Expert: Mark Bornfeld DDS - 6/7/2007

Question
Hello Doctor, My wisdom tooth was paining me(not a lot) since the last week.Its only painining when i bite with it,not otherwise.My dentist said i will need a root canal done on it.He has seen the small xray(not the panaromic one).Actually i had a rather large filling done on the back side(facing the neck) of that same wisdom tooth 4 years ago.So the dentist said that first that filling has to be removed,then a root canal performed,and then a filling will be put on this molar.He said i can wait upto 1 year before putting a crown and a post.I am trying to postpone putting the crown and post till when i go back to India(native country),where it will be much cheaper.How long could i safely use that molar without the crown and post.What are the chances of it fracturing or any other complications without the post and crown.Also what procedure will be employed to fit the crown and post after lets say a year? What do u suggest doctor.Should i try to postpone the root canal treatment by a few weeks or months,or will it make my tooth worse(i dont mind the pain),but i dont want further complications which can make me loose my tooth.Also is root canal treatment advised on the wisdom tooth.Thanks a lot Doctor

Answer
Dear Dinesh,

Before I answer, I just want to be sure that you're truly referring to the wisdom tooth, because my answer depends on the assumption that you and I are talking about the same tooth. The wisdom tooth is the third permanent molar- it usually erupts between the age of 17 and 25 years of age, and is the 8th tooth from the front of the mouth.

Your last question is perhaps the first and most important question to be considered. In fact, it is often customary to extract wisdom teeth due to complications from their position. While I don't agree that all wisdom teeth should be extracted, I certainly don't advocate for expending much time, effort, and expense in the service of wisdom tooth repair unless the tooth plays an important functional or logistical role in the mouth. In most cases, wisdom teeth are not worth the amount of effort your dentist is proposing. Very little chewing is done so far back in the mouth, and the short roots of the typical wisdom tooth make it poorly suited to supporting or retaining a fixed or removable prosthetic device in the event you lose teeth in the future. In addition, the internal anatomy of wisdom teeth tends to be quite difficult, and a successful completion of root canal therapy is therefore not assured. The position and inclination of wisdom teeth often predisposes to episodic infections of the gum. Finally, the removal of a wisdom tooth almost never presents the risk of bite collapse and tooth drifting that the removal of other teeth might cause.

Because of these things, the best thing to do in cases such as yours is usually (although not always) to remove the tooth rather than go through extensive root canal and crown fabrication. I would advise you to seek a second opinion before embarking on the course of treatment your dentist has advised.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY