth structure that was removed to gain access to the pulp chamber and to the canals in each root as well as to replace any tooth structure that is decayed or damaged. Then the tooth can receive a crown. Obviously saving a tooth is more involved that just getting a root canal. Get a consultation with an endodontist. They are specialists in performing root canal treatment. Ask questions. Find out what it will cost. Find out what the prognosis will be for the tooth if it has root canal treatment, core buildup, and a crown. Find out how much the core buildup will be and how much the crown will be. Some endodontists will perform the core buildup on the same visit as the root canal treatment. Endodontists generally do not do crowns. You will need your general dentist or a prosthodontist to restore the tooth with a crown. The endodontist will provide you with a prognosis, that is a generally idea of how long the tooth will remain successfully restores. He or she will assign one of the following prognoses (prognoses is plural for prognosis):Excellent, good, fair, guarded, and hopeless. If the prognosis for the tooth (after it is fully restored) is excellent or good then the root canal (along with the core buildup and crown) is the way to go. If the prognosis for your tooth #19 is less than good then have it extracted. If you cannot afford the root canal, the core buildup, and the crown all performed within a couple of weeks or so, then have it extracted. It will be a big waste of money if you pay for the root canal, put off restoring the tooth, then the tooth becomes hopelessly fractured. The amount of out-of-pocket money depends of course on whether you have dental insurance and how good that dental insurance is. If you get all of the other molars removed first then there should be no upper tooth that can contact the molar #19. This will obviously eliminate chewing forces on tooth #19 (at least until you replace the opposing molar) and greatly reduce the possibility of it fracturing. This scenario gives you the opportunity to restore #19 in a couple of phases. First you get the other molars removed, then you get the root canal done on #19 and your get the tooth immediately restored with a full-contour core buildup. This kind of core buildup doesn't just rebuild the center (or core) of the tooth. It also rebuilds the entire tooth so that the exterior of the tooth is back to normal size and shape. This will make the tooth comfortable and easy to clean. Now you can wait until you are ready to afford the crown. Keep in mind the possibility for supereruption so speak with your dentist about options. Even a simple retainer would work as long as your wear it every night. By the way, the procedure for inserting a dental implant is not painful at all. In fact, is is easier on the patient than the extraction of a tooth. Dental implants must be placed precisely and gently for them to integrate properly with the bone. In any case, make sure you are confident in the skills of your dentist and any dental specialists you enlist in your care. Only high quality dentistry has the potential to last a lifetime. Let me know how it goes, and good luck!
- Dr. Appleton
Brena,
Yes your night guard will prevent your upper teeth from supererupting. You will find most orthodontists reluctant to try to move your remaining molar(s) forward to fill the space, even a little. It is very challenging to do. Get an orthodontic consult before doing anything else. Consider the interim removable partial denture. It is non-invasive and inexpensive. Or ask the orthodontist to make you a retainer and just wear it at night while wearing your night guard. These last two options can put off doing anything indefinitely. Just keep all of your removable appliances well-maintained. Bring everything with your to your semiannual check-ups and your dentist will check them out and adjust them as needed. Do not just let your teeth shift on their own. The result will be bad. The loss of the one tooth will not change your appearance. Don't panic. First see your orthodontist and arm yourself with information. Get a referral from someone you trust. Then get the hopeless tooth out before your get pregnant and have the retainer or partial denture put in place. Stress kills. Don't worry. It's just one tooth. Let me know how it goes, and good luck!
Thanks for your reply Dr! I should have probably added that I am strongly against implant surgery so that is not an option in my case. The options Im considering are leaving the space - but do you think I can survive many more years that way and what are the possible repercussions? How can I avoid them? Some people claim they have survived fine without a molar - maybe not the first. My only other option is orthodontics to close the space even halfway to prevent eruption of the top tooth - in the meantime I can were my night guard for my top teeth - would that stop eruption of upper molar for now? I feel like Im in a nightmare that I cant escape. Otherwise I am considering fixing the tooth and risking it, but im told this is a huge risk to take as I could suffer infection/pain/bone loss - potentially during pregnancy which I plan in near future - without long term success due to crack. What do you think? Could I leave the space and would it close over time. Which teeth would move towards the space - front, back, both or none? Will it change my appearance or cause tmj? or should i go for ortho asap after extracton? so worried sick.
I have a question I'm not sure if anyone can answer but it would be nice to have my fears put to rest. I am 23 and facing loosing all 8 of my molars as well as possibly one more on the bottom right side just in front of it. I'v never had any teeth pulled so I am worried. How bad is the aftermath? I think you can see the top of the one tooth they want to pull when I smile. Will this affect my smile more then I am expecting? Or will I just smile differently because of it? Debating on getting a root canal on the nineth tooth if they consider it savable but I hear they don't usually last. I don't mind the idea of a screw in tooth but it sounds sooo painful! Looking for advice! chatterley_cfc@hotmail.com Thanks!
I notice some key words are missing from my previous posting. Here is the revised version.
I have my premolar #27 extracted last December. I was given antibotics - pencillin and clindamycin and both gave me horrible rash - morbilliform eruption. Even after I finished the course, the rash lingered on for some weeks. Though the rash is nowgone, my skin has become very sensitive and can break out easily.
I am worried that I may have to take antibotics again and have to go through that horrible horrible itch when I have my dental implant. My question is: should I move forward with the dental implant procedure to replace the lost tooth? If I do not replace my tooth, will there be any impact on my other tooth and jaw bones?
Please note I am of Chinese ethnicity and have short roots. Not sure if this information affect anything.
Please advise.
I have my premolar #27 extracted last December. I was given antibotics - pencillin and clindamycin and both gave me horrible rash - morbilliform eruption. Even after I finished the course, the rash lingered on for some weeks. Even the rash is gone, my skin has become very sensitive and can break out easily.
I am worried that I may have to take antibotics again and have to go through that horrible horrible itch. My question is should I move forward with the dental to replace the lost tooth. If I do not replace my tooth, will there be any impact on my other tooth and jaw bones? Please advise.
