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  #1  
Old 01-04-2010, 05:19 AM
Oglomott Oglomott is offline
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Crown came off tooth - what if I don't replace it?

A couple of years ago, a cracked tooth (number 18 for those with this sort of knowledge) led to me getting a root canal and a crown. All was well until a week ago. The crown came off, and the tooth was now broken in half, front to back. Not really half, more like a 75/25 split.

Anyway, I go to the dentist, she pulls out the 25% portion of the tooth and leaves the remaining 75%. She says the remaining tooth can't be saved, and she recommends pulling the remaining portion and replacing it with an implant. She says that pulling the remaining portion and leaving the space empty is an option, but not recommended, because the tooth above it will, in time, drop down and cause problems. And, since my wisdom teeth were removed in my teens, a bridge is not an option. Also, a new "extended" crown might not be possible because of lack of support, not enough bone, or some such thing.

My issue is that the cost of what she recommends is almost $4000, and isn't covered by my dental insurance. (Dental insurance, that's a topic for the pit. What a racket!)

So, here is my question: What if I left the tooth just as it is, with no crown on it? It's had a root canal, it doesn't hurt, doesn't interfere with my eating, and is not visible to anyone. My desire to leave everything as is is strictly financial, as $4000 for one tooth seems stupid high. My dentist's answers are skewed by the desire for profit, so I don't want to ask her.
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  #2  
Old 01-04-2010, 05:29 AM
even sven even sven is offline
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Won't it rot and eventually get infected?
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  #3  
Old 01-04-2010, 07:37 AM
What the .... ?!?! What the .... ?!?! is offline
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Originally Posted by Oglomott View Post
She says that pulling the remaining portion and leaving the space empty is an option, but not recommended, because the tooth above it will, in time, drop down and cause problems.

My dentist gave me the same advice.
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  #4  
Old 01-04-2010, 09:37 AM
Cat Whisperer Cat Whisperer is offline
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I read about a procedure where the tooth is pulled then the socket is filled with bone dust to fill the empty socket (bone loss after tooth removal is the big concern, and why surrounding teeth become loose) - the bone dust should be incorporated into the empty socket to re-grow the tissue lost when the tooth is pulled. Maybe you could visit an endodontist or someone who specializes in problem teeth and see what can be done other than an expensive implant. I know if I lost the tooth at the end of the row, I wouldn't care much about replacing it, either, except for that bone loss problem.

A few other thoughts - I think you will need to get that tooth pulled. I think you're looking at a possible abscess from having what is basically a dead, split tooth left in your gums. That tooth is over.

Also, $4000 sounds like a good price for an implant - I've heard prices like $20,000 for one implanted tooth.
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  #5  
Old 01-04-2010, 10:07 AM
Oglomott Oglomott is offline
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Originally Posted by Cat Whisperer View Post
A few other thoughts - I think you will need to get that tooth pulled. I think you're looking at a possible abscess from having what is basically a dead, split tooth left in your gums. That tooth is over.
I thought once you get a root canal, that tooth is dead anyway. The only difference now is that the crown is gone. Would the tooth rot just because the crown was no longer present? I don't know.

Anyway, at the prices quoted, I imagine there's lots of people running around that "need" crowns, root canals, etc. that are doing without.
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  #6  
Old 01-04-2010, 10:17 AM
pan1 pan1 is offline
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Your tooth is exposed without the protective enamel. It will rot faster than a normal tooth.

I had a similar situation, and had the tooth pulled, but no replacement implant or anything, just a gap in my molars. I've had the gap for 20 years without a problem. Far easier to floss there.
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  #7  
Old 01-04-2010, 10:18 AM
astro astro is offline
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I lost a big filling off a molar a long time ago and figured if I just kept it brushed and washed it out be OK. That was very stupid of me. The tooth got infected and I had to get a root canal and a replacement tooth.

Don't roll the dice with your teeth. You've got one set. Get it fixed. Holes in sockets will cause surrounding misalignment over time.
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  #8  
Old 01-04-2010, 11:16 AM
LurkerInNJ LurkerInNJ is offline
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I don't have dental insurance at all, but I signed up for Avia Dental. It's not insurance, but you get discounted dental services from providers who are enrolled. You can see participating dentists before you sign up.

http://www.aviadental.com/

You can see the dental fee schedule for your state on the site.

It costs around $80.00 a year (and follow their cancellation policy exactly if you don't want to be renewed automatically), but they have saved me a freaking ton of money on dental work.
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  #9  
Old 01-04-2010, 05:26 PM
Bijou Drains Bijou Drains is offline
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Another way to save is go to your local dental school. You get top notch care at a reduced rate. Some work may be done by advanced students but for implants that likely will be done by professors.
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  #10  
Old 01-04-2010, 07:26 PM
Oglomott Oglomott is offline
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Originally Posted by Bijou Drains View Post
Another way to save is go to your local dental school. You get top notch care at a reduced rate. Some work may be done by advanced students but for implants that likely will be done by professors.
My FIL used a dental school to have all his teeth pulled. Don't know how many teeth he had left, but the cost was $1800. Plus there was a long waiting list, on the order of 4 to 6 months.

