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Old 09-08-2012, 05:05 PM   #1
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Exclamation Abscess on molar that had root canal? Extraction or ??

I woke up one day to notice there was a bump on my gum. Didn't think much of it, had no pain / swelling, or anything... it was just a bump.
Through normal brushing, it went away. Then it came back, and away again.
Well, finally went to a new dentist, since my old one passed away, and they said it was a abscess. : eek:
It is on the big molar in the rear bottom, the 2nd tooth in, and it already had a root canal on it (All the roots were sealed I thought).

She was saying that the tooth is too far gone, and then they want a $4.5k treatment of extraction + a three unit crown. Almost had a heart attack then and there. $4.5k wow, and no, I don't have insurance.


Now after looking around the net, and reading many posts, I am more confused than ever.
Some people say I should see a Endodontics for a second opinion.

Other people say having done the three unit crown was the worst mistake they ever made, either because it didn't last very long, or they had issues on the once good teeth, that were crowned, and they now have to redo the whole three unit crown again, costing more $$$, and they still had jaw bone loss.

Then we got people saying to get a dental nesbit, then others saying no, nesbit isn't good, and then they recommend some other partial.

Then their is the implant option, with both normal implants costing $3-4K, and then the mini implants, costing 1/2 that.

I am really confused what I am supposed to do now, $4.5k is way out of my price range.
Do I go for the 2nd opinion on the tooth (don't know how much that will cost)
or just get a extraction, with no partial, or try a partial (of XYZ kind), but knowing that bone loss will still happen, this gets highly depressing.

Anyone care to chime in on what is the best thing to do in my case ?
I am 43 right now, and none of my other teeth have any issues at all, no pockets, the rest are all healthy.

 
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Old 09-08-2012, 11:45 PM   #2
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Re: Abscess on molar that had root canal? Extraction or ??

I had a similar scenario last year. My tooth was cracked though. I am not a fan f second root canals-in my experience they are a waste of money.

With it being in the back, you can always extract and the do a bone graft while you save money. You will still lose, but not as much. I would save for an implant. A bridge does ruin the other teeth. Please don't do it. Also, mini implants normally support dentures not a single crown like you need. You would do a normal implant. Implants last longer than bridges and don't compromise your other teeth. Your dentist likely doesn't do implants and didn't suggest it for that reason (I've grown to appreciate how money driven many dentists are-if you doubt me check out the wealthy dentist blog).

Also, implants have to heal. If you can cough up the money, you can do the extraction and implant, and then restore the implant 306 months later. Where I am the implant is around 1250 before the restoration. Given that you have an infection, they may need to wait 3 months before they place an implants after extraction. Meaning you would have more time to save money. That's what I reccomend.

I'm 37, so I feel your pain. Way too young! I has one tooth pulled and waited a year. I did have bind loss, but the implant is fine.

Also, check dental schools in your area. They take longer, but lower their rates. I went to Mexico to save money. Finally, don't stress on insurance. Dental insurance would pay 1500 max, and even then not an implant-the current roccomended standard of care.

 
Old 09-09-2012, 12:01 PM   #3
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Re: Abscess on molar that had root canal? Extraction or ??

If I were you, I would see an endodontist right away to find out if the abcess involves just one root of what I assume is your first molar (#19 or #30, depending on which side). An infected root tip can be removed in a minor surgery called an apicoectomy. I had one done, and it was absolutely painless as the root tip was taken out through a small incision in the gum. This saved my molar, as the tooth is held in place now by its other roots.

If the molar really cannot be saved, you might have a bone graft done at the time of extraction to prevent bone loss. (This will pave the way for an implant if you decide to get one down the road.) Then you have several choices when it comes to filling the empty space, and your decision depends on the condition of your other teeth and the condition of your wallet:

1) You can, of course, opt for a dental implant, which is the most invasive of all the choices. (I personally would never have one placed in my mandibular jaw, owing to the fact that if the major nerve running through the lower jaw is hit during surgery, you can suffer lifelong facial paralysis and/or pain!) A properly done dental implant will set you back at least $4,000 (at least in my part of the country). If you decide to go ahead with one, I would really do my research about implants and the risks, and I'd go to the best surgeon, even if it costs more. Surgery in your head is surgery in your head, and there are always risks, so don't go to a dentist with little implant experience (and there are plenty out there). You should keep in mind also that despite dentists' hype, implants do not always last "forever." They sometimes fail right away or years later, and you'll be back at square one, after enduring lots of discomfort and chair time and additional cost.