Dizzyt,
The wisdom tooth behind your hopeless second molar will quite likely tip into the space that results from its loss. However, when any tooth moves into another tooth's space it is rare for it to position itself properly relative to the tooth in front of it. Short of recommending you go into your woodshed out back and knock out your own tooth, I would highly recommend seeing a dentist who is well recommended. Just ask for an examination and consultation. A good dentist should gather all the information he or she needs about your mouth and then present it to you and discuss your options. Thus you will be armed with a lot of good information and this is the only way to make good decisions. The information you receive will be well worth the fee for the examination and radiographs. You might find that the wisdom tooth may need to be extracted along with the hopeless second molar. You might also find that if you have a healthy first molar, you may not need the second molar or the wisdom tooth. Read the entire article above. If you are not satisfied with the first dentist you see, find another. Keep looking until you find a dentist you can trust and who spends the appropriate amount of time to provide you the information you need to care for yourself and to make good decisions. You health is worth paying for. Remember that preventive health care is by far the most effective and the least expensive treatment of all. Let me know how it goes, and good luck!
- Dr. Appleton
Charity,
See my response to Cherjo, it looks like exactly the same situation as yours, same tooth number too. Read the entire article. Let me know how it goes, and good luck!
- Dr. Appleton
Kimberly,
With all of your molars missing from the left side of your lower jaw, you only have two options for replacing them. Dental implants or a removable partial denture. Dental implants do not always require bone grafts. Bone grafting does not necessarily result in debilitating postoperative recovery. I would imaging it is less severe than the extractions were. I would also imaging the surgeon would have placed grafting material into your sockets as a bone preservation procedure. It is fairly standard practice. Your need to at least get the first molar replaced. Because it is such a large tooth and it would be the last tooth in line, it is often recommended to have two implants support the first molar or to maybe get three implants to support the first molar and second molar splinted together. This is very valuable treatment and having the military provide this service can save your $10,000 to $15,000. My father was an Army prosthodontist for 20 years. Definitely push for dental implants and implant crowns. You'll thank yourself in the long run. Let me know how it goes, and good luck!
- Dr Appleton
Brena,
A crack within the walls or floor of the pulp chamber certainly does compromise a tooth severely. I agree with the endodontist about not spending the money to have root canal treatment and a crown made for a cracked tooth. This tooth will fail, it is just uncertain how long it will take. The best replacement option is the dental implant, especially for younger patients like yourself. Failure rates for properly placed dental implants that then have proper crowns placed on them are very low, approaching less than 5% failure. Before you have the 36 molar removed consult with a prosthodontist. That is what I am. See my profile for my credentials. A prosthodontist will guide you through every step of the way and will coordinate any treatment provided by any other specialists that may be needed. Bring you night guards in with you when you see him or her. Your prosthodontist will check all of your teeth, will make sure your bite is appropriate your your jaw joints, will make sure your teeth are protected properly from the effects of nighttime clenching and grinding, and will make sure your replacement tooth 36 is very well made and adjusted to be in harmony with your other teeth and your jaws, etc. He or she will provide you with options for a temporary replacement tooth if there is some waiting period before the molar implant can support a crown. Ideally, he or she would coordinate your treatment with an oral surgeon who would extract your remaining wisdom teeth, extract the cracked tooth 36, place an appropriate dental implant into the 36 molar site, graft bone around the implant to fill what remains of the socket, and return you the the prosthodontist. The prosthodontist will provide a temporary crown on your implant if appropriate or an interim RPD (the flipper) or possibly no temporary tooth if you want to save a little money. Since your hard (acrylic) night guard fits onto your lower teeth, it could be adjusted to serve as a retainer and it will prevent your lower teeth from shifting. You would still just wear the night guard at night or anytime while sleeping. I'm not sure why the opposing upper molar is aching. Your prosthodontist will make sure your night guard is properly adjusted as it will prevent the upper molar from drifting down (supereruption). The hard lower night guard should be preventing your lower teeth from moving. So begin right away by seeing a prosthodontist. Ask your general dentist for a referral. If he can't or won't, then ask one of your dental specialists for the name of a prosthodontist in your area. At your initial appointment carefully relay your dental history. Make sure you include the name and contact information of your general dentist, your orthodontist, and your endodontist, and any other dentist or specialist who has cared for you. Explain your concerns to the prosthodontist and let him or her know you are interested in comprehensive evaluation and care because it sounds like you may have other dental issues. You don't want to just have a hopeless tooth replaced, you want to make sure all of your teeth, your jaw joints, and your jaw muscles are all healthy and working in harmony. Wear your properly adjusted night guard every night and any time you are sleeping. Bring it in to every dental visit no matter what. Let me now how it goes, and good luck!
- Dr Appleton
Cherjo,
You are right about the implant being your best option. The answer to your question about bone loss depends upon whether or not your had socket preservation performed once the tooth was extracted. This is where your dentist places some bone regeneration material into the socket and possibly places some sort of regenerative membrane over that. This will preserve the bone for a good 6 to 12 months. If you did not have socket preservation performed then 80% of the bone loss and remodeling occurs over the first two months. The bone will continue to shrink slowly over the years so the sooner you can get the implant the better. However, a good implant surgeon can perform guided bone regeneration and restore much of the bone loss. I do absolutely recommend you get something to stop the teeth from shifting. You could get the interim RPD (the flipper) which if made properly can serve as a retainer and give you a replacement tooth with which to smile. I would imagine it would be priced the same as a retainer. Get the interim RPD, your insurance will pay for 50% of it. It will buy you time while you wait to get the implant. Stay away from the bridge! Let me know how it goes, and good luck!
- Dr. Appleton
Hi there
My top right second molar is about to fall out due to my wisdom tooth coming in above and slightly to the side of it.when this comes out will the wisdom tooth take over this space?the wisdom tooth has already erupted 90% but is mostly above the second molar?i live in the uk so have to pay for all dental work (as nhs reduction of costs is minimal!) so i would like to properly evaluate the situation before having to save up loads of money to see an orthodontist that i might not need.
Im no longer in any pain from the tooth as it is almost completely out although is uncomfortable eating at the moment.hope u can be of help.
Many thanks
Hi, i have had to have both of my lower left molars extracted. ( the one in the very back and right next to it.) no wisdom teeth. What are my options ? I have read the whole article. But wasn't clear on what the options for me or the best" road " to take would be! Thanks for the advice. ( Not to upset anyone.. I live on a military instillation overseas so payment isn't an option. I just need to know what to push for and to stay away from. I am a mother of two small children and I don't think a bone graft is a good viable option for us, ( dads always deployed.) so help is sorta slim.