And I do have dental insurance, which more or less just gives you a small discount off of the dentists' prices. The prices I mentioned were after the insurance, where covered. Implants aren't covered at all.

Since most people seem to think it needs to come out anyway, I will leave it be until it starts giving me problems, then out it will come.
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  #11  
Old 01-04-2010, 07:49 PM
Ignatz Ignatz is offline
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Must be an epidemic. Sunday evening, while I was chewing on a hard pistachio nutmeat, I broke the enamel on an old filled tooth (#3 upper right 3rd from rear). I think I swallowed part of it but retrieved a part. Left in place is a quite old black filling showing, with sharp edges of the remaining enamel. It must have had a root canal long as there is NO PAIN. I emailed my dentist (who had installed 2 crowns 2 weeks ago (#17 & 18 lower left rear)) and explained and asked for an appointment asap. We talked today and I'm going in tomorrow first thing. I expect that either it can get a crown or it must be yanked, widening the old gap in front of it.

I had an implant 3 years ago on #8 (front right big) and love it. It cost about $3500 (to periodontist) plus $900 for a crown (to dentist). I have a quote for an implant for gap #7 of $3500 n/incl crown. My main concern with implantation is that they are not guaranteed and any cost to "fix" failures is on the buyer.

You might look into www.carecredit.com for an interest-free credit card (GE Money Bank) which is available for such care. Interest free if paid within usually 1 year, or for a shorter agreed upon period. The dentist did my application for the first crown, for which it worked out well. Paid off the loan early.
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  #12  
Old 01-05-2010, 01:08 AM
beo.thuck beo.thuck is offline
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Originally Posted by Oglomott View Post
So, here is my question: What if I left the tooth just as it is, with no crown on it? It's had a root canal, it doesn't hurt, doesn't interfere with my eating, and is not visible to anyone. My desire to leave everything as is is strictly financial, as $4000 for one tooth seems stupid high. My dentist's answers are skewed by the desire for profit, so I don't want to ask her.
I'm pretty sure that eventually you will get a jaw infection. Jaw infections interfere with eating and everything else, lol. Get it pulled at a local dental school and if you are thinking of a future implant/post, pig bone is a more frugal choice than human cadaver bone.
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  #13  
Old 01-05-2010, 07:27 AM
Jophiel Jophiel is offline
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Originally Posted by Oglomott View Post
My issue is that the cost of what she recommends is almost $4000, and isn't covered by my dental insurance. (Dental insurance, that's a topic for the pit. What a racket!)
My implant is costing me closer to $2900 which is still a racket in my opinion but a grand cheaper than your quote. If you do decide to go with an implant, you might as well get options since you don't have the insurance restrictions to worry about.

It seems ridiculous that just the crown ($900) can cost more than a 42" flatscreen television these days.
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  #14  
Old 01-05-2010, 12:04 PM
old_joe old_joe is offline
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My implant is costing me closer to $2900 which is still a racket in my opinion but a grand cheaper than your quote. If you do decide to go with an implant, you might as well get options since you don't have the insurance restrictions to worry about.
.
My mom went to Yuma for a holiday last year just so she could get dental work done in mexico. Less than a third of price in Alberta and top notch work. Saved enough money to pay for the entire holiday of 3 months!
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  #15  
Old 01-05-2010, 01:03 PM
astro astro is offline
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Originally Posted by Oglomott View Post

Since most people seem to think it needs to come out anyway, I will leave it be until it starts giving me problems, then out it will come.
Umm.. no. This is the worst possible thing you could do. You need to get the tooth fixed or replaced.
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  #16  
Old 01-05-2010, 04:27 PM
Oglomott Oglomott is offline
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Originally Posted by astro View Post
Umm.. no. This is the worst possible thing you could do. You need to get the tooth fixed or replaced.
Why?

What makes this tooth more prone to infection than any other tooth? Basically it's just a tooth that's been given a root canal and ground down in preparation for a crown. Do any of these things make it prone to infection?

BTW, pulling it and leaving the empty gap is only $250. (Actually it's the last tooth in the back, so more of a space than a gap). So pulling isn't a cost issue for me, the replacement of it is.
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  #17  
Old 01-05-2010, 04:37 PM
Diogenes the Cynic Diogenes the Cynic is offline
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I had a crown break on me once. It would get infected and painful from time to time. I had it pulled, and left the gap, despite getting the same BS pitch to get the implant. I've never had any problems from the gap.
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  #18  
Old 01-05-2010, 04:45 PM
Cat Whisperer Cat Whisperer is offline
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Originally Posted by old_joe View Post
My mom went to Yuma for a holiday last year just so she could get dental work done in mexico. Less than a third of price in Alberta and top notch work. Saved enough money to pay for the entire holiday of 3 months!
I have an uncle in Saskatchewan who's thinking of doing that. I'll pass your anecdote on to him.

