Expert: Tony Appleton BDS DPDS - 5/10/2007

Question
QUESTION: I have a missing molar on both upper sides. In neither case is there enough bone to do an implant, so bridges are needed – given my nocturnal grinding problems, I’ve been advised to get them sooner rather than later (bridges would also deal with my main sites of decay recurrence and filling dislodgment). I’m now in Argentina and able to get them done very cheaply, with a dentist I’m comfortable with. However, he plans to do root canal treatment on the teeth that will be the supports of the bridge. I’ve just spoken to two dental surgeries back in Australia, and in both cases they say it is better to leave the support teeth alive, and only to root canal if there is a problem with those teeth. Do you have any view as to whether it is indeed a bad idea to remove the nerves unnecessarily? Or is it a way of reducing the chance of future decay/pain problems in the teeth within the bridge? Thank you!!
ANSWER: Hi Brett

Is your dentist advising root canal treatment because the teeth need root canal treatment or because he is proposing bridges? If the teeth need root canal treatment in their own right then that is fair enough. If he is proposing root treatment just because he is going to do bridgework then run a mile!

Your Australian dentists are absolutely correct. Under no circumstances should you have root canal work done unless there is an absolute indication for it - and bridgework is in no way an indication!

Your question rings a number of alarm bells with me. Firstly you have a problem with recurrent decay. This should be your number one priority. Decay is caused by a diet containing too much sugar, and this needs to be got under control before thinking of any advanced restorative dentistry. Your dentist should be giving you dietary advice and making sure your oral hygiene regime is right first. If you proceed with advanced restorative work (such as bridges) whilst having a high decay rate, then it will all end in tears - yours!  The bridges will fail in a few years time.

The next issue is your grinding. Do you wear a nightguard?

Finally you seem to have discounted implants. These days implants can be put in to areas with little bone without too much trouble - you need an opinion from an implant specialist.

I really regard conventional bridgework as a last resort these days. In order to replace one missing tooth a conventional bridge requires removal of a large amount of tooth structure from two otherwise healthy teeth. This will significantly increase the chance of problems with those teeth in the future. Implants are where you should be looking. I know they are more expensive and much more complicated to carry out - but the final result will be much much better, and will last far far longer.

Please get another opinion, and let me know how you get on!

Kind regards

Tony Appleton

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

QUESTION: Excellent advising style, just what I sought! The abutment teeth don't need root canal work in their own right. Re implant possibilities - both have extremely limited bone content (I can confirm how little - can you suggest an expert I can contact?), unlike another gap where he wants to put an implant. Grinding - I now have a nightguard. Decay - my diet and hygiene are apparently good - problem has been 3 food trap sites that are very difficult to floss (dodgy teeth forms) where fillings have often come out.

Answer
Hi Brett

I'm afraid I can't suggest an expert as I'm in the UK and you are in Argentina. However, it shouldn't be too difficult to track down a specialist reasonably local to you. You could phone local dentists and just ask them who they refer complicated implant cases to. It is obviously better to have a personal reference from someone who has actually been treated by the specialist, and maybe by asking around friends/colleagues you may get some good advice.

Hope this helps

Regards

Tony Appleton