Every day, a patient in my office presents with either a decayed, fractured tooth or a tooth with an old filling. The questions commonly asked by patients are “Can you fix it?” “Can you save it?” “Is it a big job?” “Is it worth it?” “How long will it last?”
The answers are usually “Yes,” “I’ll do my best” and the favorite “It depends!”
You see, the mouth is not as predictable as the dentistry we deliver. The factor here is that there is a person behind the tooth, who is using it, and wear and tear is an overriding factor. So, in a vacuum, your teeth and my dentistry will last forever, but in a functioning mouth, with our diets, predictability is minimized.
So, how do we decide what’s the best treatment decisions for our mouths? Well, obviously in the scope of this article, I’m not going to review all the options of dental restorations in the field, or get too academic. However, I will attempt to highlight three common scenarios that are discussed daily in my office. Hopefully this will guide those who are perplexed in their dental lives.
The cavity. Well, most are restorable. If it’s a virgin lesion, then usually a filling will suffice. If it’s larger, than an inlay or a crown (cap, for the layman) may be needed to restore, reinforce and rebuild the tooth that has a large hole or missing vital structure.
The old filling. Well, some have stood the test of time, and continue to function well. Others have outlived their usefulness. Frankly, I find that most keep their old fillings beyond their time. The problem is that unless it doesn’t fall out, we feel that they are fine. However, the call I get is usually “my filling broke!” And more times than not, that old filling is intact, and the tooth around it fractured. So, many times, early intervention is more prudent than waiting for that moment. Replacing an old filling is much more predictable, less painful and usually less expensive than that unpredictable sudden emergency appointment on the weekend, holiday or the “night before your daughter’s wedding” (all are actual scenarios that have happened).
The root canal tooth. There are those that need the root canal to be rid of infection, and others that need to rebuild a fracture at the gum line. This can be a result of an accident or extensive decay. And then there are those teeth that have had a root canal before, and need a new crown. Yes, all these cases can get even more complicated, but for the sake of this discussion, there comes a point where “saving the tooth” is just not worth it. Many years ago, before dental implants, we would do anything to save a tooth, because the alternative was toothless. However, now with modern dentistry, we have to look at the prognosis, life-predictability, of each tooth, as well as the investment one is putting in, to determine if what’s left of your natural tooth is a better foundation than titanium (that’s what implants are made of). The dental implant can be stronger and last longer than the tooth God gave you. Frankly, I don’t recommend “jumping through hoops” to save teeth anymore. Those that are severely broken-down and compromised call for dental implants, which have become much more predictable, successful and pretty much the standard of care for tooth replacement. This is the “third set” of teeth that we can be blessed with. God has His plans....
So, this touches upon the surface when thinking about saving the teeth that you have. Overall, trust is extremely important.
If you have confidence in your dentist, and trust that he/she is recommending the best treatment options for your optimal oral health, then follow their lead
By Dr. Brian M. Kalb