Problem with teeth - options available?

linlin_3

I had my first abscess over 30 yrs ago - the tooth was capped and it's now looking terrible. As it's at the front I'd really like to know what options are available. I've had about 25 abscesses in total and have had all my upper molars extracted - I still get twinges of pain where these teeth were. The next-to-the front capped tooth is bridged. Despite regular checkups, dental work, brushing regularly, my dental heath is very bad. My current dentist will not replace my cap as he feels the bone loss in the jaw is too far gone. The bone loss could be explained by osteoporosis which was diagnosed in 2003. I was prescribed Fossamax but could not tolerate it - perhaps because I'd been taking long-term anti-inflammatories (prescribed for TMJ) which conflict with Fossamax. I had an operation to remove a tumour on my parathyroid glands in 2004 and was told my bone density would improve within 1-2 yrs. A recent scan revealed minimal improvement, so I wonder if there's some other reason for the bone loss - that's under investigation.
Back to the teeth.......given that I have advanced bone loss in the jaw, I doubt implants could be an option. Is there anything else I could consider?

Toothsmith

Are you taking anything for osteoporosis at the moment?

If you are taking tablets in the Bisphosphonate group of medicines, then your dentist must refer you to hospital if you have any teeth taken out, as there is a significant risk of bone necrosis after extraction in patients taking these tablets.

Do you have replacement teeth for your back molars? If you're not wearing a denture to repleace these, that would probably explain an awful lot of the TMJ problem, and the extra pressure on your front teeth could easily be contributing to the bone loss.

Other than that, I can't say too much - your condition obviously has a lot to do with your medical condition, and needs much more information than you could describe.

It could easily be that your best option would be a decent set of dentures.

linlin_3

Thanks Toothsmith

No I'm not on medication for osteoporosis at the moment apart from regular calcium. I have a denture for the lost upper molars, but can't stand to wear it. TMJ was diagnosed - I felt strongly it was a case of hanging a label on symptoms which they couldn't otherwise ascibe - after a number of extractions turned out not to be abscess related, although with immediate loss of pain.

My objective is to find an alternative to dentures.

Toothsmith

linlin wrote: »

Thanks Toothsmith

No I'm not on medication for osteoporosis at the moment apart from regular calcium. I have a denture for the lost upper molars, but can't stand to wear it. TMJ was diagnosed - I felt strongly it was a case of hanging a label on symptoms which they couldn't otherwise ascibe - after a number of extractions turned out not to be abscess related, although with immediate loss of pain.

My objective is to find an alternative to dentures.

Implants are the alternative, but as you are rightly aware, success here depends on bone volume AND quality.

If it was just a lack of bone, then a bone graft frrom another part of your body would build it up - but if that bone is of poor quality, then the implant(s) would be doomed to failure.

It would be worth getting checked out, but don't get your hopes up too much. If dentists say they won't do it - don't keep looking until you find one who will. You'll be setting yourself up for a very expensive failure, and then you'd probably be left with less bone to support a conventional denture.

Sometimes, there just isn't an alternative.

Toothsmith

ts_aly2000 wrote: »

Hi Toothsmith, may I ask a question please?

OK, well, my 2nd from back lower to visual inspection is perfect, no decay, no fillings. Yet, on the x-ray, it is showing up as black from the bone below the gum line almost right up into the tooth. It has my dentist quite stumped as to what to do with it. He says that it *should* have collapsed already yet to visual inspection looks perfect. He even had someone else come and look at it there and then to show them.

The issue mainly is that my last dentist of several years never took ANY x-rays whatsoever. He was a get-em-in, get-em-out, wait for 2-hours man. So the early stages of this were never spotted.

My current man took another x-ray of the same tooth and was thrown again, as it now looks not as bad as he first thought. But the problem being that the decay is below the gumline and under the tooth.

Not entirely sure what I'm asking here, as I'm more worried that anything else that I'll lose it. It's more of a fear leading on from the previous dentist doing things as cheaply as possible. My current man is going to discuss it with his partner as to what to do since technically I should be in igony (touch wood) by the looks of the x-ray.

Help!! What's your reaction? Have you seen this before? What was the outcome?

Bit hard without seeing just what you're talking about.

Decay below the gumline is a pig of a thing to treat, and I can understand why your dentist doesn't want to go delving about down there for no 'good' reason. He doesn't want to take you from a situation where you have no problems, to a situation where you have lots of problems just because he's done the 'right' thing.

It seems that he's doing all the right things. He's getting other opinions, he's keeping you fully informed and he's not diving in just for the sake of it.

What to do has to be a decision you make between you given the problems it might cause over the non-existant problems you are having from it at the moment.

It may well only be when the tooth is out of your mouth that anybody will know for sure exactly what was going on!

One other possibility is an external resorption of the tooth. This is where the body just decides to 'eat' the tooth away. I've seen it on one tooth in a patient of mine - it's really very rare, but it happens. That will almost certainly result in the loss of the tooth, but it's not something that 'spreads' to others.

Can look a bit like decay on an x-ray.

linlin_3

Thanks Toothsmith. Not really the answer I wanted, but your honesty is appreciated.
I've heard of a false gum - which is a shaped piece of plastic/rubber/whatever the wearer uses to disguise being a bit long in the tooth. I think it's a stick-on/peel off, which improves the overall appearance of a smile. Have you heard of that? Does it have a proper name? I wonder about having one until I have to face the reality of dentures.