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THIS IS A LONG POST, so don't feel obligated to read it.

While I think I have very healthy teeth and have never experienced decay beyond what I experienced as a child and what comes with relatively normal wear after 45 years with the same teeth, I do have ongoing cosmetic issues the result of genetics and a childhood injury to my teeth.

I am genetically missing my 2 incisors AND my 2 front teeth were chipped to an inverted V shape from a croquet ball that I threw up in the air to catch and missed, at the age of 11. Okay, so there's the old history. The new history is that I have had the benefit and successful fulfillment of 2 cantalevered bridges in my dental history.

Recently, the second bridge has been showing signs of looseness on the right front tooth where I have a 20+ year-old root canal and post. Hysterics range from dentist to dentist over this and suggestions being made the post has come loose to there being decay at this tooth. Extensive films DO NOT indicate decay, but a prosthodontist wants to destroy the bridge and aggressively treat decay, while another dentist wants to keep the bridge intact, as he can't see any signs of decay, and the third dentist saying he can't see signs of decay on the films.

Okay, so why a discussion of decay by the prosthodontist if the films don't seem to indicate decay?

The first dentist I went to, in a series of 3, felt that the root canaled post was loose, but was certain that to repair it would require destruction of the bridge, which is why he referred me to the prosthodontist.

The prosthodontist wants to destroy the bridge and has promised me the root canaled tooth will be destroyed, too. He has hinted that the post in the root canaled tooth could be loose, but to determine that or if there is NO decay, the bridge has to destroyed.

I have finally gone back to my old favorite dentist who has been my dental health provider for years and who knows my all my toothy warts. He seems to be the calmist of all the dentists and does not want to destroy the bridge, but to monitor the situation.

How is decay detected under a bridge? By films? By pain? By odor? By sight? Does a bridge have to be destroyed to make any of these determinations? Can a loose post be repaired from the back side of the bridge? I had the root canal done this way with my first prosthetic device. Why would it be different now to repair the post?

Well, I've vented in this post a lot of fear, so thank you all for this forum to express my concerns. Regards, pat Brown

Well I don't know alot in this area but here's my thought on it. You can do what you want, though a loose brigde is not a good sign. It could be just the crown/bridge that is loose, it could be coming from the post within, or it could be your whole tooth that is loose. If it's not the whole tooth, then either of the two other things could mean that you have some kind of leak in the seal and then decay could slowly set in and destroy your tooth, if there is not already decay present. You don't have a nerve in the tooth so you won't feel any pain if the decay gets really bad. If you decide to wait and hold off any treatment, I will suggest that you should get frequent x-rays of the tooth to keep an eye on it. The decay could be under the crown and not be showing up on any x-rays yet, as the metal base will completely block out the view of the tooth under the crown. If you feel that there is a bad taste or smell coming from that area, I would see about getting treatment underway, as this is not a good sign of a healthy tooth either. If there is decay under the crown, eventually it will show up on the x-ray at the tooth rots away further up the tooth towards to root. But at that time it may be questionable how much tooth is left to save.

Hope this helps, good luck!
Hi, Shaelle. Thanks for bringing to my attention the fact that the decay of the tooth could be covered on the xrays due to the metal in the bridge. This had not been explained to me in such succint terms.

The prosthodontist kept pointing to a picture in a root canal booklet the area of the root's enamel that could be decaying. He never said anything to the effect the decay could be occurring directly under the bridge and then spread upward to the root. I'm sure he was thinking this, but didn't think I was dense enough not to think of this for myself.

Frankly, I had never connected that even with a root canal, the "dead" tooth still is a structure subject to decay. I thought dead meant DEAD and decay affected only living tooth enamel and related structure.

So, now I have another concern which is this: the prosthodontist has promised me that the dead tooth will be destroyed if the bridge in the removal process. If the tooth is decaying, it will eventually deteriorate and likely fall out from under the bridge, right? What's the advantage to destroying the bridge to get to a tooth that will basically destruct on itself anyway?

I understand the fear of decay getting out of control, but can decay be harnessed with drugs? Continual monitoring with xrays is a good idea. And assuming the xrays don't show anything for awhile, when the decay does start to show up on the films, what have I lost, in terms of a tooth that will be destroyed NOW or later? The only issue I see is that some dentists might be more reactive to decay of any kind of tooth--even dead ones.

The prosthodontist likened treatment of decay to that of treating it like cancer (his words). These scary words, and also to face the possibility of having a beautiful bridge destroyed AND a tooth (albeit just a structural filler in my jawbone) destroyed too, are all just making my stomach do flip-flops. I get nervous and then I get calm and then I start thinking the worst all over again.

Obviously, this news is sickening to me. If I were to get a fourth opinion from a dentist, should I consider a general dentist, a cosmetic dentist, a prosthodontist or maybe an endodontist? I have such an uncertain feeling in my flip-floppy gut about destroying the bridge, but I do know decay is not to be taken lightly either.

Thanks so much for having answered me. Regards, pat






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