AIBU to ask for advice on whether to get this tooth removed? WWYD?

[Amanitacae]

Looking for any advice or experience in this field!

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Background:

Had a sore tooth when chewing (the one immediately next to my wisdom tooth after having had teeth removed for orthodontics as a teenager), and in July 2023 had a root canal done in it. It didn't immediately stop the pain and after a couple of it grumbling of weeks antibiotics seemed to help. However it never seemed 'quite right' when chewing etc.

Recently it has become very painful with hot/cold + chewing. It flares up in incredible bursts of pain sometimes triggered by those factors, sometimes just on its own. But the pain fades back to a very mild throb very quickly. For this reason, I haven't needed to take many painkillers despite it being very painful for short bursts.

I have been told (medically) that I have a high pain threshold.

I grind my teeth very badly when I sleep - I have a mouthguard but I often remove it in my sleep.

I'm 42.

I have 3 kids, my husband doesn't work (stay at home dad), and we don't have a large pool of savings.

I have an NHS dentist (but am not eligible for free dental care).

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Dentist advice:

Can't see any sign of infection. It's likely either a cracked tooth (likely caused by grinding) or it's an accessory canal which wasn't discovered during the root canal which still has some nerve in it.

Option 1:
Pay for a specialist investigation in the hope that it's an accessory canal which can be root treated in a bid to try to save the tooth = £900
(Obviously if I go for this option there's a chance it's a crack all along, and that I then need to move on to option 2 regardless).

Option 2:
Have an extraction + either get an implant, or a removable prosthetic tooth - if I did this I would most likely want to opt for an implant = £3000-£4000

Leaning towards going for option 2 straightaway due to a hunch, given the symptoms, that it's a crack.

YABU = Pay £900 up front and try option 1 first (it's worth it to try to save the tooth)

YANBU = Bite the bullet and go for option 2 straightaway

Would appreciate any advice or experience with this. Dentist is really helpful, but seems it's up to me.

I don't need any 'we can't help you only your dentist can' comments. I am very aware that this is not a forum full of dental professionals waiting to help me with my issue - just looking for general advice, experience, WWYD type advice (and if there are any dental experts here would very much welcome any advice too!)

If it's at the very back, I'd go with secret option 3 - have it removed and just leave a gap.

I had a molar extracted last summer. It took me a long time to come to terms with needing it done, not helped by the unsympathetic manner of the dentist, but it was a back tooth that had been filled, cracked, been refilled, and cracked again. I was eating on one side of my mouth only and was worried about infection.

I was so worried about having a gap, but it's so far back you genuinely can't see it. And I worried my face would be lopsided, but it's fine.

Well I immediately thought that they hadn’t done the root canal properly (not a dentist but far too much experience with root canals). And I would always be inclined to try and save a tooth, I don’t see why a quick X-ray would not identify an incorrectly done root filling though.

If I were to have a tooth removed from the back, I would go for a gap rather than an implant, the other teeth will slowly move up a bit.

You don’t need to replace it if it’s right at the back. I’ve got 3 teeth missing at the back and never got an implant or anything and just left them. Doesn’t bother me at all and you’d never know -you can’t see it when I smile etc. I’d just have it removed and leave it.

As others have said, I'd leave the gap if at the back. I had one removed during lockdown and was so so upset but when it was done, I could only see it with a really open mouth and don't even notice it now

Similar happened to me. Lots of pain over months. Had root canal then months later cracked tooth. I had it extracted. I’ve now got a gap next to end tooth. Remember dentists, while lovely people, want to make a living the same as the rest of us. You don’t need an implant but of course they’ll recommend one as it’d be the ideal option. Honestly I don’t miss it! Not noticeable at all when I talk or smile etc.

In my own experience it's probably an accessory canal and its got an underlying low grade infection in it. A crack would normally be visible on X Ray unless its very fine and given you've not long had a root canal and infection I'd wager it's an extra canal that's been missed.

You definitely do not need an implant, if it's beside the wisdom tooth it's so far back you'll never notice. Ive had two teeth at the back removed and never even considered an implant, nobody notices and it only took a couple of weeks to get used to the gap myself! As you get older you may lose more teeth that are nearer the front and wish you'd saved your money!

Personally, I'd probably go for the extraction and the implant. Most root canals tend to fail at some point - I've had a couple in the past, and one has failed a couple of times, and I eventually had to have the tooth extracted, and the crown on the other one snapped at the top of the post, so that one's had to come out too. I've just had the posts for the implants fitted, and am waiting to get the final teeth in place. Having all of the root canal work only really postponed the inevitable.

