Dental question

[Tap]

I have a lot of repair work in my mouth, including several caps. I had a dentist 18 years ago who I think did a lot of repair work that may or may not have been necessary. I had good insurance and I think he took advantage of that.

 

 

I had a different dentist for the past 10 years, who is a 'don't fix what ain't broke' type person. He doesn't take my insurance anymore so I had to change doctors. I saw him a year ago and had a cleaning/exam. Everything was just fine.

 

I found an office and asked who isn't an 'over filler', this doctor was recommended by two different people on different days. I want a doctor who does needed work, not filling every dark spot they see.

 

New dentist and he wants to do a lot of new work. I am wondering how to figure out who is right. I understand things can change in a year, but I don't know how to figure out who is right on some major repair work.

 

~~New dentist wants to fix 3 old fillings in my upper front teeth (prob 18 years old) that are 'leaking' (there is some darkness just starting to show up around them). He says that at least one, but possibly all, may need to be capped once he gets in there and sees what repair work needs to be done.

 

~~I have one cap on a molar that broke after it was in for a year. The corner chipped off. My old dentist from the past 10 years. polished it up and said that since it didn't impact my bite, and since the chip was only in the cosmetic part of the cap, not worry about fixing unless a problem came up. The new dentist says, it already chipped, it is damaged, fix it now before it becomes a problem.

 

~~ I have a tooth that has several fillings in it on different surfaces. Old dentist says, it is strong and healthy (no gum disease around it), no pain or issues, so leave it be. It has been this way for 5+ years. He is the one who put the last filling in and at the time he said to try a filling first, and if it didn't stick, then we could cap it. His opinion is that a natural tooth with fillings is better than a cap. New dentist says, it will eventually crack due to previous repairs so fix it now before it cracks and leaves me in pain.

 

I have no problem saying "no thanks" and holding my ground but I don't know what I should do. Each cap will cost under $350 each (total with dentist fees, cap fee) so while it isn't cheap to fix them, it isn't really a overwhelming financial issue for us either (we have it in savings).

 

 

WWYD?

[dancer67]

After several years of dental work due to a huge fear of dentists, the one piece of advice I can offer you. Small problem=small fix=less money now. Eventually, those teeth WILL get worse over time.

I have a tooth that has several fillings in it on different surfaces. Old dentist says, it is strong and healthy (no gum disease around it), no pain or issues, so leave it be. It has been this way for 5+ years. He is the one who put the last filling in and at the time he said to try a filling first, and if it didn't stick, then we could cap it. His opinion is that a natural tooth with fillings is better than a cap. New dentist says, it will eventually crack due to previous repairs so fix it now before it cracks and leaves me in pain.

ITA with the dentist here. When teeth have large fillings, the tooth is weak. Large fillings should ONLY be used as a temporary measure until a crown can be placed. Ask me how I know.It is untrue that a natural tooth with large or many fillings is better then a cap. I had a tooth like this for 7 years. It finally broke and I ended up with a root canal AND a crown. And I do not have any dental insurance, so even if I feel a small hole or something isn't right, I see the dentist to get it fixed ASAP. Good luck to you.

[theYoungerMrsWarde]

I showed this to dh who is a registered dental assistant (6.5 years of experience.) This is his response (Please don't sue us. ;)):

 

I'm used to looking at x-rays and photos as a basis for advice but I don't have that luxury here, so I will try to give you some advice so you can make an informed decision on your own.

 

The broken crown is probably something that can be ignored for awhile, assuming more porcelain doesn't chip off. If it does, as long as it doesn't open up a space between the teeth where food can get trapped, It's (relatively) stable. That's probably one of the last things to fix, but should be done at some point.

 

The fillings around the front teeth are probably discoloring because of leakage around the edge, which is to be expected with most composite fillings(especially ones that old.) If they have been in for 18 years, and there are no fractures, keep them clean and you could probably get more life out of them.