Ginger,
I've never seen such an interesting dental plan policy. So it sounds like you are missing your first and second molars on one side and the first and second molars on the other side plus one of the premolars. That's quite a deficit in posterior teeth (back teeth). I just can't imagine what rationale your dental insurance company can have to justify such a policy. Maybe they have provisions for you to receive an implant on the side that is missing the most teeth? Maybe they have figured out that it can cost them less to have you replace one necessary tooth instead of a removable partial denture. Without additional posterior support you ability to chew is going to be greatly compromised. You should ask you dentist to write a narrative to appeal your dental plan's decision. If the policy cannot be flexible then often times an alternative benefit is made available. The key is to not give up. Let me know how it goes, and good luck!
Dr. Appleton
I'm 22 and I just got #12 tooth taken out. I try to avoid any eating on my left side. I want to get a fake tooth, but I don't know if I can afford it. I don't know the types of teeth to consider when looking a tooth replacement. I'm really stuck on what to do. Any help would be great?
Hello, I had to have my #12 molar removed due to a fracture that went up to the root. It is the left molar behind my canine tooth. You can see it when I smile fully and I do want to do something about it. I have been getting prices on implants, etc. That does seem like the best route to go. I didn't realize that a partial had all the gear associated with it until I was reading your site. How long does it take for bone loss to occur? I had the tooth out about a month ago. If I do have to wait due to cost, do you recommend that I get a retainer to stop the teeth from shifting in the meantime? Do you have any other advice that you can give me? I know that my dental insurance does not cover any type of implants, or crowns that are attached to implants. It covers 50% of partials and bridges. I do not want to go the bridge route because I don't want to impact the canine which you will really see when I smile. Thanks for any guidance you can give me.
Hi, i have had to have both of my lower left molars extracted. ( the one in the very back and right next to it.) no wisdom teeth. What are my options ? I have read the whole article. But wasn't clear on what the options for me or the best" road " to take would be! Thanks for the advice. ( Not to upset anyone.. I live on a military instillation overseas so payment isn't an option. I just need to know what to push for and to stay away from. I am a mother of two small children and I don't think a bone graft is a good viable option for us, ( dads always deployed.) so help is sorta slim.
John,
Allergy to local anesthetics is very rare. The only way to know for sure if you are allergic is to be tested. Seeing a physician who specializes in allergy is your best bet. He or she can either test you or assure you to your satisfaction that it is safe. Let me know how it goes, and good luck!
Dr. Appleton
Faz,
The first thing you need to do is get your gum disease under control. Gum disease is known as periodontal disease. It is infection around the roots of the teeth in the gums and bone. If you have a hopeless tooth then it needs to be removed soon. How soon it needs to be removed depends on the specific situation. You can arrange to have a replacement tooth placed immediately after the hopeless tooth is removed. See the article above about the different means for replacing the tooth. However, in the presence of active periodontal disease it is probably best to start with an interim removable partial denture (a flipper) to serve temporarily while you treat the periodontal disease. Periodontists are dental specialists that treat periodontal disease. They will begin by performing a thorough examination of your entire mouth. Controlling periodontal disease begins with controlling plaque and bacteria by keeping your teeth very clean. The first phase of treatment will include detailed oral hygiene instruction. That means the periodontist or his/her dental hygienist will sit down and carefully teach you what you need to know to keep your teeth very clean. You will be evaluated over time on how well you are cleaning your teeth. Depending upon the severity of the periodontal disease the treatment can range from the application of topical medicines to periodontal surgery to eliminate the disease and correct any defects in the gums or bone. This is a slow process and can take months. Most patients who have successfully treated their periodontal disease will need to continue to see the periodontist regularly for maintenance visits. Once your periodontal disease is under control you can then get a consultation with an orthodontist. Having braces on your teeth will make your fastidious oral hygiene routine more challenging and if you fail to keep up with keeping your teeth very clean your periodontal disease can return and even cause the loss of additional teeth. Once your periodontal disease is under control and your orthodontic treatment is complete you can decide which method to use to replace your missing tooth and any other teeth that may be missing. The cost for having a flipper made varies from one part of the world to the other. However, in my practice the fee for a flipper ranges from $450 to $1200 depending on the complexity. Read the article above in full. Let me know how it goes, and good luck!
Dr. Appleton
HopeAngeleyes,
You are very welcome! Thank you for the kind words!
Dr. Appleton
Sorry accidentally submitted without completion. I am 37 yo female and faced with losing bottom left first molar (tooth 36 in Australia) - terrified about repercussion as I have never had dental problems - can i live without this tooth? what risks exist? Endodontist discovered internal crack in the root chamber, advised tooth is compromised, max life of 2-5 years if complete treatment (RCT/crown) and suggested I save my money, extract and look at replacement down the track because I wish to get pregnant asap. does crack compromise rct/crown that much? What would you recommend? Which specialist should I see for what and when? I had braces at 17 and dont want to ruin my straight teeth. Since braces i had upper wisdoms removed - all other teeth remaining, including lower wisdoms. Top teeth are still good after wisdom teeth extracted. Lower teeth are quite crowded and have gone slightly crooked again - cant remember if wisdoms came out after braces or not - probably causing crowding/pressure? should i remove them also? I also clench/grind at night and have both soft and hard guards due to surface cracks on front teeth. What should I do and why is my tooth above the lower first molar aching now? moreseo when I wear the guard? Is it because the lower molar is ground down now and upper is missing contact/trying to move down and the night guard stops it - is this possible in such a short timeframe? im very stressed due to constant headaches discomfort and worry.
worried about implant risks and failure rates re: bottom first molar. please help, what should i do and in what order? i want to do the best thing for my age and situation. should i save this tooth or let it go? if so, how to replace, who to see? please let me know if you need more info.
please help
Hello Dr. Appleton,
In Dec 2011 I was approved for upper partial and lower partial but my Oregon Dental Plan changed Feb 2012 that you had to have 6 or more teeth missing not counting 3rd Molars. I was re-approved for my upper partial but denied for the lower partial because I only have 5 teeth missing. So, my question is how can I properly chew with only 1 lower back tooth 7 front lower teeth?I need to appeal this and don't know how to impress on Capitol Dental that having the upper back and no lower back partial is going to affect my quality of eating? Can you help me say the right things to prove I need the lower partials as well? This is my first time ever having a dental health plan. Sincerely, Ginger Flores. gingerflores@ymail.com (I have 45 days to appeal from the letter date of Feb 14, 2012)
Mr Appleton, I need to have a dental implant put in but I am worried about sensitivity from injection of the pain killers. Is there any way the dentist can discern whether or not I have an allergy to the product before really using it?
