Dental implant (££££) vs. single tooth denture

Cloudane

I asked during a similar dilemma just before covid, but it's come up again and I'm thinking again.

I'm 39.  When I was about 16 I fell off my bike and broke both front teeth and one of the small neighbouring teeth.  Got given root canals as the teeth had died, and some sort of "build up" stuff to make the teeth look whole (which soon snapped off) and sent on my merry way.  Can't remember why crowns weren't put on but I think it was that it would've been excluded from the coverage as a child as it was deemed only cosmetic for those teeth so it would've incurred a cost, and my parents weren't able to fork out for them.  Basic dentistry was free for me at the time.

To be honest, I left them as they were until 2014 (so I was 32) as I didn't think my teeth looked TOO bad or worth the £600 per crown cost, but being still single and wanting to maybe work on that I decided I'd better get the crowns done and stumped up the £1200 thinking it was a great investment and I'd be set for 30+ years.  One of them has always had quite a wide margin at the back and I have a feeling that's where things have started going wrong.  But anyway.

Fast forward to 2020 just before the pandemic.  Went in for routine checkup with new dentist (same practice, previous dentist had retired), I commented that the gum around that tooth tends to flare up a lot with a little bit of bleeding.  Xray taken, she wonders how the tooth is even hanging in there as there are huge shadows suggesting there's barely anything left under the crown.  I get told it's a goner, told about implants, my wallet starts crying, and I run away from there very fast.

Follow up call a few days later, the head dentist wants to see me.  They found my old x-rays going back several years and noted that the shadows have always been there and if they take the x-ray at a different angle then it looks okay.  So I was told "let's leave it as it is" and breathed a massive sigh of relief.


Fast forward to 2 weeks ago. Biting into a sandwich feels tricky.  Not painful, but like my left front tooth is weak and will snap if I bite too hard.  Then a few days later the gum over it starts to get a bit puffy.  Then about a week ago little bump appeared (not far up from the crown) and has been flaring up and dying down repeatedly, sometimes a bit of pus comes out.  The dentist called it a chronic something when speaking in code to her assistant. It's generally worse in the morning and almost gone at night.  Went in today, because if it's an abscess then it needs seeing to of course. 

As I fully expected, she took another x-ray, said the shadows do seem to be closing in and well this just proves her right back in 2020.  There's nothing more that can be done to save the tooth, and so here are my options.

1) Do nothing.  The 'pimple' will probably always be there on my gum.  The risk is that eventually it gets properly infected and I get the swelling and pain, and then if I don't get seen to asap then systemic infection and beyond.  A big risk is if I become ill and the infection flares up in an immunocompromised state.

2) Extract and get a single tooth denture.  It'll feel a bit odd and have to be taken out at night. ~£300.  If I don't get on with it after 3 months then they can try a bridge, but warn that at around £900 it's a big gamble given the two neighbouring teeth that would be used to support it are the other ones that got killed on that fateful day in c1998 and I risk being up to 3 teeth down. The other front tooth would need a change of crown and they may well find problems anyway when they remove it.  So a bridge is an option but not a wise one.

3) Get referred for an implant.  £2.5k-3k!!!!!!! (YIKES)

4) Extract and leave a gap.  No thanks, the Jimmy Tarbuck look isn't for me, that's a flat no go.  I like to think I'm not too bad looking and would like to keep that confidence.

I need to make a decision soon.  I've left to have a little think for now and will calll them with a decision next week but meanwhile remain with an infected but painless tooth that ideally needs to come out sooner rather than later.
I hoped maybe I could go the denture route and get an implant after a few months if I don't like it, but was told this isn't an option.  For the implant I'd have to be referred straight away and the tooth left in place, so I'd be on the railroad.  Or if I opt for the denture then that's also a railroad - the tooth comes out, the bone starts to shrink and the implant is no longer an option.  She said something about it maybe being doable with a bone graft if I delayed, but I didn't dare ask what that would cost and when I kept pushing "so If I go the denture route that's it?  It's bridge or nothing if I don't like it, I can't try it and choose an implant later?" it was a pretty flat no.

So... a decision that will affect the rest of my life, is irreversible, and needs to be made soon.

£3k is a ridiculous amount of money.  I don't have a very high paying job, I have some savings so it's doable, but that's a rather large percentage of them.  I get that it's something that would theoretically last a lifetime (though I'd be mightily peeved if for some reason it only lasted as long as the crown did) and is less hassle, but I may eventually face the same dilemma with the other two dead teeth, and it's really difficult to convince myself to pay out that kind of money.

But a denture?  How bad are they, do people live with them and find them alright like the dentist was trying to reassure me when I winced at the implant costs and gravitated towards a denture, or are they actually horrifying?  I know that once I've picked that route, it's set in stone and I'll have to mess with it for the rest of my life.  Thing is "the rest of my life" is (hopefully) a long time, I'm "only" 39.  I suppose a big part of the question for me is not just the sensory side (my tongue has always been "bothered" by the gap behind the crown, and I remember when I had braces I kept subconsciously popping them in and out) but also how much I'd be judged for it.  If I do like, sleep with people on occasion, the embarrassment of "right I have to take my denture out now" like an old man, would that put them off me?   Do you have to dump it in a glass of water too?  Gross...  Or, perhaps, is it more attractive to be sensible with your money :S
But, it's £300 vs £3000.  If it was say £1500 I could probably grudgingly justify it, but 3k is really hard.

I think I know the answer as I've seen before people cherfully saying they paid £17k upwards for a set of implants and are generally better off than I'd expect from a money saving site, but what would people here do, any thoughts?  Don't think I fancy going to Poland - that's a long way to go back if it goes wrong.

Toothsmith

That's a real essay!!!

Some brief points : - 

Teeth that are badly damaged when you're young do tend to have a very poor prognosis and are often lost young as well. So I would have been very surprised if a dentist had actually told you that crowns on them would last you 30+ years, as 10 - 12 years is average, and on teeth root filled as a 16 yr old, I wouldn't be making many promises at all.

Implants - yes, at the front giving implants good aesthetics with how they come out of your gum is really hard, and the best way to get the best result would be to have them done pretty much as soon as the tooth is taken out. I have sent people for front tooth implants when it has been some time since the tooth has been taken out, and the result has been good, as there has still been lots of bone in the area to work with. No-one could guarantee this for you though if you tried living with a denture for a few years. Bone does start disappearing as soon as the tooth is extracted, and no one can predict how quickly this will happen in an individual patient

Bone can be replaced with various surgical techniques or replacement products if you decide to wait - but these procedures will add to the cost, and their outcomes are not as predictable as getting an implant pretty much as soon as the tooth is extracted.

From what you've written, it sounds like you've had things explained to you pretty well by the dentists who are looking after you. Implants are expensive, but they are a predictable and generally long lasting way to replace teeth. It will be the nearest way to get something back that both looks and feels like a natural tooth. Their survival times if done well, looked after properly (and don't suffer accidental damage!) are good - 95% still there 15 yrs later - but dentistry will not last a lifetime like healthy undamaged teeth can, so you will have to accept that at 39, you may have to consider some sort of replacement within your lifetime

Dentures - Simple, much cheaper, and many people have been perfectly happy with them for very many years. They will wear out every few years and need replacing, They are still a perfectly good way to replace a missing tooth for those on a budget.

Cloudane

Thanks for the input!  The dentist who did the crowns (about 7 years ago) is retired now which is a shame as I have some questions (not necessarily accusations but wouldn't mind some answers) like why he suggested (didn't promise as such) that if looked after properly they could last 30 years or so, and why he never told me the tooth is very clearly failing on the X-rays (as I mentioned, the lead dentist looked back at the historic ones and it looked like this in 2014 too - but the new one picked up on it immediately and said it has to come out). 

Still soliciting opinions, quite a few people are saying that if you can afford it (technically I can it's just a huge outlay, it's almost a car upgrade, and it's a few months pay) then do the implant. I suppose part of the issue to consider is £300 every 3-5 years for a new denture will eventually add up, though I don't expect to necessarily live another 50 years (or care at that age) but also if prices increase and there are consultation costs to go with it. 

Quite the dilemma. Another suggestion I'm getting a lot is visiting Turkey or Poland, but I'd want to know more about the success rate as that's a long way to go back if things go wrong. (Just realised I made that point in the OP essay)

Also, if the crowned tooth next to it is not expected to last long, I have to consider that the costs will add up to £6000 which is crazy to think about, I mean that's what I paid for my car and would rule out upgrading that for a long time. (Not really a luxury thing, I'm trying to stay electric and the current one is barely usable now due to obsolete charging method)

sheilavw

my front crowns are 29 years old. I had dental work done in Fethiye Turkey, a bridge 15 years ago, its been fine. My dentist here was impressed with the work. I am having one of my front crowns replaced in December. The metal work is coming through. I can feel it with my tongue. I thought that what I could feel was the bridge anchored to it! The NHS dentist at my practice is not confident at doing it. She called it something like a core and post? My two front teeth are crowned, were done at the same time but only one has this type of  post? I was referred to a private dentist in the same practice and he said there is only a minimal risk and he feels confident to do it. I am paying for a porcelain one

welshdent

Perhaps ask if they think a referral to an endodontist may be worthwhile? That could be a fourth option.  There may be scope to re do the root treatments or carry out a surgical procedure to the ends of the roots.

Cloudane

thanks all, well almost 2 weeks ago I said "okay go ahead and refer me to the implantologist".  Choice of a local one with a £130 initial consultation or one further afield with a £75 initial consultation, I asked for the local one and am hoping their other prices aren't also almost double. 

