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Old 03-08-2002, 10:15 AM   #1
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toskinnapat HB User
Post How is decay detected under a bridge?

THIS IS A LONG POST, so don't feel obligated to read it.

While I think I have very healthy teeth and have never experienced decay beyond what I experienced as a child and what comes with relatively normal wear after 45 years with the same teeth, I do have ongoing cosmetic issues the result of genetics and a childhood injury to my teeth.

I am genetically missing my 2 incisors AND my 2 front teeth were chipped to an inverted V shape from a croquet ball that I threw up in the air to catch and missed, at the age of 11. Okay, so there's the old history. The new history is that I have had the benefit and successful fulfillment of 2 cantalevered bridges in my dental history.

Recently, the second bridge has been showing signs of looseness on the right front tooth where I have a 20+ year-old root canal and post. Hysterics range from dentist to dentist over this and suggestions being made the post has come loose to there being decay at this tooth. Extensive films DO NOT indicate decay, but a prosthodontist wants to destroy the bridge and aggressively treat decay, while another dentist wants to keep the bridge intact, as he can't see any signs of decay, and the third dentist saying he can't see signs of decay on the films.

Okay, so why a discussion of decay by the prosthodontist if the films don't seem to indicate decay?

The first dentist I went to, in a series of 3, felt that the root canaled post was loose, but was certain that to repair it would require destruction of the bridge, which is why he referred me to the prosthodontist.

The prosthodontist wants to destroy the bridge and has promised me the root canaled tooth will be destroyed, too. He has hinted that the post in the root canaled tooth could be loose, but to determine that or if there is NO decay, the bridge has to destroyed.

I have finally gone back to my old favorite dentist who has been my dental health provider for years and who knows my all my toothy warts. He seems to be the calmist of all the dentists and does not want to destroy the bridge, but to monitor the situation.

How is decay detected under a bridge? By films? By pain? By odor? By sight? Does a bridge have to be destroyed to make any of these determinations? Can a loose post be repaired from the back side of the bridge? I had the root canal done this way with my first prosthetic device. Why would it be different now to repair the post?

Well, I've vented in this post a lot of fear, so thank you all for this forum to express my concerns. Regards, pat Brown


 
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Old 03-08-2002, 02:05 PM   #2
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Shaelle HB User
Post

Was the "post" placed during the root canal proceedure? I am confused, I guess. You had the bridge done, then later you had the root canal done, and when they did the root canal, this is when the post was placed? Or is this "post" part of a build up of your tooth prior to the placement of the crown/bridge?

 
Old 03-08-2002, 03:01 PM   #3
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>[QUOTE]Originally posted by Shaelle:
>[B]Was the "post" placed during the root canal >proceedure?

Yes. The root canal and the post inserted were done at the same time, 20+ years ago when I must've been about 22. I had the first appliance cemented on at the time and the endodontist went through the back to do the root canal and post. The infection was detected on xrays during a routine dental exam. I had no pain and would never have known the root was dying.

>You had the bridge done

I had the first appliance cemented, then the root started to die a couple of years later.

>Later you had the root canal done, and when they did >the root canal, this is when the post was placed?

Yes.

>Or is this "post" part of a build up of your tooth >prior to the placement of the crown/bridge?

No. The chipped tooth was healthy when the first bridge was cemented on to it. It was a couple of years later that the tooth started to die and the root canal and post were done. As long as the tooth was living and had its blood supply, I had a pair of living teeth providing the support the bridge needed. To maintain that support after the tooth had died, the post was implanted in the root canal.

Thanks for taking the time to answer. Pat



 
Old 03-08-2002, 04:25 PM   #4
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ADDENDUM TO MY ORIGINAL POST:

At the time I had the root canal AND post done, I did have an appliance cemented on at the time. It was a cantalever bridge--one of THREE I have had in my dental lifetime. I said I had had 2 bridges, but this was not true. The cosmetic quality of each bridge has been improved over the years as materials improve.

But the first bridge was not put on after the root canal and post--it was on WHILE the root canal and post were done.

I am on my third bridge which seems to be wiggly on the root canaled side and there doesn't seem to be a good reason why, YET. Personally, I side with the dentist that says do nothing if no decay is indicated on the films. Hey, I like my bridge--I'm really very attached to it, LOL!

