Dental Doom -- need advice in 24 hours

In My Humble Opinion
1

Looking on the bright side, toothache is my most major problem now. Would that we could all be so lucky.

But Tooth #5 is in pain. The pain is increasingly frequent and often severe. I often hold my face at an angle when eating to minimize pain.

Even brighter, although my teeth overall are far from top shape: I still have all eight incisors, all four canine teeth, all four 1st bicuspids! glass isn’t half-empty … it’s more than half-full. :slight_smile: I am missing some 2nd bicuspids, wisdom teeth, and most of my 1st molars, but on the bottom, teeth #22-#31 are all present and accounted for :), one saved by root canal 25 years ago. (Tooth #21 also root canaled but the crown was so faulty that the tooth eventually broke off.)

Still, I am missing enough teeth that food chewing is more difficult, and puts added strain on the remaining good teeth. My best plan, I think, is to emphasize soft foods during my remaining years (I’m already threescore-and-eight).

I’m not sure when the pain in tooth #5 began, but it was probably long ago. There are very few competent dentists near my home and, as some of you may know, I am easily irritated by imperfections in others. (The best local dentist is the one who gave me the faulty crown. :smack:) I am a supreme procrastinator but have outdone myself this time. Instead of thinking “This dental problem needs to be addressed” I’ve been more like “Wow! last week there were two whole days without unrelenting pain – maybe I should put off the dental visit for another year!”
…

Tomorrow I am scheduled to begin root canal on tooth #5, with a man (oral surgeon? - 60 miles away) I’ve never met. (I met his colleague, who doesn’t do root canals, yesterday, and he seemed very competent.)

My question is: Should I just tell the guy to Extract tooth #5 instead of “saving” it with a root canal? I’m sure most of you will plead for #5’s life, but I’m hoping someone will make a convincing case to just the extract bicuspid now, get it over with, and thereby minimize total future pain.

Help?

2

I’ve had two root canals, one a dozen years ago and another two years ago and both of those teeth have been totally problem-free and fully functioning ever since. IME root canals suck but better an hour or two of misery than having to deal with a missing tooth for the rest of your life.

3

Agreed, I only had one done and it took several visits due to it’s complexity (apparently how I had a huge hole in a tooth that never got infected or caused me severe pain as it should’ve and it caused them to marvel at it), but it was choice of dealing with shifting teeth and more problems later or getting some misery out of the way, right away. Question for OP though, do you have familial history of tooth problems by chance? I have a theory I want to reinforce.

4

You’re in Thailand, right? So for you “tomorrow” is this evening for me (I’m in CA). It may be too late, but I just so happen to be planning to see a buddy of mine tonight who is an endodontist (does root canals for a living). I can ask him what he thinks, but it’s going to be late evening before I can get back to you.

5

My appointment is for 3 PM BKK time, which is 1 AM SFO. I’ll bring the wife and try to connect her cellphone here for any midnight reprieve.

AFAIK my family’s teeth are generally good; I’m afraid I’ve mistreated mine.

Three visits are scheduled. Refresh my memory — will I have to wait until visit 3 for the severe pain to subside? Or will the dental operation itself (what’s the proper name?) be so unpleasant as to make the present pain irrelevant for the next week or two? :eek:

6

Dentist here. There isn’t any really right answer in these situations. From a cost and time standpoint extraction would be faster and cheaper. Since you have a fair amount of missing teeth already, extracting one that has an opposing tooth will reduce your chewing surface area a fair amount. With the teeth you are already missing and since you have a fairly rational grasp of the situation I’d say if you’d really rather extract, then do that. As a general rule dentists would prefer to save teeth when we can but each situation is different and there isn’t as I said there isn’t a right or wrong answer.

Don’t know how you feel about future restorative options but if something like removable partials are a consideration then one more missing tooth won’t make much of a difference. If fixed bridges or implants are a consideration then another missing tooth is a bigger deal.

PM’s are welcome but don’t guarantee quick responses.

7

The pain has always subsided after the first visit, when I’ve had root canals – once the nerve is out, there’s no more pain.

I normally a dose of ibuprofin right after treatment to head off any discomfort due to trauma to the gum and adjacent areas. Occasionally I’ve needed a second dose before bedtime, but normally not. Compared to my adventures in tooth-removal (dry socket EVERY TIME), I prefer the root canal.

8

Thank you. I must admit to complete ignorance about removable partials. This may be what I should have been studying.

Neither the time nor the cost is an important issue.

[QUOTE=GrumpyBunny]
The pain has always subsided after the first visit, when I’ve had root canals – once the nerve is out, there’s no more pain.
[/QUOTE]

Is this certain? If the offensive nerve is destroyed on visit #1 I’ll have a much more sanguine opinion of the procedure.

ETA: I’d like to ask the dentist: “No crown please, just a ‘temporary cap’.” The ‘temporary cap’ on my 25-years ago root canal is the best tooth I have!

9

In my experience, the first visit is where they remove the nerves and shave the tooth down. Then they plug the hole, tell you not to crack walnuts on your tooth-nub and send you off. Then you come back soon after for the temporary crown and wait for a few weeks while the permanent crown is made. Return to have that one installed and you’re off. But the real pain-fixing part happens on the first visit, the rest is largely restorative.

10

Generally the pain does subside after the root canal. Nothing is always of course but pretty safe bet that you’ll have relief after the root canal. Some folks a sore a day or two but most feel better then prior to the root canal.

