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Dentistry/One tooth extraction affect on jaw bone

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Question
I am a 47 year old female and have all my teeth except for the top left wisdom. I have had a couple of root canals and a apecoetomy (spelling). Currently I have a infection and abscess in my right lower molar next to my wisdom tooth. I did see a dentist am on Amoxicillin and pain relievers until the infection clears for treatment. The tooth originally broke off partially from a large silver filling. In Kenya, I had a composite filling done around it in March, and had planned to replace it with a crown late this year. I suppose either decay was left from the dentist inn Kenya or the composite cracked. In any case, my choice is a root canal or extraction The tooth is fairly weak, but the dentists said it could be done--not knowing how long it will last. I do still have a healthy wisdom tooth in back of it.I am terrified to have it extracted for all the possible complications and especially for loss of jaw bone. I am afraid it will change my bone structure in my jaw (appearance). Will it in any way? I have to also consider the price difference but do not want to make a mistake in extracting this tooth, if it will change the appearance of my jawline or largely impact my mouth in any way. What would be your opinion, from your experience? Thank you.

Answer
Dear Cherie:
I understand your concern.  However, I do need to clarify some things to you in order for you  to make an educated decision.
It is very common for people, patients and dentists alike to weigh an extraction vs. root canal treatment.  This is a misguided comparison.  
Before a decision whether to have root canal treatment or not can be made, a much more important decision has to take place... Is the tooth restorable with a crown?
It is incredibly important to have an excellent crown fabricated to seal the tooth following root canal treatment.  As a matter of fact, the research shows that if root canal treatment is completed and a crown IS NOT placed within a month, the root canal treatment can get reinfected and is futile.
In cases, like yours, when a tooth has fractured, The first order of business in my office is to prepare the tooth for a crown and fabricate a provisional (temporary) restoration and place it on the tooth.  In this manner, we can find out if a crown can be made to seal the tooth.  It also reminds you that you MUST have a final core and crown made right after the root canal treatment.
Only then, are you referred to the Endodontist for root canal treatment.  This is also the best way to find out ALL the costs involved in treatment.  I have seen too many people who had had root canal treatment, only to realize that they cannot afford the core build up and crown necessary to complete the job.  If you cannot afford the core build up and crown, do not waste money on root canal treatment.  Just have the tooth extracted and replaced with a removable partial denture.  An implant or a bridge will cost about the same and will be even more costly than the original root canal, core build up and crown.
So...
Here is what you have to do...
Talk to your dentist about the complete and true costs of All treatment involved and whether the tooth can be restored with a crown BEFORE root canal treatment is done.
If you are ready for the costs, proceed with root canal, core build up and crown.  If you cannot have the treatment done, then an extraction and replacement of the tooth with an implant, or a removable denture (depending on what you can afford) is in order.
Best of luck,
Dr. Zev Kaufman

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Zev Kaufman, D.D.S.

Expertise

I can answer any question from simple routine dentistry to very complex dentistry with emphasis on reconstructive, cosmetic, and implant dentistry. My expertise is in co-ordination of very complex treatment plans with other dental specialists or as a one-man-team, since I have extensive training in Prosthodontics, Surgical Implantology, and orthodontics.

Experience

Over a decade in private practice of Surgical Implantology and Prosthodontics. Founder and owner of Prosthodontics & Implant Surgery of Manhattan, PC. Clinical Assistant Professor at the Post-Graduate Department of Periodontics & Implant Dentistry at New York University College of Dentistry. Lecture weekly since 1999 on advanced Implant Prosthodontics at New York University College of Dentistry Post-Graduate Program in Periodontics & Implant Dentistry. Former clinical assistant professor of Dental Radiology at the NYU College of Dentistry. Former clinical and lecture faculty at Lincoln Hospital, Dental residency program. Former clinical and lecture faculty at St. Barnabas Hospital (Bronx, NY) dental residency program. Lecture nationally on Prosthodontics and Implant Dentistry.

Organizations
Memeber of the American College of Prosthodontics. Memeber of the Acacdemy of Osseointegration. Member or the Omikron Kappa Upsilon (OKU) Honors Dental Society. Member of the American Dental Education Association.

Education/Credentials
Graduated with Honors from New York University College of Dentistry. Post-Graduate training and certificate in the specialty of Prosthodontics. Post-Graduate training and ceritificate in Surgical and Prosthetic Implant Dentistry. Honors-program in Comprehensive and Applied Practice Management. Honors-program in Orthodontics.

Awards and Honors
NYU Cervice award to the community. OKU honor society. National Dean's List. National Who's Who.

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