Hello doctor I have very bad teeth and gum disease and also need braces. My dentist said I have to take my bottom front tooth out, I feel very depressed about it. I would like to know how long would I have to wait before I can replace it and how much it will cost me becuase I am working part time with less hours and also what kind of treatment will they give me for the gum disease. Thank you
Hello again Dr.Appleton.I finally had my upper second molar extracted today! I'm soo glad that it's over and done with. Now, i hope to recover quickly =) Thank God the bleeding stopped. I just hope i can brush my teeth tomorrow morning! I just want to thank you soo much for helping me make my final decision a little easier to decide. Your're awesome and definitely a friend for life! GOD bless you always! x x x
Nikki,
I'm not sure if you have a question. I've never seen a patient who has had a visible external facial change from having the wisdom teeth (the third molars) or the second molars removed. It's possible that after the extractions were completed that the subsequent swelling filled out your face a little. Now that the areas have healed the swelling will have gone down. You may have liked the fullness the swelling gave to your face, but now that it is gone you may be disappointed in your face's appearance. It is obvious that you are concerned. I recommended you see an oral & maxillofacial surgeon as soon as possible. They will evaluate your face and jaws and advise you on why your face looks the way that it does. They will let you know what your options are and they can answers your questions. Let me know how it goes, and good luck!
-Dr Appleton
ive had my wisdom teeth out all four but ive got a big gap up the top an my face has sunk in i want the gap filled to fill my face out i hate the way i look now should never of taken top ones out
Hopeangeleyes,
Thank you for such kind words! The short answer is yes your custom night guard can prevent movement of your lower second molar upwards into the space left by extracting the upper second molar. I'm glad you read the whole article. It contains a lot of useful information. Let me know how it goes, and good luck!
- Dr Appleton
How i wish i read the whole article before i asked you my first question! First of all, i want to personally and kindly thank you for all of this wonderful and useful info you have provided for us all. I am at peace now, all thanks to u! Thank you soo much! After reading the whole article, my first question was answered! I am confident to go ahead and get my upper second molar extracted, rather than go through the pain and high cost of a root canal. THIS IS WHERE MY CONCERN STANDS....if i do end up wearing a custom made night mouth guard every night, will this help with preventing my lower second molar from drifting upwards towards the empty space in the future???? I hope you say yes!!! Then i can finally put all my worries to rest! I look forward to reading your answer and again, thank you soo much for all the great advise and best information given throughout the entire internet! GOD bless you and your family always! You are an Angel and friend....a GOD sent! I'm soo glad i ran across this wonderful page! I'm going to tell all my friends and family about it! That's how much i am excited! Have a great day/night and again, thank you!
Hello. I wanted to ask you another question, if may. I grind my teeth heavily at night and i was wondering if i should wear a custom made mouth guard to help me with this problem that i have. Is it true that the mouth guards they sell at the stores are not worth it! I might need to custom make mine and it will cost me $300! What is your suggestion Dr.Appleton?
Good day/evening to you Dr.Appleton :) I need some advise please. I can't afford to get a root canal on my upper left second molar so i think i might just as well get it extracted. My question to you is, will any of my upper teeth shift at all? I have removed all of my wisdom teeth when i was much younger. Now, i still have all of my second molars with the exception of the one i might extract. Is it risky or do you think i can get away with it and not worry about any of my teeth shifting from where they are now....please let me know. Thank you in advance! Have a wonderful day/night.
P.H.,
Your treatment choices are going to depend greatly upon the health of your remaing lower teeth. Your age is not a factor. But your health is. If your remaining teeth are healthy all of the tooth replacement options mentioned above are possible assuming your health is good enough for elective oral surgery. If your health prevents dental implant placement then your only options are a fixed bridge supported by your remaining teeth or a removable partial denture, or a combination of the two. You are at a critical turning point in your oral health. I would strongly recommend that you see a Prosthodontist. We are specialists in handling complex dental problems and can offer you solutions that will not only replace your missing teeth but ensure your salvageable remaining teeth will last. In contrast, improper treatment can lead to the early demise of your remaining teeth. Go to www.prosthodontics.org and click on Find A Prosthodontist. This website is operated by the American College of Prosthodontists and can help you find a Prosthodontist in your area. Let me know how it goes, and good luck!
- Dr Appleton
I am 63 years of age. I have a full set of upper teeth including a twelve unit bridge.
I have only seven lower teeth remaining all at the front of my mouth. The middle two of those seven teeth are now loose. I know I am suffering a bit by not being able to chew my food properly.What are my realistic options for replacement teeth?
Nisha,
If I understand you correctly, you have had your lower left and right wisdom teeth (the third molars) removed as well as your lower left and right second molars removed. Read the section of the article above titled "Not Replacing A Tooth." As long as you have all of your first molars and all teeth forward of them, you do not have to replace missing second and third molars. However, you are down to your critical teeth and cannot afford to lose any more. Make sure you get regular checkups and have your dentist check your bite to make sure it remains healthy. Do everything you can to preserve your remaining teeth. You can still afford to lose your upper wisdom teeth if you have not already. Remember, only your own dentist can best advise you of your best treatment options. Make sure you have an excellent general dentist that you are comfortable with and that you can trust. Let me know how it goes and good luck!