Twenty five year old temporary? Seems a bit unusual. What is it made of? Most temporaries are either pre fab aluminum or acrylic or are custom acrylic.

11

OK, so my buddy was a bit reluctant to “diagnose 2nd hand over the internet”, but I convinced him you were just looking for friendly advice. He agreed that root canals can vary, and if you don’t trust your dentist, it might be best to have the tooth pulled, BUT… he said he could only recommend that if you intended to get it replaced with something like an implant. More or less what our resident dentist here suggested. And since an implant is something you can do at your leisure, you have the advantage of going somewhere to have it done by a dentist you trust more. Otherwise, take your medicine and have the root canal. If it doesn’t fix things, you can always have the tooth pulled later.

12

Out the door soon — will follow this prescription.

One interesting fact I didn’t mention is that I didn’t know which tooth was causing the severe pain! Is this normal? When the pain came it was huge pain that seemed to overwhelm the whole side of my face! I tried to do experiments (“Wife, put a tiny ice cube on the different teeth and remember where it was when I started screaming!”) but the experiment was inconclusive. Two incompetent dentists had no clue which was the painful tooth!

I got sudden confidence in the new dentist (colleague of the root canaller I will see today) when he told me which was the bad tooth after a single glance. I asked him to PROVE it to ME. With a small hammer or something he started tapping on my teeth. “Hurts a little … hurts a little … OOOUUUCHHH!”

Is it common to not know which tooth is the problem? Or just another example of my abnormality?

13

Yeah, that’s totally normal. Dental pain radiates, so it can feel like it’s coming from somewhere other than where it is.

14

I may as well report on my dental visit today. No root canal was begun. :dubious: The friendly competent-seeming young female dentist learned that I had a coronary stent — according to her, stented patients need to take antibiotics 1 hour prior to root canal due to the risk of the tooth’s bacteria making their way to the narrow coronary passage. (I think she mentioned “American” when citing this recommendation — does this sound normal?) Perhaps she was over-cautious, but I prefer over-cautious to under-cautious. I was slightly annoyed since there had been a clear question-answer with the apprentice on Friday — he knew I had a coronary stent (“sa-tent” since the “st” consonant blend is unavailable in Thai.)

The plan is for five more visits, once every two weeks (:smack:), three for the root canal, two for a crown. (This includes a “pin”(?) or such to help the decaying tooth next to #5.) One reason for the long delays is that she works only 2 days a week at the private clinic. Other days she works at a hospital, probably to repay government for student loans.

Cost may seem modest by U.S. standards. My visit on Friday was completely Free. Today’s was $6 for x-rays, with 2 grams of amoxycillin thrown in for free (to be taken 1 hour before next appointment). The root canal will be $165 total; the crown $195.

To write yesterday’s post I studied Wikipedia to learn one word in dentistry: “It’s the #5 tooth, doc!” But she kept calling it the #4 tooth. We got that straightened out — I was using the American numbering system; her count started from the middle. :smack:

Since it’s 3 hours on the road (round trip) to get to this clinic, I should feel disappointed. But … I’m happy. My outlook has changed from gloom (“I need to research suicide methods in case the pain gets worse”) to proud delight that I’m taking the high road back to pleasure and longevity. :slight_smile:

The long trips to the dentist will detract from my day job — pointing out political errors on SDMB — and I apologize for that. (I’m not sure I’ll ever catch up.) My wife’s day job is watering her herbs, fruits and flowers. Since it rained today, she’d have invited friends over for whiskey instead, so the “useless” trip worked out well! :slight_smile:

15

Nothing useful to add here. I mean, I wish you well with your tooth issue, but I just wanted to post and say I like the way your wife does things.

16

Pre med for a stint is correct. You will need it prior to all appointments that are invasive(any injection, cutting etc). Two grams of amoxicillin each time. Three appointments for a root canal? I do all mine in one as does everyone else I know except sometimes in cases of massive infection. The pin is like a tiny screw that helps hold in the material replacing the missing tooth structure, sort of like tiny rebar. America’s numbering is different from the rest of the world so her first quadrant fourth tooth is our number five.

17

This has happened to me a lot but I have a lot of damage in my mouth going back to a young age. As I understand it, the inflammation from an infection will affect nerves that lead to other teeth. You’ll notice the dentist may not shoot anesthetic into your gums right by the problem tooth to numb the nerve further away from it.

Best of luck with this. If implants are inexpensive where you are you should consider pulling that tooth and replacing it with an implant. Depends on the extent of the damage and the general condition of your teeth. I’ve had a number of teeth initially root-canaled that eventually had to be extracted anyway, but my situation is not typical.

18

Nice to hear things are working out for you. I had one bout of tooth pain many years ago, and I still remember how excruciating it was for several days (started out while I was on a business trip). Best wishes for a road back to health and happiness!

19

Thanks for all the good wishes! It does seem like removable partials may be a better plan. I’ll ponder this a little but probably go with inertia and just begin the root canal 2nd September. (I didn’t sign a contract, but feel that I’ve agreed already.)

My previous root canals were also done in Thailand and each took 3 visits (not counting any crown) IIRC. Is single-visit root canal a new thing? Is there a technique used in U.S. which Thailand lacks?

20

Just a couple of weeks ago, I had a ceramic crown fitted on a tooth to replace all the amalgam which was what most of the tooth was before it started disintegrating. I had the crown fitted, fired and glued within about 2 hours. One visit to the dentist. I was mightily impressed.
No root canal work done and the tooth is now doing mastication duties as well as any other.