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Dentistry/To Pull All Bottom Teeth or Leave 3 Teeth?

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QUESTION: I need to have all but 3 bottom/lower teeth extracted, due to gum recession/root exposure/loose teeth.  Numbers 23, 24,25,26 are getting pulled.  I have already, in the past had several teeth pulled on the bottom and am now getting 6 more teeth extracted...the incisors and the teeth next to those.  This will leave me with JUST 3 TEETH ON THE BOTTOM (due to previous extractions), number 17, 27, 28.  My top teeth are real and fine.  

I am prone to decay on the bottom and worry about the 3 remaining teeth becoming decayed at a later day.  Plus #17, the back molar that's being kept is just a stub due to the loss of a crown.  The dentist recommends crowning that tooth.  This will be expensive!  So I will be paying for 6 extractions, a crown, and a temp and permanent Valclast partial.  

My question is this:  Is the Valclast partial more comfortable than a full lower denture?  I want comfort and chewing capabilities...something I haven't had for some time (the chewing part).  Cost wise, of course it's cheaper to pull all the teeth..I assume.  I am working with a new dentist and am not sure on her skill set, so that's why I am asking you, a skilled DDS.

I want the smartest option...do I pull all the bottom teeth left and get a denture or leave 3 teeth and get a Valplast partial?

My appointment is coming up.  Thanks for your valued time!

ANSWER: Sunday - First of all, the Valclast partial denture is one that is very difficult to repair and adjust.  The adjustment to insure proper fitting is important.  Leaving those few teeth does very little for stability vs a full denture.  I think extracting all the teeth and having a full denture sounds best.  Of course, without examining you or viewing xray films of the area I cannot be completely sure, but it sounds like a denture might give you more complete and longer success.

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QUESTION: This is appreciated.  Just to ensure I fully understand your statement on stability...are you referring to BOTH the fit AND the function in terms of chewing capabilities?  Meaning a full bottom denture will do both better vs. the option of leaving the remaining 3 bottom teeth in and getting the Valplast partial.  And thanks so very much for your timely response!

ANSWER: Sunday -  The main criterion of leaving those teeth is the stability of them and lack of any history of decay.  With your dental history and having extracted teeth for seemingly advanced periodontal disease, the chance that the remaining teeth will definitely be strong long term, is small.  For that reason, fabricating a partial denture resting on teeth that might not last very long is not a good solution.  Why pay for a partial now and soon a denture.  That is my reasoning, based on what you have described as your history.

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QUESTION: That makes good sense.  All of the previous bottom teeth have been extracted due to decay, maybe involving periodontal issues.  I have Rheumatoid Arthritis (for 30 years) and also have Osteopenia (nearly Osteoporosis...I am a small boned/small person in terms of weight) and am 59 years old.  I am currently injecting Orencia and also take Methotrexate and have had a bone infusion injection of Reclast...a year ago.  I know the risks of bone healing issues after extractions when on the Reclast type meds.  All of my extraction sites have healed well.  Just wanted to give more insight.  

Also, the periodontal issues are ONLY really involving the bottom 4 teeth/the incisors, with gum recession only on the 4 bottom teeth...severely so on the 2 bottom teeth and has been for many years.  But, the rest of the bottom teeth are in fact very loose, except for the 3 that are not being pulled.  So I suppose that must mean the periodontal issues involve all the bottom teeth...if they are loose, right?  The gums are NOT inflamed at all.  I guess I answered my own question in this paragraph.  I have periodontal issues on the bottom teeth...period.

And yes, I totally agree with your point on why pay for a partial now and then a denture later.  Exactly right. And your point on the history of those 3 teeth...2 do NOT have a good history.  Only 1 has never been decayed...just one.  And all teeth getting extracted are very loose, except for the very back molar that's just a stub with the recent lose of that crown.  And the expense to re-crown that tooth...makes no sense to me and so glad you see it that way too.  Thanks!

Of importance:  Just one month ago I woke-up with a severe tooth ache in #22 (a crowned tooth) and had to have that tooth pulled...the root nerve was SEVERELY ABSESSED according to the dentist (her words..infection the size of Texas).  After that extraction the two teeth on either side of it (#21,#23) became very loose and were tight before that.

I am in Wisconsin and the dentist I saw has only been out of school for 5 years.  I am not comfortable with her (seems inexperienced and uneducated) and need to find someone to help me proceed as per your recommendations, which I agree with.

I can't begin to tell you how much I value your time and expert advise as a skilled doctor.  

If you can elaborate any further or have additional valued insight for me, I would appreciate it.  Thanks Dr. Teig

Answer
Sunday -  It is important that any dentist you choose is skilled.  Just because the dentist you are seeing is only out of school 5 years does not mean that she is not skilled.  A simple test of the doctor's skill is to ask her for names of patients you can speak with who have had similar treatments.  If she hesitates or refuses, find a different dentist who is more secure in his or her dentistry.

I wish you well and hope the new denture will be comfortable and functions well.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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