- Dr Appleton
I got my two wisdom teeth pull in the bottom plus the one in fron of that wisdom. So on both side of my mouth I'm missing two teeth plus two wisdom. Do I need to get detures to place them
Rae,
Read the entire article above. You do not have to go any time without your teeth. Implants are usually the best option for replacing missing teeth. You could continue to wear your flipper while the implant sites heal. In ideal situations you could have a temporary crown attached immediately to the implant the same day it is placed. Then after the appropriate amount of time, usually 4 - 6 months, procedures for making porcelain impalement crowns can begin. At no point do you have to go without your teeth. At worst you continue to wear the flipper, even immediately after the implant placement surgery. At best you throw away the flipper and have temporary implant crowns to immediately enjoy! Talk to you dentist. If he or she does not sound well-informed about implants or does not answer your questions to your satisfaction, go see an oral surgeon or periodontist. They will explain everything and can refer you to a dentist or prosthodontist that is skilled at implant dentistry. Let me know how it goes, and good luck!
- Dr. Appleton
John C,
I think you've made the right decision regarding replacing your lost tooth with a dental implant. Your age has nothing to do with whether or not dental implant treatment is appropriate. Your health has much more to do with it. If you are healthy enough to have minor elective oral surgery then you can have a dental implant. If you mention age because you're thinking "I'm too old to spend that kind of money on myself," then it's not a medical decision. It is a personal decision. I get that question a lot in my private practice. I answer the age question with another question. "What do you like to do at your age? Skydiving, mountain biking, and extreme skiing? Or maybe eating, socializing, and perhaps singing? The latter require a healthy mouth. The molar you are missing is an important part of a healthy mouth. This is particularly true since you have a retained deciduous tooth in front of it. This deciduous tooth will have to bear extra work and stress due to the missing adjacent tooth. This can lead to failure of the deciduous tooth. Then you'll be missing two teeth. Replace the missing tooth. Get the implant. Talk to the dentist who will be making the implant crown. See if he has different options for what material the implant crown will be made of. Perhaps a screw-retained milled titanium crown would be less expensive than a porcelain crown or porcelain-fused-to-metal crown. It would look like a shiny silver crown but a lower molar is not usually that noticeable in one's smile. Less labor would be involved by the dental lab so perhaps less cost to the dentist who could pass the savings on to you. You could ask for a temporary crown (that is, a well-made composite resin crown) to serve in the interim as you wait for you checking account to recover from the trauma of paying for the implant placement surgery. A well-made screw-retained temporary crown can last a good while, years even, and the cost should be a fraction of what a permanent crown would be. The worst thing that can happen is it could break after a while, but it can be repaired easily. It may even wear down after a while but it can be re-surfaced. This may buy you a couple of years before needing the permanent implant crown depending on how hard you are on your teeth. I use this option for many of my patients. Talk with your dentist because only he or she knows the particulars of your situation to best advise you. Let me know how it goes, and good luck!
Hi My name is Rae Im 21 yrs old and I had my flipper for over 7 years because I never recieved two of my teeth and my gums are so sensitive and I been look fowarded to getting implants but I'm kind of nervous about the procedure and having to go a while without the teeth can be pretty embarassing but I was wondering if there another option or like a same day procedure will I would have my permanent teeth placed
Dr. Appleton
I am age 72 and have "fractured tooth syndrome". I had a lower second to the last molar fracture off and extracted with placement of bone graft in preparation for a dental implant. The socket has healed and is now ready for the implant. The adjacent tooth (towards the front) is a deciduous tooth that has partially fractured off but is still viable and well rooted. I'm having second thoughts about proceding with the implant process due to cost and my age. Any advice at this stage? thank you.
Divya,
The problems resulting from a supererupted maxillary second molar, that is, an upper second molar drifting downwards, are generally much less severe than a lower molar drifting upward. It has also taken 5-7 years for the upper second molar to drift down far enough to be detected by your dentist. So don't feel too pressured to replace your lower second molar now. The lower third molar, the one that would be used to support a fixed bridge along with the first molar, has probably tipped forward and may be difficult to use as part of a fixed bridge anyway. An implant is usual the best option and is very safe when planned and placed by a trained specialist. Quality dentistry is the same anywhere in the world. Well-trained professionals provide safe, long-lasting, comfortable, and natural-looking dental work. If your nervous about the work, maybe you are not working with a dentist that instills confidence. A perfectly good option is still to not replace the lower second molar at all. Just make sure a good dentist checks your bite regularly to help you avoid complications. So don't worry too much. Relax and consider your options carefully. Only work with highly trained professionals and make sure they explain everything and answer all of your questions to your satisfaction. Don't butcher your teeth with a bridge. Get the implant or do nothing at all. Let me know how it goes, and good luck!
Dear Dr. Appleton
I am based in India and in urgent need of your advice. 5-7 years ago, I had my lower second molar extracted. Now my dentist says that the upper tooth is drifting downwards and is suggesting an implant. I am very nervous about this and not keen on doing it at all. I also dont wish to have a bridge put since it involves grinding teeth. Please advise.
Thanks and regards
RM,
Unfortunately most dental insurance plans do not cover implant dentistry. Many insurers are coming around, however, and are starting to realize the long-term benefits of implant dentistry to patients as well to their own long-term cost savings. Regardless of insurance, you son is too young to have a dental implant placed. You do not place a dental implant into a patient who is still growing. Your son’s jaws will continue to grow until he is 18 - 21 years old. If you read the article above you will see the different options for replacing a single missing tooth. The fixed bridge would be another choice and is included in nearly all dental insurance plans. However, your son is rather young for a fixed bridge as well. I would recommend having an acrylic removable partial denture (AKA “the flipper”) made to replace the tooth #29. He could wear it while he finishes growing. A more expensive option would be to have a Maryland bridge made to replace the missing tooth. This procedure takes skill so make sure you have confidence in your dentist. The Maryland bridge is usually also covered by most dental insurers. When he is finished growing you should speak to a prosthodontist, periodontist, or oral surgeon about having your medical insurance pay for your son’s missing tooth. You may have to try a few different offices to find someone willing to do the paperwork. Your son was born without his adult tooth 29 so it is congenitally missing. He did not lose it from neglect, that is a cavity or gum disease. The missing tooth is essentially a birth defect and thus should be covered by medical insurance. The recommended treatment for the congenitally missing tooth is a dental implant and implant crown. The more you push your medical insurance company the more likely you will get what you want. They will resist your first two attempts. Just follow proper procedure to appeal the first rejection and get your implant dentists to support you with the information requested for your claim. So in short, get the flipper, bide your time, then work your medical insurance to get the best treatment for your son. The flipper will preserve the space and keep his teeth aligned until he’s ready. Let me know how it goes, and good luck!