2) If the teeth abutting your molar are in good condition (no deep fillings, no crowns), you could opt for a Maryland bridge, which is the least expensive and most conservative fixed dental bridge option. I believe they cost about $1,000 or so. A Maryland is a pontic with two wings. The wings of the Maryland bridge are merely bonded to the abutment teeth, with the pontic filling the space, and those abutment teeth are barely altered in preparation for the wings. I would opt for this if I were in your shoes. The only problem with the Maryland bridge is that it might become unglued. But the remedy is just another trip to the dentist to have it reglued. (Note that if one of your abutment teeth does have a restoration, you could opt for a Maryland wing on the nonrestored abutment tooth and a dental crown on the restored abutment tooth, with the pontic in between.)

3) Another choice is the conventional dental bridge, with crowns on the abutment teeth. If your abutment teeth don't need crowns, you would be losing valuable tooth structure by having them shaved down for crowns. A conventional dental bridge costs around $3000.00 or so. If they are well taken care of, they can last a long time. My father has had one for over twenty years.

4) A removable single-tooth partial denture is a fourth option, but I have read that they tend to be very cumbersome in your mouth since a lot of material is needed even though just one tooth is being replaced.

I just want to add that I, too, have had problems with only one molar, but after I had that apicoectomy years ago on that molar, I decided to embark on a really intensive oral care regimen to ward off possible future problems with other teeth and my gums. In addition to dental cleanings twice yearly, I brush with Sonicare and floss right after every single meal or snack (even if it means flossing in restaurant bathrooms or the car!), and I use a Waterpik right before bedtime, making sure to give the problem molar lots of extra attention. I can really feel a difference in my mouth. I would recommend this regimen to everybody, and especially to those with a root-canaled tooth.

Best of luck to you!

Last edited by Calais13; 09-09-2012 at 02:31 PM.

 
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Old 09-12-2012, 02:36 PM   #4
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Re: Abscess on molar that had root canal? Extraction or ??

I had a 3-unit bridge done to replace a single tooth, and that was the WORST mistake of my life. I was drawn by the best price (only $1500 after my insurance compared to $4000 for an implant), and believe me, now I have paid almost two times the implant price and almost 2 wasted years to fix the mess. And I am back to the step one, this time doing implant.
If the tooth cannot be saved, go for an implant. They take a year to place and you can save (no need to pay all the fees upfront). They prevent bone loss too. Yes it is invasive but they now do sedation. Good luck.

Last edited by TMJ82; 09-12-2012 at 02:38 PM.

 
Old 09-12-2012, 09:21 PM   #5
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Re: Abscess on molar that had root canal? Extraction or ??

Hey, thanks for all the replies, was busy trying to find a job, with no luck so far, but anyway...

I have been reading pretty much everything I could find.

Yeah, it is the first molar on the bottom right, so I guess that is #30.

Calais13, I will definitely ask about a apicoectomy, thanks for the tip!
From what I read, it seems the best thing to do is to do a synthetic bone graft done at the time of extraction to prevent bone loss.
I am unsure if I can get all the $$$ together for a implant, so I was thinking either option #2, or #4 that you mentioned.
Really appreciate your response & information!

tanyasue, yeah, already checked dental schools, they are all booked up for 8 months(!), and their cancellation list is also full to the brim.

