A Dental Dilemma

This is the Problem Page. I will put the occasional dilemma that comes my way up for discussion

There is one above

What the hell is going on here you might say? Plenty is the answer. 

The tooth labelled 12 has several problems. Note the dark area at the tip of the root. This is the result of an infection that is present in the root of the tooth. This tooth should have been root filled before the metal post was inserted into it. Note the metal post has gone through the side of the tooth. This is called a perforation and is something that should not happen. I can tell that the dentist who did it was right handed and was a sloppy operator.

BUT it has served the patient for years despite being work that is deficient in many ways

Tooth 11 has been poorly root filled but there is no evidence that it is not doing its job. Note the abscence of a dark area at the tip of the root. Remember the abscence of evidence isn't evidence of abscence.. Should we redo the root filling?

It gets more involved as the tooth 12 is buggered. It cannot be repaired as the available tooth structure is not strong enough to support the crown of the tooth.

Here we have to examine the entire mouth and have a discussion with the patient to find out what is the most appriopriate treatment.

Dental Dilemma  Number Two

The radiograph below shows a tooth that has broken rather badly but is not sore at all. As long as we leave it alone it will stay perfectly happy. Anything, and I mean anything, i do will make this tooth worse. It is a real dilemma.

The patient is not concerned about the look of it and since the tooth next to it was lost many years ago his chewing on this side is not great anyway.

What could we do? Nothing, a simple filling, a root filling followed by crown-lengthening followed by a post and core followed by a crown, or finally an extraction and placing an implant!!!!!!!

What a range of choices that the patient has to make.

What would I do? I really don't know. Probably wack a filling on it and see what happens. As long as we avoid those appalling tooth coloured fillings that destroy teeth we will not damage and preclude the patient from the other options later on.