 

As for the molars, the old dentist was probably trying to do you a favor by placing a filling instead of a crown. It sounds like (from what you said he told you) he was not 100% sure if a filling would hold up long term, but he was confident it would last a few years at least. I know from working with many doctors that with an ambiguous diagnosis like that, they would probably be pleased that it held up as long as it has. Five years can be a long time in dental land depending on the situation, especially since a lot of them will only guarantee their work for a year or so(If you stop being their patient that is.)

 

As a general rule, what they teach in dental school is that if fillings take up more than 1/3 of the tooth, it should be a crown. Silver(amalgam) fillings that are that big can cause fractures over time that could become a big problem. Large composite fillings can leak over time and don't provide a great deal of support to the tooth. I have seen way too many of these guys break off, some end up needing root canals, some don't, but it's still a gamble. Molars take a lot of force and fillings are meant to fill a hole, not hold teeth together. Honestly, $350 isn't that expensive in terms of what a lot of doctors charge, but a root canal will probably double or triple that easily. If I was looking a a picture of it right now, and there were no fractures and no discoloration around the edge of the fillings, I would feel better about risking it. Just keep in mind that multiple fillings on multiple surfaces WILL eventually need to be taken care of, and a lack of discomfort is not a reliable indicator that there isn't a problem.

 

Hope this helps, good luck.

[Tap]

I showed this to dh who is a registered dental assistant (6.5 years of experience.) This is his response (Please don't sue us. ;)):

 

I'm used to looking at x-rays and photos as a basis for advice but I don't have that luxury here, so I will try to give you some advice so you can make an informed decision on your own.

 

The broken crown is probably something that can be ignored for awhile, assuming more porcelain doesn't chip off. If it does, as long as it doesn't open up a space between the teeth where food can get trapped, It's (relatively) stable. That's probably one of the last things to fix, but should be done at some point.

 

The fillings around the front teeth are probably discoloring because of leakage around the edge, which is to be expected with most composite fillings(especially ones that old.) If they have been in for 18 years, and there are no fractures, keep them clean and you could probably get more life out of them.

 

As for the molars, the old dentist was probably trying to do you a favor by placing a filling instead of a crown. It sounds like (from what you said he told you) he was not 100% sure if a filling would hold up long term, but he was confident it would last a few years at least. I know from working with many doctors that with an ambiguous diagnosis like that, they would probably be pleased that it held up as long as it has. Five years can be a long time in dental land depending on the situation, especially since a lot of them will only guarantee their work for a year or so(If you stop being their patient that is.)

 

As a general rule, what they teach in dental school is that if fillings take up more than 1/3 of the tooth, it should be a crown. Silver(amalgam) fillings that are that big can cause fractures over time that could become a big problem. Large composite fillings can leak over time and don't provide a great deal of support to the tooth. I have seen way too many of these guys break off, some end up needing root canals, some don't, but it's still a gamble. Molars take a lot of force and fillings are meant to fill a hole, not hold teeth together. Honestly, $350 isn't that expensive in terms of what a lot of doctors charge, but a root canal will probably double or triple that easily. If I was looking a a picture of it right now, and there were no fractures and no discoloration around the edge of the fillings, I would feel better about risking it. Just keep in mind that multiple fillings on multiple surfaces WILL eventually need to be taken care of, and a lack of discomfort is not a reliable indicator that there isn't a problem.

 

Hope this helps, good luck.

 

 

Thank you so much! I really appreciate the advice (I promise not to sue LOL).

 

This was almost exactly what this dentist said, so that makes me feel more confident in his assesment. It is so hard making changes of medical providers, especially when I think I was over filled at one time. His order of prefered repair was: front teeth first, filled molar to crown next, crown redo last. (obviously he has the benefit of xrays and exam to lead him). I have a cleaning scheduled with the office in a few weeks and then I will start scheduling the work. I have pretty good insurance right now, so I guess it would be a good time to get it all taken care of.

 

Thanks to you hubby! Have a great Sunday,

~~Tap