Question:
My wife recently went to the dentist because a tooth (upper left 2nd molar)
was bothering her. Well, the dentist started drilling and told her that it
would only be a filling. Within a few seconds all of a sudden it turned
into a root canal and a crown.
My first question is: Should not a dentist stop at the point where a
filling becomes a root canal and give the patient all their options?? My
first thoughts were that the dentist was "drilling for gold." The cost of
the procedure went from $65 to $1350 in a matter of seconds!!
Secondly, what is wrong with extracting this tooth? I realize that this
will give her less chewing surface, but what other problems could occur.
The dentist says the teeth will eventually shift.
Lastly, why would shifting be a concern for a 2nd molar and not for 3rd
molars? The same dentist wants to extract 3 of 4 of my 3rd molars the
forth of which is impacted against one of my 2nd molars. I would think
that since I have a tooth that is actually pushing against my other teeth
that this would cause my teeth to shift.
Answer:
Generally, before the dentist started the filling,
your wife should have been warned that the tooth
decay may reach the pulp thus necessitating a root
canal or a pulpotomy. It is not normally possible
to know how deep the decay is before the filling is
started however if the tooth was bothering her he
should probably have figured so.
Once that point has been reached (that is,
the decay is found to have reached the pulp)
a simple filling is no longer a treatment
option. The only options are extraction,
root canal or pulpotomy. A simple filling
can not be done because this would cause the
trapping of bacteria inside the pulp and will
likely lead to further and more serious infection.
My belief is that dentist do not warn every
patient about the possibility of a root canal
before every filling because of the fact that
there is no turning back once the decay has
been allowed to reach the pulp.
If your wife has a tooth behind it, generally
over time it will tip and shift into the empty
space. This is generally caused by the persistant
biting forces on the tooth. This will usually
produce a deeper pocket in the gums and it will
be difficult to keep clean, possibly leading to
infection and bone loss which in turn can produce
the loosening of the teeth around it. Nevertheless,
their are a lot of people who are able to do well
enough with a few missing teeth and do not encounter
the above problems. Personally, I would not feel
afraid to have the tooth extracted if there was no
other option.
My advice is that you should first ask your dentist
why a pulpotomy can not be tried. This may be a
third option. It involves just removing the nerve
tissue from the crown of the tooth but not touching
the nerves in the roots. This is done a lot in
places were root canals are not very affordable.
However, in some patients not all, the tissue that
is left in the roots produces what is called secondary
dentine, walling themselves off and sealing themselves
from the crown of the tooth. As well, this procedure
is much easier to perform and cheaper. However, it is
not always successful and just depends on the health
of the tooth. In most cases, patients still develop
infections because bacteria have been able to creep
down the roots and then the only options are to have
a root canal or an extraction. It is for this reason
that dentists do not normally like trying this because
patients call back in the middle of the night.
Personally, if it were my tooth and even if the decay
was severe I would still take the chance with a pulpotomy
and even endure the pain. This is only my opinion because
I have a lot of faith in the body's ability to fight
infection, which it does all of the time, and also because
the pulpotomy is so much cheaper. I also enjoy gambling.
If it did not work out and a root canal is unaffordable for
me, I would look all over for a loan to pay for the root
canal because I truly see my teeth as being that valuable