-Dr Appleton
my son is 15yrs old and has lost a baby tooth number 29 that we capped years ago to save because he does not have an adult tooth underneath to come up i went to get a price on an implant and cannot afford to do so wanted to know an alternate route that his insurance will cover?
Shannon,
Thank you for your question! A flipper, or temporary removable partial denture is the most inexpensive solution to replacing a missing tooth. The price will vary quite a bit depending upon what region of the country you are in. It can also vary within your state or even your community. Flippers can be made a number of different ways, some more costly and others fairly cheaply. Here in Baton Rouge the price range would probably range from $200 to $900 depending upon who you ask and what type of flipper is chosen. Just explain your situation to the receptionist. If they don't have time for you then call another. In this economy someone will be glad to take good care of you! Just make sure someone sits down with you and explains exactly what you will be getting and exactly how much it will cost and what their payment options are. Let me know how it goes, and good luck!
-Dr Appleton
JJ,
Now I'll answer your question regarding your bruxism, or the clenching and grinding of one's teeth. Some believe that bruxism would eliminate you as a candidate for implant dentistry. This is not true. However, you should only pursue implant treatment if you are protected from the extreme forces bruxism places on your teeth. This means you must wear a properly constructed night guard. A good night guard is not soft and rubbery like a sports mouth guard. It should cover all of your upper or lower teeth with rigid acrylic and the bite should be carefully adjusted so your teeth contact it evenly and simultaneously. You will have to wear it every night and any time you're sleeping. Forever! Every time you sleep! Did I mention forever? This I no joke. Bruxism can destroy anything in you mouth whether implants or your natural teeth. You should bring your night guard in with you every time you see any dentist. They should check it to make sure it is functioning properly. Also, if your dentist changes any of your teeth, like if you have a filling done, he or she must adjust the corresponding surface of your night guard. You do not want to have even a single night of unprotected bruxism! A proper treatment plan should account for your bruxism. Let me know how it goes, and good luck!
- Dr Appleton
JJ,
Sorry to have taken so long to respond. I must have missed my alert that there was a new post on this hub. Yes it is true that nerve damage can be a complication of dental implant placement in the posterior mandible. That is, implants being placed in any of the lower back teeth sites. However, it is rare. The nerve that runs through the back of the lower jaw, there is on on each side, provides for sensation for half of the lower lip and some of the surrounding skin. It can be damaged if the implant surgeon is not careful and he or she drills into it while preparing the site to receive the implant. It can also be damaged if the implant is inserted too far into the jaw. A good implant surgeon will locate the nerve during the treatment planning process. Sometimes all that is needed is a panoramic radiograph. It depends upon your particular anatomy. Sometimes advanced radiographic imaging is needed, like a dental CT scan, also known as cone beam CT. This type of x-ray provides a 3D image of your jaws and teeth and provides precise information on the location of the nerve and other critical structures. The dental CT scan is much easier and cheaper than a medical CT scan. You just sit in the little chair and the sensor goes around your head. A competent surgeon with good planning will nearly never harm the nerve. I keep saying "implant surgeon" because a number of different dentists perform implant placement surgery. Some general dentists place implants and two different specialties are trained to place implants. They are Oral & Maxillofacial Surgeons and Periodontists. These specialists have years of advanced training in implant placement surgery as well as bone grafting / bone regeneration surgery. I'm a Prosthodontist, by the way. Get your implant surgeon to sit down and discuss the particulars of your personal situation. They should be able to show you using your radiographs what their plan is. If they don't instill confidence in you then find another. Sometimes it is possible to extract the bad tooth and immediately place the implant and graft any gaps around the implant within the tooth socket. This is great in that it saves you months of time and you only have to go through one surgery. However, it is a very advanced procedure and only a very experienced implant surgeon should attempt it. Even so, he or she may not recommend it for your particular situation. The most predictable process is to extract the tooth and graft the socket in the first surgery. In the second surgery the implant is inserted and the gum tissue is sewed over it to cover it up. In the third surgery the implant is uncovered so it can be accessed for implant crown fabrication. Typically you must wait three to four months between each surgery. There are many variations on the number of and timing of these surgeries.
I have a tooth in the front missing and don't have insurance how much is the flipper? I know later I will have problems like my mom and grandmother and my dad growing up spent a lot of money carrying us to the dentist and we still have rotting teeth and I brush 2-3times daily and have all my life , could you please give me a average price for a flipper for a front tooth, thank you and god bless
just wanted to clearify that the molar to be extracted is on the bottom
Dear Dr. Appleton,
I need to have one of my molar extracted. It is the one before the last tooth (not including wisdom tooth, the wisdom tooth has been pulled) I believe you call it the 1st molar. I have bruxism. I grind my teeth and sometimes clench them. Even though I have a night guard, I still seem to grind some of my teeth down.
Since it is the 1st molar, I have read that I am at risk for nerve damage if I choose a dental implant. Is this true?
And since I grind my teeth, am I a good canditate for dental implant? or Should I look into other options like getting a removable partial denture instead. I am not fond of the ideal of a bridge unless it is the only option. What do you think and recommend?
Many thanks to any advice you can give me.
Just make sure your bite is checked not just in your normal "centered" position but also while grinding your teeth forwards from center and to either side from center. Let me know how it goes and good luck!
- Dr Appleton
BR,
You are certainly welcome for the information! Your history of having orthodontic treatment and four premolars removed doesn't change anything, including tooth names and the description of their position. Socket preservation in your case is probably unnecessary provided the bone surrounding the adjacent tooth, the first molar, is healthy with no previous bone loss. If the bone is lacking around the first molar you would want socket grafting to protect the first molar from further bone loss. Remember, first molars a very important so do what's needed to protect them!
Yes the tooth can be ground down ("adjusted" sounds so much more gentle...) easily during your checkups
Dear Dr. Appleton,
Thank you very much for your information, which has set my mind at ease, as well as anyone else's who may be in the same position. I realize that all mouths are different and you need to see things 'in situ' but I am grateful for your advice, nonetheless, to take to my next appt.