Thanks for reading. Regards, pat

 
Old 03-09-2002, 08:45 AM   #5
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Well I don't know alot in this area but here's my thought on it. You can do what you want, though a loose brigde is not a good sign. It could be just the crown/bridge that is loose, it could be coming from the post within, or it could be your whole tooth that is loose. If it's not the whole tooth, then either of the two other things could mean that you have some kind of leak in the seal and then decay could slowly set in and destroy your tooth, if there is not already decay present. You don't have a nerve in the tooth so you won't feel any pain if the decay gets really bad. If you decide to wait and hold off any treatment, I will suggest that you should get frequent x-rays of the tooth to keep an eye on it. The decay could be under the crown and not be showing up on any x-rays yet, as the metal base will completely block out the view of the tooth under the crown. If you feel that there is a bad taste or smell coming from that area, I would see about getting treatment underway, as this is not a good sign of a healthy tooth either. If there is decay under the crown, eventually it will show up on the x-ray at the tooth rots away further up the tooth towards to root. But at that time it may be questionable how much tooth is left to save.

Hope this helps, good luck!

 
Old 03-09-2002, 07:46 PM   #6
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Hi, Shaelle. Thanks for bringing to my attention the fact that the decay of the tooth could be covered on the xrays due to the metal in the bridge. This had not been explained to me in such succint terms.

The prosthodontist kept pointing to a picture in a root canal booklet the area of the root's enamel that could be decaying. He never said anything to the effect the decay could be occurring directly under the bridge and then spread upward to the root. I'm sure he was thinking this, but didn't think I was dense enough not to think of this for myself.

Frankly, I had never connected that even with a root canal, the "dead" tooth still is a structure subject to decay. I thought dead meant DEAD and decay affected only living tooth enamel and related structure.

So, now I have another concern which is this: the prosthodontist has promised me that the dead tooth will be destroyed if the bridge in the removal process. If the tooth is decaying, it will eventually deteriorate and likely fall out from under the bridge, right? What's the advantage to destroying the bridge to get to a tooth that will basically destruct on itself anyway?

I understand the fear of decay getting out of control, but can decay be harnessed with drugs? Continual monitoring with xrays is a good idea. And assuming the xrays don't show anything for awhile, when the decay does start to show up on the films, what have I lost, in terms of a tooth that will be destroyed NOW or later? The only issue I see is that some dentists might be more reactive to decay of any kind of tooth--even dead ones.

The prosthodontist likened treatment of decay to that of treating it like cancer (his words). These scary words, and also to face the possibility of having a beautiful bridge destroyed AND a tooth (albeit just a structural filler in my jawbone) destroyed too, are all just making my stomach do flip-flops. I get nervous and then I get calm and then I start thinking the worst all over again.

Obviously, this news is sickening to me. If I were to get a fourth opinion from a dentist, should I consider a general dentist, a cosmetic dentist, a prosthodontist or maybe an endodontist? I have such an uncertain feeling in my flip-floppy gut about destroying the bridge, but I do know decay is not to be taken lightly either.

Thanks so much for having answered me. Regards, pat


 
Old 03-10-2002, 08:06 AM   #7
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Quote:
Originally posted by toskinnapat:
So, now I have another concern which is this: the prosthodontist has promised me that the dead tooth will be destroyed if the bridge in the removal process.
What did the other dentist say?

Quote:
If the tooth is decaying, it will eventually deteriorate and likely fall out from under the bridge, right? What's the advantage to destroying the bridge to get to a tooth that will basically destruct on itself anyway?
No the tooth will not fall out from under the bridge. You will be looking at a really bad odor and taste, along with an eventual infection/abcess.

I couldn't tell you who to see for this exactly, possibly even a cosmetic dentist. Most of all I would look to friends and co-workers and ask around who they see and if they are happy with the work that their dentist performs. Alot of dentists keep pictures of the actual work they have performed. Ask if they have any pictures. A dentist can also do a wax build up on a model of your teeth for you to see what your final look will be. With all this expense you've already put in, have you considered implants? Even just one could improve your situation with your bridge.

-Shaelle

 
Old 03-12-2002, 11:38 AM   #8
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couldbeworsaspose HB User
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hi,
I had two root canal's done,and one of the teeth that had the canal done had broken so this was built up,and a post fitted.the next tooth had a post fitted,and then a bridge was fitted.All was fine for 5 years,then for some reason the first post under the bridge came loose.The dentist tried drilling through the bridge to see if the post was loose at the bridge end or the root.It turned out to be the root so the bridge had to come off.This took some removing,by a sliding hammer believe it or not.It came off with minimal damage.The post was pulled out and a new one fitted.I had a plastic bridge fitted while he fettled the bridge up.the plastic bridge was harder to get off than the original....and had to be ground up a tooth at a time.Anyway the bridge is back on and has been o.k. for 5 years touch wood,still don't know why it came loose in the first place.

 
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