TMJ82, I have talked to three other people who had a bridge, and it also has been a disaster for them, and they each had different issues, but they all ended up paying double (getting root canal on the once 'good' tooth that they shaved down) and quadruple+ (root canal on both once 'good' teeth, and one failed, so another extraction, and now, can't do a bridge anymore) the amount of $$$

 
Old 09-18-2012, 05:24 PM   #6
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Re: Abscess on molar that had root canal? Extraction or ??

Slight update, I went in to see the endodontist for a second opinion, and he told me that he don't see why the dentist said I needed a extraction.
So he is going to do a retreatment, and was pretty confident it will work.

I am unsure how I can get two completely different opinions.

 
Old 09-18-2012, 06:09 PM   #7
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Re: Abscess on molar that had root canal? Extraction or ??

Well if you see 50'different dentists you will get 50 different treatment plans, because dentistry is somewhat subjective. Good luck on the root canal, in my experience the second root canal on a tooth usually ends up with the tooth dying anyway, but hopefully you'll have better luck!

Also, maybe get a 3rd opinion as a tie breaker? The truth is that you have different opinions that both represent their own experiences. I'm only saying that because I've had dentists say something would work, and then say "oops" after the work is done and I'm out the money, and the tooth is done for. I just don't want you to experience that!

 
Old 09-19-2012, 04:39 PM   #8
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Unhappy Re: Abscess on molar that had root canal? Extraction or ??

Quote:
Originally Posted by tanyasue View Post
Well if you see 50'different dentists you will get 50 different treatment plans, because dentistry is somewhat subjective. Good luck on the root canal, in my experience the second root canal on a tooth usually ends up with the tooth dying anyway, but hopefully you'll have better luck!

Also, maybe get a 3rd opinion as a tie breaker? The truth is that you have different opinions that both represent their own experiences. I'm only saying that because I've had dentists say something would work, and then say "oops" after the work is done and I'm out the money, and the tooth is done for. I just don't want you to experience that!
You called it, I went to a 3rd specialist, and *surprise* *surprise*, he said endo work isn't worth it in the long run, and I would be better off with getting a implant.


The latest odds are, 50/50 for endo treatment told by a implant specialist.
80-90% as told by the endo specialist.

Seems to me that each specialist says their procedure is the best, and the general is just trying to push the bridge.

No consensus at all as to what is best. Can't really go by trust, if you just met each of them.
I know that each person's teeth are different, but this is incredibly frustrating.

 
Old 09-19-2012, 05:00 PM   #9
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Re: Abscess on molar that had root canal? Extraction or ??

Quote:
Originally Posted by Elbin View Post
You called it, I went to a 3rd specialist, and *surprise* *surprise*, he said endo work isn't worth it in the long run, and I would be better off with getting a implant.


The latest odds are, 50/50 for endo treatment told by a implant specialist.
80-90% as told by the endo specialist.

Seems to me that each specialist says their procedure is the best, and the general is just trying to push the bridge.

No consensus at all as to what is best. Can't really go by trust, if you just met each of them.
I know that each person's teeth are different, but this is incredibly frustrating.
I'm not a dentist and have no financial interest. But I've had 12 root canals. Any that have had a secon root canal on I've lost. Often times if the first one fails it's because there is a small crack in the root. I've also come to appreciate that they can never get rid of all of the infection. They can treat the largest canals, but there are tons of little canals that are still infected and they can't treat them so you always have a low grade infection in your body. I've found that I. The first root canal. They tooth lasts a long time- some of mine are at 20 years. It's the second treatment that seems to indicate the tooth is a goner, in my experience.

Go for a fourth opinion? Go to a different general dentist. From what I've experienced, they all consider an implant the gold standard for a missing tooth over a bridge. So, now I think you need to decide if you want to try the root canal again knowing it has a higher failure rate, or if you want an implant that will cost more but more a certain prognosis. I don't consider a bridge an option, they truly, truly screw up your teeth which is why they are losing favor with most dentists. If you can't do an implant for financial reasons, then you can do a partial for that tooth, or even go without.

I don't want to sound cynical, but dentists often have their own practice in mind. That is why they all reccomended what their practice can do.

If it were me, and my mouth, I'd pull the tooth.

 
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