Options for fractured, abscessed tooth

[Stace_case]

Hi, I have a cracked tooth that developed an abscess.  I originally posted on the question about swollen cheeks and abscesses, but I haven't had a response and my situation has changed, so I'm posting a new topic.

I've been to two dentists and one endodontist this week.  (I thought it best to go to a dentist on my insurance plan when I realized how expensive this would all be, which is why I went to the second dentist.)  The tooth is cracked and dead.  It has had no prior dental work.

Today I went to the endodontist for the root canal, and he looked at the X-rays and said the tooth is hopeless.  He said he could tell this from bone loss above the gum line evident on the X-ray.  (The tooth is #13.)  So he referred me to an oral surgeon.

However, the two dentists I saw this week both said you can't really know if the tooth is hopeless without drilling inside it and visually inspecting where the crack ends.

Now I don't know what to do:

1.  Go for a root canal with the dentist not on my insurance and leave open the possibility that he'll extract the tooth, if he finds it's beyond repair upon examining its internal structure - OR

2.  Just have the tooth extracted.

The first option seems like a no-lose, EXCEPT that a cousin who's a dentist said if the tooth needs to be extracted, it really ought to be done by the surgeon who will do the implant.

Also, it's possible to do the root canal and crown and still need an extraction later, which would really be regrettable.

Any suggestions?

[Jerome Tsang, DDS]

Thanks.  Glad to hear that everything went smoothly.

Don't forget to get an implant placed soon.  The bone will begin to change and resorb.  The more jaw bone you lose over time, the more difficult the implant will be.  I would think that about 4-6 weeks from the extraction date is a good time to start the implant although I don't personally do them myself.  Call your dentist or oral surgeon to see about the placement.

[Stace_case]

Thank you for your information.  It validates the action I took yesterday (Saturday) - I had the tooth extracted in an emergency oral surgery appointment.  I am so glad!  The swelling in my face was worsening every day, despite antibiotics. The oral surgeon said the infection was very deep; she had to put stitches into my gum from having had to go deep inside to clean it.  And she doubled my antibiotics.  I think the viability of the tooth was extremely low, for the very reasons you stated - the endodontist is a specialist, and he gave it a poor prognosis.  I respect him for turning down a job!  Meanwhile, my general dentist had said I could come in Monday (tomorrow) and he'd start a root canal and do an extraction if that was deemed necessary. But it wouldn't have been under anesthesia, so I'm glad I went the oral surgery route.

Thank you for the service you provide. It's a huge benefit to the lay community!

[Jerome Tsang, DDS]

Hi again.

Okay, situation has changed I see.  Well, I would probably go with the opinion of the specialist as they're specially trained to do root canals and determine the restorability of a tooth.  I generally refer my patients to an endodontist to determine the extent of cracks in teeth as they have mircoscopes that can magnify the tooth.  If there is significant bone loss in an area where the crack leads, then it can indicate the crack is below the gum line quite deep into the bone.  If a crack is deep, the bone around the crack will die and that's probably what hes seeing.  If thats the case, then he can determine the extent of the crack that way.

I would recommend extracting the tooth and placing an implant.  It is possible to do a root canal and a crown but if the chance of success is so low, then it may not be worth the time, money, energy and of course discomfort of the extensive dental treatment only to need to have an implant done later on.

Sorry to have to give you bad news on the tooth but it would probably be best to remove it.