Not heard a thing since though. And I've been procrastinating chasing it up as I'm not in pain but rather am nervous (about the situation and about chasing things up in general)

Its not swollen up or anything and is still just a pimple on the gum but the tooth is now starting to feel a bit more loose, if I wiggle at it in the mirror I can see it shifting.. not much, a fraction of a mm, but can see it anyway and if I try to bite with it it can end up throbbing for an hour.  So this is making me nervous that it's just getting worse (might just fall out?) and potentially losing jaw bone etc while I sit here waiting for a referral (which in itself will probably be in x weeks...)

I feel quite "alone" in it all to be honest. Much preferred being a kid and just being looked after and told "this is what's best for you, this is what's happening and when".  But that's a whole other tangent about the way I am mentally..
(also doesn't help that I don't feel cared about at all by my dentist, and I know they can't be expected to actually care that much but it's nice when they at least put up the pretence, look a bit sympathetic, reassure you etc)

twiglet98

I have no practical advice but I just wanted to say I truly sympathise, and I hope you are ultimately happy with the decision you've made. It's so frightening that dental care has become a luxury for the rich.  I wish I'd been able to afford insurance for it when I was working full time, and not assumed the NHS would be enough.

I've been in limbo since 2012 with a very similar problem - a shifted veneer, next to a yellowed root-canal filled tooth, next to one which lost its large filling, next to a hideous gold crown one tooth from the back... I also have the pimple on the gum which sometimes swells slightly, and with pressure pops out a tiny amount of pus... I can move it fractionally with my fingers but not with my tongue, it doesn't hurt BUT the whole quadrant looks awful.  I love being able to hide it behind a mask!  I'm 65 and will never have the funds to get it sorted.  The dental practice I'd attended regularly until 2010 proposed extracting the bad tooth and making a denture as the cost of an implant was out of reach, but as they couldn't provide sedation unless it was done privately, I never went back.  Tooth pain can tip you over the edge, and I cannot understand why NHS funding for dental work has been so cruelly slashed - I too would have to choose between my car and my teeth, so I understand your dilemma (though mine's an old diesel model...).

Good luck.  Keep us posted.

gozaimasu

Hope you don't mind me hijacking your thread, but I have a question for @Toothsmith

I had a crown in 2011 which fell out in 2013. Surely it should have lasted longer than that? Should I have reported the dentist to the General Dental Council for shoddy work? I wasn't eating toffees every day or anything like that. Fell out when I was eating a curry

I rang round a bunch of dentists to see how much they would charge to put it back in, but they said "nope 2 year NHS waiting list". Apparently a tooth or crown falling out isn't urgent enough to be seen before 2 years.

I subsequently lost the crown so I gave up and haven't been to the dentist in 10 years.

I'm at a point now where I think it's time to go back to a dentist, and sadly, it will probably be a private one. I can sign up to dental insurance through a work scheme and hopefully pick a programme that will reimburse 100% of private charges.

I would also like to get a copy of my dental records from the shoddy 2011 dentist - is this easy enough? The dental practice is in the same building, but there is a new dentist who took over in 2018.

brook2jack2

A tooth that needs a crown is one that is very badly damaged in the first place. If you do not change what caused the damage the crown fail very quickly as eg decay can still eat away at the tooth , or grinding /clenching can break what's left of the tooth under the crown , or even because a crown is a last ditch effort to save a very badly broken down tooth there just may not be enough good enough tooth underneath for the crown to survive. 

A dentist only has to keep an adults records for no more than 10 years so it is unlikely that the practice will still have them , they have most probably been destroyed. 

It is very unlikely you will find a scheme that will refund 100% of charges, particularly if you need treatment. Most will have a cap on yearly expenditure and schemes such as Denplan require you to be dentally fit before you join. 

Toothsmith

In addition to Brook's post there is also a time limit for claims. 

I think it's 6 yrs after becoming aware of the problem. So if it's work that seems OK, but a few years later, an X-ray shows something to have been done badly - then you have 6 yrs from that date to decide if you want to start action.

In your case, the day the crown fell off would be the day you were aware there was a problem with it - so just doing nothing for the next 8 years means you're not going to be able to launch any sort of claim even if records can be found.

After 10 years of non-attendance, it would be really hard showing anything was the fault of a dentist over and above your own neglect.

gozaimasu

brook2jack2 said:

A dentist only has to keep an adults records for no more than 10 years so it is unlikely that the practice will still have them , they have most probably been destroyed.

Well I contacted them and they still appear to have my records over 10 years later, minus the x-rays which were allegedly lost during a "viral attack" on their computer systems. Do I now have grounds to report them to the ICO for storing my data for longer than is necessary? I will of course be making a request for them to delete all of the data they hold as soon as I obtain a copy. If someone could point me to the thing which says "10 years" so that I have an official source to quote when I make the complaint. Thanks.