The dentist did say that I might be able to get away with just doing a root canal on the upper 2nd molar and subsequent filling, but a crown will be ‘on the cards’, dependent on the amt. of remaining tooth structure. Obviously, I would hate this to eventually fail given the depth of existing filling (which does extend down the front-facing side to below the gum), esp. after having the bone/gum ‘removed’ - yes, not as frightening! All in all, I agree with you and I believe it won’t be worth the risks to go ahead... I’m OK to have it extracted, and wear a retainer, subject to a couple of (hopefully minor) concerns:
- I forgot to mention that I had braces due to overcrowding “buck teeth” when I was a teenager - they removed 4 of my premolars then (not sure whether they were the 1st or 2nd ones), so I hope that won't affect what you mentioned last time, ie. surely it won't effectively make my 2nd molar the 1st molar, mucking up your explanation of still being free to extract the tooth in question!? (BTW, as for my top 3rd molar (wisdom) it fully erupted behind the second molar, like two others {the pesky bottom one on the other side erupted not far above the gum - I can now appreciate first hand how the top one has supraerupted to meet it!) And, by way of the adjustment you mentioned, can such a tooth be easily ground down if necessary at regular checkups?
- Finally, when you spoke about bone loss and needing socket preservation/ grafting/ plug (in your other article about missing a 1st molar), can I safely assume it won’t be necessary for my molar extraction, as I wouldn’t need to worry about getting any future work done in this gap down the track…?
Kind regards,
BR.
BR,
When a second molar has deep decay, like the situation you are having, it can need a root canal ($800 - $1400), a core buildup ($350 - $550), and a crown ($1,000 - $2000). This can add up qickly! The crown must extend approximately 2 mm beyond any decay or fillings. If your tooth has decay or fillings that extend down the side of the tooth deep below the gum line, then crown lengthening would be necessary. This is where the level of the bone around the tooth near the filling or decay is reduced and the overlying gum tissue is trimmed appropriately. This exposes more tooth so the crown can extend beyond the problem area and not have to be extended deep below the gum line near the bone where it can cause periodontal problems. Crown lengthening surgery adds even more to the cost, perhaps another $800 - $1200. Notice the less frightening language... I hope no one at your dentist's office uses phrases like "scraping away the gum", youch! No one will elect to have that done! All kidding aside, it is a lot of costly work in a very difficult area to access. Extracting the problem upper second molar is absolutely a reasonable alternative. Now regarding the tooth behind it (the third molar, also known as the wisdom tooth). Depending on its position, it may need to be exrtracted as well. Is the third molar impacted against the back of the problem tooth? Is it unerupted and hidden beneath the gums? Is it encapsulated within the bone? Is it fully erupted behind the second molar? Your dentist or oral surgeon can tell you what your situation is and provide the appropriate recommendation. Generally speaking, however, wisdom teeth are trouble and you might take the opportunity to have it extracted at the same time. Now the opposing second molar (The one on the lower jaw. I think I understand that it is your upper second molar with the problem) may supererupt causing the problems mentioned in my article above. Your dentist could monitor it during your semiannual cleanings and make minor adjustments to it as needed. You do get your teeth cleaned twice each year, right?!? Of course you do! Your dentist could make you a retainer that you wear while sleeping. This would hold the tooth in place and would be relatively inexpensive. Of course you have to be compliant and wear the thing. Let me know how it goes and good luck!
- Dr. Appleton
Dear Dr. Appleton,
I was shocked recently to discover I had widespread decay in a top second molar, which had a very deep filling in it 6wks. ago. Now it is starting to get sore and the nerve is showing black on an x-ray. The dentist mentioned doing root canal treatment, but said that because my filling is below the gum line, a crown may be ineffective and then mentioned scraping away the gum and getting surgery performed to reshape the bone to compensate! Due to all this uncertainty - and high costs! - I'm thinking that (based on your article) an extraction will be a very viable option! However I DO have all four wisdom teeth, so does that mean the following may apply? {"If there are one or more teeth behind a lost tooth, drifting and tilting of these teeth usually occurs. This can lead to a number of serious complications that include developing bite problems and even loss of additional teeth."}?
Also, if the upper tooth may supererupt, what are the problems you alluded to that can be prevented or dealt with simply by your dentist?
Many thanks for any advice!
If the tooth you have lost is the second molar, that is, the last tooth in the back (assuming there is no tooth behind it, i.e. the wisdom tooth), you could seriously consider not replacing it as well. Clinical studies indicate that even with all four of your second molars missing, you ability to chew food properly is not significanly altered. A lost second molar rarely effects your smile or facial structure and appearance. However you must be aware that the tooth that opposes the lost tooth may supererupt. That is, an upper tooth that does not have a lower tooth to chew against will migrate down until it finds something to stop it, and vice versa. This does not always happen, but your dentist can monitor for it at your semiannual check-ups. A supererupted tooth may not necessarily cause problems. Problems can be prevented or dealt with simply by your dentist. Like a lot of things, early detection leads to simple solutions. Any other lost tooth should be replaced as a loss of chewing abiltity will be noticed as well as a change in your appearance. If there are one or more teeth behind a lost tooth, drifting and tilting of these teeth usually occurs. This can lead to a number of serious complications that include developing bite problems and even loss of additional teeth.
DL,
You're welcome! It will be well worth it.
- Dr. Appleton
Thank you for your advice.I have an appointment tomorrow for an implant and will go ahead and keep the appointment. Just wanted to know it was really necessary as it will cost over $2800.
