Dental Issue -- need advice

I have a problem with a molar. It has a crown. But there is a cavity under the crown invading the root area. No pain or any discomfort for me... yet. Dentist says we need to pull that tooth and a wisdom tooth. I can then see how that goes and consider an implant. He is referring me to an oral surgeon. Their office specializes in that stuff and has good reviews.

My question: I know one doesn't want to be on drugs for low bone density due to jaw necrosis issues. Not an issue for me. But I have a rising PSA. Next PSA in 3 months or so. If PSA rises, we do a Pylarify PSA scan possibly followed by HT and then SBRT. Is the aforementioned kind of dental work a bad idea given that scenario?

Oh, anybody have an implant? What's it like? Sounds involved, Is it worth it for just 1 tooth. 76 years old.

Mel

Post Edited (compiler) : 6/26/2022 7:30:03 PM (GMT-6)

I asked him about a root canal but he seemed to eschew that.
I am going to ask the oral surgeon about that, too.
Hope I get an honest answer.

Mel

Go see a Endodontists.... They specialize in root canals.

I'd also guess that if you pulled the two teeth, you could get away with Not doing the implant. The Endo or any dentist could advise on that... Leaving a space between teeth is what you want to avoid... Chewing meat and other stuff would become difficult and you'd end of chewing on the other side all the time.

My wife had an implant of a tooth that could not be saved about 7 years ago. In all it took about 9 months and several thousands to complete. She is very pleased with it.

Mel - This definitely calls for a second opinion. Probably best to see an endodontist for this, as these are the dentists who specialize in root canals and similar treatments. While the extraction with implant and crown may be the elegant solution, it is far from fast and is very costly. My wife has had a couple of these, and it cost thousands for the implant and more thousands for the crown each time. Great, if you can afford it, but took months to complete all the steps.

An option to bring up with a competent endodontist is the possibility of drilling out an access "port" in the chewing surface of the crown and performing the root canal through this opening. Then, once the root canal is complete and has proven to be stable, just place a filling in the new hole drilled into the crown. I've had this done, and it has been in place for a number of years in this state.

Dentists are like all other doctors. They like to do what they like to do, and that may not always be your preference.

I have spent a lot of time (and money) in various dental offices. Several root canals, many crowns, one implant and one bridge by now.
I recommend you discuss Paxton's approach with an expert endodontist to see if the tooth can be saved.

Speaking from a guy who last say a dentist 20 years ago, but still has 32 teeth, I'd either ignore the tooth if it's not hurting, or just get the tooth removed.

At present I have four implants, where a decade ago I did not have any. Most of the saga of having all but eight of my teeth root canalled, recrowned, or implanted (at a total cost of approx $75K) occurred during the same time period during which I learned about and endured treatments for my prostate cancer.

As I often get carried away and tell too much of my story in my posts, I will simply cut to the nitty gritty and say that I'd had oral surgery and started an antibiotic (Amoxicillin) the same week in which I started eight weeks of adjuvant radiation. I mentioned it to the radiation nurse but nobody said anything about it.

The following week (week two of ART) I developed severe diarrhea which persisted throughout my radiation treatment. Six months later I had a colonoscopy and was Dx'd with radiation colitis, which I understand to be a step above the more common radiation proctitis. Some say it was caused by the antibiotic. It would have been nice if someone had informed me about that being a possibility. Typical of my entire PCa journey... nobody ever told me anything about nothin'.

Reading the other comments above, I could go on at length about most of what everybody else has mentioned... root canals, "end teeth" (molars), bridges, wisdom teeth. I've been thru it all. In each case, my dental professionals strongly urged me to preserve my natural teeth. As I see others my age struggle with dentures, I can appreciate that sage advice. Dentures aren't cheap either. The implants create an issue wherein they stay put while your other teeth slowly move around (generally migrate forward). It's not a panacea, but thankfully my teeth don't come out at night.

I needed a root canal two years ago because of bad pain when chewing. Had it done as urgent care at the VA at the height of COVID (before there were vaccines). I had an endodontist and a dentist working together. They did the root canal right through the crown and then patched the crown. May not be the same thing for you depending on how bad the tooth is underneath.

And as (bad) luck would have it, I had a crown come off today and will be calling tomorrow for an appointment. I suspect that tooth is a goner because it had a root canal and crown in the mid-90s and then had the crown replaced a dozen years later. I'm expecting to hear there is nothing left to attach a crown to. If so I'll just go with the missing tooth - next to last on upper side, right next to wisdom tooth. I can get along without it.

When I was considering whether or not to start Prolia, my oral surgeon said that he will NOT work on anyone who has been on Prolia or any bisphosphonates.

Bohemond -- If that tooth of yours is gradually deteriorating, there may be another approach for it as well. Ask the dentist if the root(s) are strong but the main, exposed part of the tooth is failing. If so, ask the dentist if they can "simply" drill into the root(s) of the tooth and glue in what they call a "post and core." This may also be just a metal pin. Sometimes they are screwed into the root, sometimes just cemented into it. Once the post is in place, the dentist can glue a crown (maybe even your original one) over the exposed part of the post. The whole assembly is held in by your natural tooth roots, but instead of a tooth with a crown, you have a post cemented into the root and a crown cemented onto the post.

These may not last forever, but it may give you some more years before you have to go without a tooth in that spot. When I had one done this way, it lasted nearly 10 years. Eventually it lost enough bone support that we extracted it and I got a partial plate to include that tooth and others already in need of replacement.

Here's my 2cents and I happen to be not only a member of the club but also a dentist. Go to a dentist you trust and let him or her make the decision about antibiotics. It's very unlikely that a person would pick up C. Diff from a dental procedure. Antibiotics are not innocuous. They can cause serious gut issues. In fact antibiotics can contribute to serious bacterial resistance. It's fine to bring up the subject of antibiotics with your treating dentist, but let them decide what the best course of action is without undue pressure.

Compiler,
I'm currently going through a similar challenge. Two weeks ago, I started having pain in an upper right molar that currently has an old crown, but hasn't had a root canal. Prior to this tooth acting up, my dentist and I had agreed to replace the old crown about 6 - 8 weeks after I had completed my radiation treatment (which ended two weeks ago). Right now, I'm on a 9 day treatment of amoxacillin and have a root canal consult scheduled for this coming Friday. The plan is for the root canal to be done through the old crown, then replace the old crown. I've had a couple root canals through crowns and they worked just fine. There is always the risk of the crown breaking while being drilled through. But, from what I understand, the new drill bits and drills reduce the risk of the crown breaking. It's still a risk. I'll let you know how the consult goes this coming Friday. Oh yeah, I've been on Lupron for about 7 months now and I take 500 mgs of calcium each day.