Nothing but the Tooth column: Ways to consider saving a tooth
Columns share an author’s personal perspective.
Q. I went to my dentist about a year ago and soon after broke a tooth on my lower, toward the back. After the initial jolt, I checked it carefully and aside from a sharp edge, it seemed OK. I remember reading a column of yours, months ago, where you said that if something like this happened and it was not a good time for me, the patient, that I could file off the sharp edge with a nail file and get to the dentist when time, desire and dollars were OK. That is what I did and it has been fine, just as you said. I was due to go back for a check, overdue actually, and the dentist looked and gave me options. He said I could extract the tooth and do an implant or build up the tooth and put on a cap. He said that I might need a root canal, eek, but was not sure. Can you be of help?
- J. R., Sudbury, Massachusetts
A. I am glad that what I suggested months back worked out for you. I agree with your dentist that you should restore the tooth as soon as you are ready. Sounds like you are. I believe that the best option is one that keeps your natural tooth assuming that it is restorable. From the options given, I believe something that includes the natural tooth rather than an implant is always best. An implant should be considered only when it is a last resort.
Individual root form implants have been done since the mid-1980s with increasing popularity. With that popularity has come knowledge that has shown us all that these implants do fail and when they do, it presents some complicated problems. It is for this reason and a number of others which I will not get into at this time that saving your natural tooth is paramount.
If the tooth is alive or vital, I would not do root canal therapy prior to restoring with a crown. The tooth may need a build up with some materials but even if there does not seem a lot left of it, as long as there is no decay and no nerve exposure, a tooth can be re-built.
As to the need for root canal treatment, that is only necessary if there is a nerve exposure or radiographic evidence of infection. If there is neither, the dentist should do what is called a pulp evaluation. This involves some testing to see if the nerve is alive. Testing for hot and cold sensitivity is important to do first. If sensitive to heat, then root canal treatment is indicated. If not sensitive to either then I would then test with an electrical pulp tester. This may sound a bit scary but when done properly, all the patient would experience is a slight tingling of the tooth as it is electrically stimulated. If that test shows that even at the highest setting, you feel nothing, then the tooth is considered non-vital or not alive. The dentist should not put a cap on a tooth that is not vital since it is prone to infection even if it has not occurred as of yet.
In summary, I believe that it is incumbent on your dentist to provide you with more information. Is the tooth alive? If so, how would he/she go about restoring, and the same information if it is not alive. I would hope that any dental colleague of mine would recognize that as long as a tooth is restorable, it should be saved. All of the options can be costly and I dare say that if root canal treatment is needed, the cost of that plus a core or post and crown would be similar to extraction plus implant restoration. If cost is a factor, I would hope that your dentist would work something out with you that allows you to accept the best treatment.
Wishing you success and good health no matter what you chose.
Dr. Richard Greenberg of Ipswich, Massachusetts practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at firstname.lastname@example.org.