Oglomott, I'm not entirely sure why, but I'm fairly sure that you can't just leave half a broken tooth in your jaw, with or without a root canal. I think you will be looking at infection/abscess - teeth aren't made to be left exposed like that.

ETA: If it's an upper tooth, you could be looking at a serious sinus infection and complications like that - the roots of your teeth go right into your upper sinuses.

Last edited by Cat Whisperer; 01-05-2010 at 04:47 PM..
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  #19  
Old 01-05-2010, 05:30 PM
Mangetout Mangetout is offline
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Originally Posted by astro View Post
Umm.. no. This is the worst possible thing you could do. You need to get the tooth fixed or replaced.
I agree - by the time a thing like this is 'giving you trouble', it's potentially a lot of rather serious trouble. Infections in the bone of the jaw are not always easy to treat.
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  #20  
Old 01-05-2010, 05:34 PM
Oglomott Oglomott is offline
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Originally Posted by Cat Whisperer View Post
Oglomott, I'm not entirely sure why, but I'm fairly sure that you can't just leave half a broken tooth in your jaw, with or without a root canal. I think you will be looking at infection/abscess - teeth aren't made to be left exposed like that.

ETA: If it's an upper tooth, you could be looking at a serious sinus infection and complications like that - the roots of your teeth go right into your upper sinuses.
Lower tooth. I may just get it pulled and leave it at that. Maybe after a second opinion from a another dentist. If I hit a jackpot at the casino I can consider an implant!
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  #21  
Old 01-06-2010, 12:39 AM
Jophiel Jophiel is offline
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Wait... it's $250 for an extraction? Granted you and I aren't the same people but you implied that you had dental insurance, just that it didn't cover the implant (it never does). But it should cover an extraction and bring the price down into the double digits.

Again, we probably don't have the same insurance plan but an extraction runs me $30. It was easily the cheapest part of my implant operation.
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  #22  
Old 01-06-2010, 07:42 AM
yoyodyne yoyodyne is offline
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I have a similar broken molar. It needed a crown lengthing and the total for that, the root canal, and the crown was over $4000. The dentist said there was a 50% chance the tooth would break between the roots during the preparation and have to be pulled anyway.

The cost and possible complications of an implant were not attractive either. The dentist suggested a bridge, but for the short term he put on a temporary composite filling. He shaped it to smooth the cracked surface and minimize pressure by not trapping food while chewing.

That temporary filling lasted over six years. When a piece broke off he re-did the filling and that's been in place over two years. I take care not to chew hard food on that side but it's worked out pretty well for me so far.
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  #23  
Old 01-06-2010, 08:47 PM
Ignatz Ignatz is offline
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DDS numbed me, took an impression, ground down the broken stub, removing the old amalgam filling. It had NOT had a root canal so no clue why there was no pain or thermal sensitivity before his work. He ground the stub flat, took impressions, made and stuck on a temp composite crown, and will have a crown made for intallation in 2 weeks. One of my two dental insurance policies does not cover crowns. One covers 50%. I know, TMI.

Get it taken care of, one way or another.
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  #24  
Old 01-07-2010, 05:24 PM
cwthree cwthree is offline
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Originally Posted by Oglomott View Post
What makes this tooth more prone to infection than any other tooth? Basically it's just a tooth that's been given a root canal and ground down in preparation for a crown. Do any of these things make it prone to infection?
A couple of reasons. First, the crown prep removed the tooth's layer of enamel and exposed the dentin. Enamel is relatively resistant to decay and mechanical wear. Dentin is much softer. Eating will wear it down quickly, and it's also much more susceptible to decay. You can expect mechanical wear and decay to reach the tooth's pulp cavity (more on that in a moment) pretty quickly.

On to the pulp cavity. The root canal procedure took out some nerves, blood vessels, and other stuff, and installed some inert material (usually gutta percha). This is good for occupying the space left in the tooth, but it's not good for chewing with, either. Once the tooth is worn down, this material will be exposed, and it will most likely fragment and work its way out. After that happens, you'll have a wide-open path from the inside of your mouth to your jawbone. At that point, you're very likely to develop an infection in the bone. That's really nasty, and could end up costing you a lot more than an extraction or an implant.

You mentioned that the tooth is broken, and that the dentist pulled part of the tooth. This, too, has created a path from your mouth into the jawbone (there's your infection risk again), which is why she's pushing you to either have it extracted completely or restored properly with an implant.

Short answer - if cost is an issue for you, have the remains of that tooth extracted soon. The upper tooth may shift a bit, but this is unlikely to pose any threat to your health.
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