Expert: Joel S. Teig, DMD, Diplomate ABOMS, retired - 10/31/2009

Question
QUESTION: If I were interested in having the first upper maxillary bicuspid extracted  do I need to have any great concern about the molars in  behind sliding or about the bicuspid beneath super erupting as
the years go by? This question is meant for a general situation?

ANSWER: Mark - The answer is yes.  After that bicuspid is removed, there can definitely be a shifting of the bite.  This shifting can create a situation where the teeth may not be functioning well and you might not be able to clean the teeth well enough.

---------- FOLLOW-UP ----------

QUESTION: Dr. Teig; It has been suggested to me that I could have a mediocre form of root canal done on the first upper maxillary bicuspid for about $1000
Canadian. This is a form without an extra cap.

Could I form a much better prognosis this way than if I had it extracted? You can't see my teeth directly but all the teeth on that side otherwise are still there and healthy.

Could I ask you about the morality of $1000 and $2000 root canal jobs?
Why are they so expensive? What would people have done 50 years ago?
Are root canals inordinately painful or difficult for the patient.

Thank you!  

Answer
Mark - Saving the teeth is best, but I understand the high fee is imposing.  A good root canal treatment is a technical procedure that requires skill.  Many general dentists do this work without skill, just to make money.  I know a fee of $1000 seems like a lot, but if you were to lose that tooth and the teeth started shifting, the overall costs to restore the area would probably be more.  

If done by a skilled dentist or root canal specialist (endodontist) there should be minimal pain.  If the tooth is abscessed, there might be more pain involved until the bacteria drains.  50 years ago people were doing root canals.  The material used for root canals was devised in 1848 and has been used since with a tremendous amount of success in skilled hands.