Can This Tooth Be Saved? Treatment Options for Dental Issues

Is there still a possibility to save this tooth? (There is a dental bud and minimal tooth structure.)

Dear Doctor,
I have a question regarding my upper right first molar (tooth #6), which has undergone extensive dental restoration.
About a month ago, a small bump appeared on the gum above it, which is palpable but does not ooze or cause pain.
The tooth itself is not painful, although I occasionally feel a heaviness in the morning.
I visited a dentist a month ago, and the primary diagnosis was a periapical abscess without a sinus tract.
Dr.
A mentioned that due to previous dental work (as seen on X-ray near the second molar), the restoration might have encroached upon the gum tissue, allowing saliva and bacteria to infiltrate, potentially leading to pulp necrosis and the formation of a fistula.
The suggested treatment plan included: 1) crown lengthening, 2) root canal treatment, and 3) extraction (if the first two options were not suitable, though the likelihood was low).

Recently, during a follow-up appointment, Dr.
B removed the restorative material from the gum tissue.
The findings revealed that there was only a thin portion of tooth remaining on one side and half a tooth on the other side, with the rest being hollow.
Dr.
B consulted with a prosthodontist who indicated that if a crown were to be placed, further reduction of the already thin remaining tooth structure would make it extremely fragile.
Even with a crown, the prognosis would not be favorable, and extraction was recommended.
I have the following questions:
1) Given the minimal remaining tooth structure above the gum and the presence of a fistula, is it generally true that even with crown lengthening, root canal treatment, or other interventions, placing a crown would be a tenuous option with a poor prognosis? Is extraction a relatively better treatment choice?
2) If the tooth is extracted, will the fistula or abscess heal?
3) Currently, the dentist has used a white temporary filling material to temporarily fill the tooth.
How long can this typically last?
Thank you, Doctor.

Tu Tu, 40~49 year old female. Ask Date: 2016/02/26

Dr. Huang Zhicheng reply Dentistry

Hello, the first molar may be at risk of decay due to its large pulp chamber and thin enamel, making it prone to fractures.
Based on your description, it is indeed difficult to preserve the tooth.
Placing a dental post may also lead to root fractures, and chewing could cause pain.
Extraction is a better option; once the tooth is removed, the source of infection will be eliminated, and the dental abscess will resolve.
Please be cautious with the temporary filling; it should not fall out for a few months! Wishing you safety and good health.
Sincerely, Dr.
Huang Chih-Cheng, Director of Dentistry, Taoyuan General Hospital, Ministry of Health and Welfare.

Reply Date: 2016/02/26

More Info

When it comes to dental issues, particularly with a tooth that has undergone extensive treatment and shows signs of complications, it’s essential to understand the potential treatment options and their implications. In your case, the right upper first molar (tooth #6) has a history of significant restoration and is now presenting with a periapical abscess, which indicates an infection at the root tip. The presence of a small bump on the gum, along with the heaviness you feel in the morning, suggests that there may be ongoing issues with the tooth.

1. Treatment Viability
Given the current condition of your tooth, where much of the structure is compromised, the prognosis for saving the tooth through procedures such as crown lengthening or root canal treatment followed by a crown is not favorable. The fact that the tooth has a periapical abscess and the remaining tooth structure is minimal indicates that even if you were to proceed with these treatments, the long-term success may be limited. The risk of further complications, including reinfection or fracture, is significant. Therefore, in many cases like yours, extraction is often considered the more prudent option.

2. Healing After Extraction
If extraction is performed, the periapical abscess and any associated fistula (the channel that may have formed due to the infection) can heal. The body has a remarkable ability to recover from infections, and once the source of the infection (the tooth) is removed, the surrounding tissues can begin to heal. However, it’s important to follow up with your dentist or oral surgeon to monitor the healing process and ensure that there are no complications.

3. Temporary Filling Material
Regarding the temporary filling material currently in place, these materials are designed to provide short-term protection and can typically last for a few weeks to a few months, depending on the specific product used and the conditions in your mouth. However, they are not meant for long-term use. It’s crucial to follow up with your dentist to discuss the next steps, especially if you are experiencing discomfort or if the temporary filling begins to break down.

Additional Considerations
If you are concerned about the financial implications of dental treatment, it’s worth discussing your situation with your dentist. Many dental offices offer payment plans or can refer you to community resources that provide dental care at reduced costs. Additionally, if you are considering extraction, ask about options for replacement, such as dentures, bridges, or implants, which can help restore function and aesthetics after tooth loss.

In conclusion, while it may be disappointing to consider extraction, in cases where the tooth is significantly compromised, it often leads to a better long-term outcome. Healing can occur after extraction, and addressing the infection will improve your overall oral health. Always communicate openly with your dental care provider about your concerns and treatment options to ensure that you make informed decisions about your dental health.

Similar Q&A

Affordable Dental Solutions for Long-Term Tooth Issues

Hello Dr. Tseng, I have the following question: My teeth have deteriorated due to lack of care, resulting in issues with all four corners of my molars, including missing teeth and root canals. After researching, I found that there are three options for reconstructing missing teet...

Dr. Zeng Guanghui reply Dentistry
Hello Jeff: If there are missing teeth or if a tooth has undergone root canal treatment, gaps in the dental arch can be filled using removable dentures, dental bridges, or dental implants. Removable dentures are more economical, but they do not provide as much biting force. They ...

Can My Tooth Be Saved? Exploring Options for Damaged Molars

I have a molar that underwent root canal treatment some time ago, and recently, while rinsing my mouth, a white layer of medication completely came off. When I showed it to the dentist, he said that the tooth could no longer be saved and didn't explain much, only mentioning ...

Dr. Huang Tingfang reply Dentistry
Dear Anonymous Miss, Hello! As mentioned, the tooth damage is quite severe! If the damage extends to the deeper parts (such as the tooth root), it may affect the surrounding bone, and extraction may be necessary; or if the tooth is mobile, extraction is also required! A thorough...

Facing Tooth Loss: Understanding Severe Cavities and Dental Solutions

Hello, yesterday I went to the dentist, and the doctor said that my molars are severely decayed and need to be extracted. Almost all of my back molars are in this condition, and I can't even get dentures! He also mentioned that the front teeth cannot withstand the chewing fo...

Dr. Wu Jinjun reply Dentistry
Hi! Don't worry, there are definitely options! Your situation may not be ideal, but it’s not as dire as that doctor suggested. Dental medicine has advanced significantly, and there are many new treatment methods available to help us preserve teeth or create suitable dentures...

Understanding Periodontal Disease Treatment: Expert Insights and Options

Five to six years ago, I underwent orthodontic treatment and had bone screws placed. This year, I was diagnosed with moderate to severe periodontal disease throughout my mouth, and there is a family history of periodontal disease. An X-ray of my lower right molar shows that the a...

Dr. Zeng Guanghui reply Dentistry
1. The treatment for periodontal disease primarily involves the thorough removal of dental plaque and calculus from the tooth roots and the surrounding periodontal pockets, with the aim of reducing the depth of these pockets. Traditionally, in addition to regular dental cleanings...