ASK THE DENTIST

Recent questions from readers answered.

Mary D:  I was recently told by a dentist that I need a root canal, a post, periodontal crown lengthening surgery and a crown. The total cost of treatment is $4500! Do I have any alternatives?

That is a difficult question to answer without seeing the specific case, but here are some thoughts. There are quite a few things to consider. The first is the general condition of the teeth. If you have numerous other dental problems that need to be addressed, you must prioritize these and decide if the cost of doing them all is something you can afford. The last thing you want to do is spend $4500 on one tooth and then be out of funds to address the other problems. This could lead to more serious problems in the future.

Let’s assume that this is the only tooth that needs to be addressed. I would look at your past history of dental problems. If you have had limited problems with a low rate of dental decay in general, this treatment may be the best option. If you have had a problem with dental decay, the best alternative may be to extract the tooth and do a dental implant. The cost of the treatment would be about the same and there would be no chance of recurrent problems with decay. Dental implants are a highly predictable treatment in this case.

Extracting the tooth and not replacing it can lead to teeth shifting, bite problems and a decrease in function. If the cost of treatment is beyond your means, ask the dentist if they have options to stretch the payment out over a period of time. Another alternative would be a retainer to hold the position of the other teeth until you are able to replace the missing tooth.

Jim G: My son has been in braces for over a year and has multiple teeth with decay. What should we do?

My first question would be – Why does he have so much decay? Although there are many factors, diet and home care are most likely the culprits. If the decay can be easily fixed, the diet can be controlled (i.e. decrease sugar intake), and his home care can improve (including a prescription fluoride toothpaste). That would be the best way to go and the braces treatment can move on. If the decay is extensive and his compliance is poor, the best thing to do may be to remove the braces and wait until improved conditions are met before continuing with the braces.

Linda T: My dentist keeps telling me that I need a bunch of crowns. I don’t have any pain and the crowns seem excessive and costly. Why can’t I just wait until something happens and fix the problem when it arises?

You can wait. However, there is probably a good reason the treatment is being suggested. Often, being proactive in replacement of aging large fillings can prevent bigger problems to come. The purpose of a crown in this situation is to protect the tooth. Waiting for “something to happen” can often mean more treatment down the road such as root canals or gum surgery. If you have multiple teeth that need this treatment, ask for a treatment plan to sequence the treatment over time. This is better than waiting.

Please send me more questions to the email below.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.