DL,
Generally speaking, the first molars are each very important. The upper first molars are the last teeth visible at the very corners of the smile. Even if supereruption is not a problem, tilting and drifting of the adjacent teeth will be a problem. The second molar typically will tilt forward into the space left by the extraction of the first molar. The second premolar (the tooth right in front of the space) can tilt backward into the space and this would be visible in your smile. This tilting of teeth can cause problems with your bite. So maintaining the space is the minimum treatment you should do. This could be something simple like an orthodontic retainer that your just have to wear at night. You could also have an interim removable partial denture (the "flipper") made which would preserve the space, fill in your smile, prevent supereruption, and provide some amount of restored chewing function. Since you have teeth on either side of the space, it is easy to design and fabricate a partial denture that is comfortable and stays in place. These are inexpensive solutions. The retainer would be $150 or less and the partial denture would be around $400 - $600. Another problem with not replacing the first molar is bone loss. Hopefully you had socket preservation performed after the tooth was extracted. This is where bone grafting material is placed into the socket and a membrane or collagen plug is placed to contain the graft. This will preserve the bone surrounding the socket. This bone preservation will not last forever but it buys you time, maybe a good six months or more. If you did not have socket preservation performed, significant bone loss will have occurred within the first two months. Bone bone will be lost on the surface and also internally when the maxillary sinus expands downward into the bony space where the roots once were. Bone loss after tooth extraction is not the end of the world and it certainly will not kill you, but it can make the area of the lost tooth have complications that affect your appearance, affect the health of your adjacent teeth, and limit your options in the future should you change your mind. Regarding your age being over 50, PLEASE! You're just starting the rest of you life! Dental health and comfort, the ability to eat and speak well, and smiling become more important with age, not less. I recommend you have a retainer or a partial denture made to preserve the space. Then have an implant placed while it is still relatively easy. You could spread out the cost by continuing to wear your partial denture even after the implant is ready to be used. The partial could be adjusted to fit over the implant and even be supported by the implant. Then when your finances recover from the implant surgery, even a year or two or three later, you can have the implant crown made. The implant will preserve the bone and if anything were to happen to your other teeth over the next 45 years or so, the implant can be re-purposed to support a fixed bridge that replaces some or all of your teeth. Think about it. At the very least preserve the space. Good luck and let me know what your decide.
- Dr. Appleton
To add to my question re replacing first molar, age is over 50. Tooth had to be pulled as it broke d/t large filling. No dental disease. All other teeth in place.
I had to have tooth 14 (first molar) pulled. One tooth left behind it as I had the wisdom tooth pulled. Because of my overbite, I am thinking I may avoid problems with the supererupted tooth problem. The tooth was pulled just a couple of months ago, so far no problems with appearance, etc. I appreciate what you said about not always replacing molars or second molars, wondering if in some cases a first molar is okay?
RM,
The best thing is nearly always to replace any missing tooth. You are very fortunate to have gotten into a dental university clinic. The fees that are charged are usually very low and generally reflect merely the cost of the materials used in your treatment. The treatment received at dental universities is usually excellent quality. The trade-off is time. Treatment visits are very long and waiting to get an appointment can also take some time. Assuming your situation is appropriate for grafting and dental implants, I would say you are on the right track. Bone grafting and soft tissue grafting have advanced far over the past couple of decades. These grafting procedures, often referred to as guided tissue regeneration, will create a good foundation into which the implants are placed. Well-placed implants will then provide excellent support for your new teeth and thus prevent adjacent teeth and opposing teeth from moving. Replacing your missing teeth will of course improve your ability to chew. This is very complex treatment so don't be afraid to ask questions. Ask the student dentist as well as his supervising faculty. The bottom line in dentistry anywhere in the world is that you must trust your dentist and have confidence in his or her skills. Otherwise you should move on and find another who inspires confidence and takes the time to earn your trust.
Please let me know how it works out for you. I wish you the best of luck!
- Dr Appleton
I just spent about 7 months getting a cantilever bridge removed and replacing the crown next to it replaced. Now I have a big space where the molar is missing from that cantilever bridge. I am doing this through a university dental school. I also had a fractured molar on the opposite side removed during this time. It had been crowned and a root canal had been done on it all between 30 and 10 years ago. I had not pain but I felt the absess on the gum and after consulting with specialists at the same school, I made a decision to have it extracted. I have debated back and forth about what to do and had made the decision to have a RPD for those missing molars but have the mold was made, the student dentist and his teaching dentist presented the complications of this devise. Now I am back to having the implants done but I am going to need bone grafting and tissue replacement where the cantilever bridge had been for many years. If I did not get this done, the tooth above it is in danger of supererupting. It is a molar that has already moved due to the removal of a molar ahead of that one. That happened probably more than 30 years ago. So now I have 2 smaller molars and that one left. I do not have that full a smile or evenly sized teeth as it is so I do not want to loose that 3rd molar on the upper jaw. What do you think is the best thing for me to do?
i have no insurance or job and i need to have a front upper 2nd tooth my sister is getting married in 2 days and i'am just looking for a price for a flipper i know i need alot of dental work but i'am only interested on the front one please can u help me i'am part of the wedding party that means pictures i told my sister if i can't find someone who can help me out i sorry but i won't be going i'am nolong employed staying with family home is in forcloser bla bla we all have life difficulties i love my sister but i don't even go out side to much because i think i 'am ugly now i have about only 150.00 -200.00 dollars
You can use a flipper (interim removable partial denture) without a wire clasp. However, it can be challenging to maintain adequate retention (how tight it stays in place). A properly designed and fitted flipper should not harm the neighboring teeth regardless of whether they are capped or not. Special consideration should be given to neighboring teeth that are diseased or week. If you are worried about appearances, the wire clasp can be located in a hidden area.
Can you use a flipper without the wireattachement. I have a tooth next to the proposed flipper that is capped and several teeth on the other side that are capped or root canals.The missing tooth is on the upper left.
Thank you!!!!
Carolyn,
Replacing a silver filling could cost $150 - $350 depending upon its size. It could be even more depending upon what material you want the replacement to be. Bridgework is typically $1800 per tooth involved including the missing tooth or teeth. Prices can vary quite a bit depending upon where you are. The dental implant option usually is the best one. Hope this helps!
So how much will it cost to revove rge silver in one roorh and bidge the other two , just a round about figure please
Miriam 13 hours ago
Hi. I recently went to the oral surgeon to have my wisdom tooth #17 removed. Looking at the xray, he suggested i take out #17 and #18 because number 18 is under a bridge and the bone holding the bridge is small he said and will cause the bridge to move and it can get infected and if i have no more bone then it becomes a bigger problem, so he suggest I extract both 17 and 18 and get two implants. I would like to know if this is the best option for me and how much this can cost me, also i have two other bridges on the upper right and left hand corner. Will these last me for long or will I need implants there too?
and lastlt, if i extract the wisdom tooth and the one adjacent to it, can they fill that empty space with something instead of having no teeth? I am only 27
Thank you in advance