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Second Molar - Root Canal vs. Extraction
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Second Molar - Root Canal vs. Extraction

My wife (age 39) recently went to the dentist.  Neither of us had been for many years prior.  Aside from a couple of fillings, her two upper second molars (#2 & 15) were bad enough that #2 needs to be pulled and #15 could either be pulled or have a root canal done followed by a crown (the dentist didn't give a preference between the two).

With the root canal option, after discussing the financial side of things, the dentist recommended waiting until our next insurance cycle to have the crown put on (at the time, we thought that was June, but it turns out it is next January).

We got an informal second opinion from a family friend who has been a dentist for a long time, and he felt that a crown needed to be put on within 2 - 4 months in order to minimize the possibility of cracking (which would then require an extraction anyway).  He seemed to lean towards extraction, given the time frame.  We were concerned about teeth shifting, but he thought that this would be unlikely so long as the other teeth are in a good bite relationship.  The main issue, according to him, was that the lower second molars would eventually erupt further, becoming taller than the other teeth, but did not seem to think this was a major concern and could be dealt with far down the road if it did become an issue.

We're weighing between the cost and discomfort and potential futility of doing a root canal followed by almost a year wait until a crown can be put on, and the potential effects of extraction.  Any recommendations, or pros and cons would be appreciated.
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4 Comments Post a Comment
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Avatar_n_tn
I should note that there is no pain currently, and my wife's pain tolerance is fairly low.
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Avatar_m_tn
If saving and restoring 2nd molar is strongly desired. crown can be delayed a while after completion of root canal treatment. Occlusal reduction is generally performed to reduce the possibility of crown fracture.
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748543_tn?1371753642
I would say that anytime you can you should save a tooth. I don't quite understand the rational behind rootcanal and waiting.. don't get me wrong, I understand financial consideration, but I don't think as a healthcare provider that is our job to plug that in. We are supposed to tell you what we would suggest as we would want in our own mouth..
So let me tell you. First of all, extarction of second molars should not be deemed so simply. at 39, your wife could statiscally be looking at another 46 years of life.. I would not give up a second molar so quickly..
When a tooth is Root canaled it should be crowned immediately, I have seen crack happen in two weeks.. It seems to me that your dentist is way too insurance dependent, meaning he is letting insurance coverage, or lackk thereof, dictate his recommendaion. That is not right.
As for your family member, I am sure he/she means well, but that is exactly why we should not work on our family.. I really don't seehow he thinks removal of second molars will not effect your wife long term.. first of all you are essentially foroing two other teeth, your lower second molars, then the posteriior bite collaps could potentially have serious outcomes longterm for your wife. 3  out of 4 TMJ paients are women.. ?? I don't really understand the rational there.. Not only you should keep that tooth but you should also replace the other that was removed before you get uneven bite and unilateral collaps of her bite.. Extarction is really a third world solution and one that requires no thought process.. Ask yourself this.. if you were going to be ok with one molar in the upper arch why do we have three per side?  I think 8 million years of evolution is a better guide than insurance based recommendation..

  
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745634_tn?1243727047
I am surprised no one has mentioned this yet, but what was the reason given for needing a root canal?
Root canals in dentistry are like ADHD in medicine, the most overdiagnosed problem in the field.  
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