Just get it pulled. I have gone through this 3 times, living with pain and throwing money at teeth only to have to get them pulled anyway. You don't need to replace it at all if it's just one at the back.

Thank you!!

Great advice - and really interesting re. those saying it wouldn't actually require the implant! I didn't know that was an option. I thought it would affect other teeth to have a gap long term. You are right about it not being noticeable. The tooth next to it (2 in from wisdom) also has had a root canal and is very discoloured, and is not noticeable at all.

Also interested in your take @Balloonhearts. I've managed to get a cancellation appointment on Monday where they are going to take another look at it (open up the root canal) and am hoping that if it's infected this might reveal that.

You need a root canal specialist to advise. The one I used saved my tooth about 15 years ago (and several others since!), whereas my dentist could only suggest removing it. I do actually have a tooth missing next to my back tooth on my bottom jaw, but you can't see it, and I would never consider an implant there.

Thanks @ajandjjmum - the problem is that the cost for the root canal specialist is £900 (which might go straight down the drain if it's actually a crack).

Again really interested in the 'no implant + wouldn't bother' option.

I've had that tooth removed, no need for an implant.

I've just had an implant on a bottom molar. I had 15 years without one and it was fine. My dentist said loads of people have a gap there and it doesn't affect them at all.
He also said if I wasn't suitable for an implant his advice was just leave it. I like the implant but it was also fine without. I ended it up getting it as I was overbrushing the other two teeth beside it and causing a few problems with the enamel but that took 15 years. The gap didn't affect anything else.
My implant cost £2800. Similar thing. Cracked tooth failed root canal. You can get it out and then save for an implant if you need

Thanks very much for your advice everyone who posted. This has been really useful. So glad I asked mumsnet advice! You've all made me feel better if I do end up getting it removed too.

Thanks for this thread, I’m in a similar position.

My root canal had small twisty bits that didn’t take. There’s infection under the root that flares up very occasionally. It doesn’t really bother me. I was hoping to leave it indefinitely!

I don’t have many on that side though, no wisdom and the other molar already removed.

I went from amazing teeth to crap teeth really fast!

Dentist here. Patients often ask me what I would do in your situation, failed root canal probably due to fracture. My answer is always extraction and leave the gap.

I had the exact same situation with an upper second molar ( the one next to the wisdom tooth) I didn’t even bother with root canal because I knew it had been fractured for a while.

The success rate of root canal after a fracture is very low, a colleague who is a specialist endodontist always says that once they identified the main cause of acute infection in an otherwise sound tooth - fracture, he extracted far more teeth than before. There is no point in trying to save a tooth that will ultimately fail.

From a litigation point of view we have to discuss all options. Unfortunately, some in the profession feel the need to push certain treatments when in actual fact doing nothing or in your case leaving a gap is fine.
If you don’t want a gap then have an implant, but don’t be pressured into expensive options if you would be happier just having the tooth removed.
I had my tooth extracted nearly twenty years ago and haven’t once missed it. In fact the gap is a convenient space to push chewing gum or a mint into for storage when speaking.

I'm a dental nurse op and as pp have said, the first option the dentists I work with normally give is to remove it and leave the gap. Then if you find the gap bothers you, you can always get an implant assessment then provided it's within a reasonable time and there isn't much bone loss. Either way the gap would need to heal before starting that process so you aren't tied to a final decision.

Is it the infection while the tooth is there that causes the bone loss, or does it happen when the tooth is out? I’m wondering if I’m making it worse by hanging on to the tooth!

Almost the exact Same problem here. The dentist sprayed cold air into the problem tooth and the pain was all I needed to know the nerve was still present, another root canal later and a crown it’s all good. Least intervention first, incremental intervention when the least doesn’t work. If your car didn’t start you would chuck the engine, you check it bit at time .. that’s how I see it anyway. I did not want to lose a tooth and have an implant, you might not mind. Depends what is your opinion on that I suppose.

Totally agree with option 3.

Remove and leave a gap.

I've had two back teeth removed. Can't see the gaps. All good. And much cheaper than an implant. I'd only get an implant on a front tooth where you'd see the gap.

I'd live with a gap there. I have a gap at the upper back but have an implant upper front that's visible - I went to a specialist implant clinic and they did 12 months interest free finance so I'm paying £293 per month (4 more to go 😊).