Replacement for front tooth

uberalles

Good morning,

Just wondering if the dentists on here could perhaps comment.

I'm fairly new to this area and just had to sign up with a new dentist. Yesterday morning I found myself toothless and the dentist kindly temporarily sorted me out.

Aged 9 I went over the handles of my bike and landed on my face , with one of the main, upper, front tooth cracked in half. The dentist killed the root and capped it.

Over the course of 39 years that half of tooth has totally worn away and about 10 years ago the cap was replaced by a false tooth with a post that got pushed into the root/jaw and cemented.

Over the past year that tooth has fallen out twice, most recently yesterday , and I have asked for solutions.

The first thing the dentist offered yesterday was either a denture (I said that was not for me) or a bridge. He quoted £250'ish for either. I said I would have a bridge as long as it gave me the option of in the future, if I decided to, that I can have an implant. He said it would give me that option although his practice does not do implants.

He tried to re-seat the tooth with the post but said it would not fully re-seat and he called in a colleague. They discussed between them that the remaining root had fractured and caused an obstacle to re-seating.

Final discussions concluded that I would have to have a denture fitted next Monday, they took a cast of my upper set. At the same time they would totally drill out the root completely. They stated the denture would need to be worn for 3 months to give the gum line time to settle then I can decide what I wanted next. I again made it clear I wanted a bridge.

They re-seated my tooth, with the post, and I left.

My questions are these:-

• Do I really need 3 months of the dentures, I mean is this standard? Does the gum line need this time?
• Am I going to be charged for two lots of treatment, eg 2 * £250'ish? I mean once for the denture then once for the bridge? Even though I made it clear the bridge is my goal?

I can and will pay 2 * £250 as long as this is a standard expectation. My thoughts are that I was quoted 1 * £250 when I opted for a bridge. I've a feeling, maybe incorrectly, that I am going to be asked for 2 payments. I want to be in a position to fully discuss next Monday. I'm more concerned about wearing the denture for 3 months.

To note, they did talk to me a lot although with your mouth open and full of a dentist's fingers it was fairly hard to digest all that was being said.

Much obliged.

welshdent

Just a quick response as on my phone but yes to both. I actually err more towards 6 months than 3 but that's just a personal thing. 3 I would say is the minimum. If you have any tooth extracted the bone that held it will shrink greatly over the following 3 to 6 'months. If you have an immediate bridge you can get spacing beneath it. Replacing a denture for a bridge is easy. Replacing a bridge for another is not to easy and can damage the retaining teeth. It is 2 lots of fees because you need 2 lots of treatment

Toothsmith

Yes - it all sounds sensible and above board.

It sounds like these are NHS treatment plans? In which case although it's sorting out the 'same' problem, because of the necessary wait between stages, it will count as 2 courses of treatment - so 2 charges as you describe.

It also sounds like they're doing a stick-on Maryland type bridge, which is a good way to do it if you're considering an implant in future.

If you are though - the sooner you do it the better.

The reason you have to wait 3 months (I often advise longer too - but it is often a compromise between the patient wanting to be denture free, and the absolute idea healing to have taken place!) is because the bone level changes and shrinks back once the tooth is removed. The more it shrinks back - the harder it will be for the implant providing dentist to get a nice gum level that matches the teeth around it.

For patients that really don't want a denture, I often provide a 'temporary' Maryland bridge. I make sure that patients realise this is temporary though, and that a replacement may be necessary once the bone has shrunk back if the gum level has shrunk away below the false tooth making it look like the tooth is 'floating' in thin air! Occasionally though, the shrinkage hasn't been that much, or a low lip line means that even if it does, then it doesn't actually show in social situations, and the patient is happy to keep the 'temporary' one as a more permanent solution.

I don't operate within the NHS though, and so patients pay for the option they want, rather being constrained by what the practice can provide for the funding they get. I know it seems like £250ish is a lot - but that's the patient charge for a Band 3 treatment - and it really isn't when everything has to be taken out of it (Remember that is covering the examination you've had, the x-rays, and all the treatment planning and investigations as well as taking that tooth out)

There are many NHS practices that would have told you that a denture WAS the NHS option, and anything else was private. So you have a good one there.

uberalles

Welshdent and Toothsmith.

Thank you both very much for taking the time and putting my mind to rest, it is appreciated .

It is NHS charging.

I do really appreciate the work the dentist has to undertake and to be fair the £500 in total is not a lot to pay to save what I see as my embarrassment, an ugly tiny piece of decayed tooth , otherwise nothing.

Thank you for explaining how the gum shrinks and therefore the reason for the delay.

I was thinking how long I was in the chair yesterday, something that last time took 2 minutes , the dentist was caring and kind enough to see me for 30 minutes or so.

As Toothsmith says, I think I have a good one, he was very descriptive and kind. However the finance bits were rushed over somewhat after his colleague joined him, that put my mind in overdrive.

Thanks again. looking forwards to having not to having to worry over it.

MichaelViscione

Thanks for share your dental opinion ..