Extraction needed, and how?

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I have a tooth 3 away from lower left molar, next to incisor, that is damaged badly. About 12 years ago there was root canal on tooth. It was not crowned. When the tooth broke there is maybe half of the tooth above gumline left, the part broken (part of) and part of remainder is partly black in color.

I saw a dentist that sais he does a lot of extractions mainly wisdom teeth, under sedation too (twilight and general) but he is not an oral surgeon he sais. I went for a consultation last week. He said that the extraction could be tricky. He said it could not be restored. It could break apart when extracted he said, then he described the process as picking glass out of concrete. He said extracting it whole would be a bonus. The xray I asked his secretary for he did not perform. When I said is there likley any infection under the tooth he said it was irrelevant..Then he gave me a spiel about how good he is at extraction (does 100 a week he said) after initially putting doubt in my mind that his technique was best option.

My question is what is my best option. To take a chance with him or go for an oral surgeon, or other dentist? I dont want the tooth to shatter then he picks the pieces out, but he said this may not occur. Right now I have ended up with no xray of the tooth either.

Thoughts? Regards.

Ps. Forgot to mention the problem tooth sits right next to a 3 unit bridge on one side, incisor on other.

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  • Posted

    I could be wrong, but it sounds to me as if you've stumbled across some kind of crook!

    Clearly you need an X-ray to establish the full nature of the problem and to see whether there's any infection. It's not safe to do an extraction without antibiotic cover if there's even a mild infection in the root.

    That being said, you may well end up having to have the tooth removed. I've had two root canals on molars in my time, and both have ended up with the tooth having to be extracted a few years down the line. (Both extractions were done by oral surgeons in a hospital, as the underlying bone had become infected.) On the other hand, I've heard tales of people having root canals that have lasted 20 years or more, so maybe I've just been unlucky.

    It does sound to me as if an oral surgeon might be a better bet in your case, particularly given the proximity of the bridge.

    Now, about this "twilight sedation" and general anaesthesia... I can't make out which side of the Atlantic you're on from your way of writing, and I do know opinions very greatly. I can only say that when I trained as a general nurse in the UK in the mid-1960s, during our first lecture on the subject the anaesthetist warned us all very gravely never to accept general anaesthesia in a dentist's office. That surprised me, as I'd been used to being given "gas" at the dentist's as a child. He said that GA should only ever be administered in a hospital, where there were full facilities on hand in the event of something going wrong.

    In spite of this, "chairside" anaesthesia - usually administered by a local GP - is still being used by some British dentists 50 years later, and is still causing unnecessary deaths. I read reports of these at least twice a year and there are probably others that go unreported. I worked for a year or so on a Casualty department (ER) in 1969-70 and can confirm that in that period I had to deal with one death due to chairside GA and more near-misses than I can remember.

    I cannot advise you strongly enough to refuse general anaesthesia outside of a hospital environment, however many times you and your friends or family may have got away with it in the past, and whatever your dentist says. (Obviously, I'm not referring to the emergency roadside GA which occasionally has to be administered to cut someone out of a car wreck, for example.)

    Conscious sedation - which is what I assume your dentist means by "twilight sleep" doesn't carry the same dangers as a GA but it's still not entirely safe. I would not accept it outside of a hospital. In fact, where I live - in a continental European country - both doctors and dentists are banned from using either GA or conscious sedation in their offices.

    Also, why do you need either? Both my extractions after failed root canals were performed by an oral surgeon in a hospital, and at no point was I even offered GA or sedation. I wouldn't have accepted it anyway, as neither is 100% without risk even in a hospital environment. Both were done under local anaesthesia (injection). The first procedure was uncomfortable, as it involved the top molar next to the wisdom tooth, so access was difficult, and the tooth was also fragmented, like yours. However, I didn't feel any pain and the whole thing was over in 20 minutes. The second one was on a lower tooth (like yours) where access is always easier, and only took about 10 minutes, including the bone-scraping exercise (which caused no sensation whatever).

    Sorry it's been long, but to summarise: see another dentist, preferably an oral surgeon, and have the procedure done in the normal way, under local anaesthetic. If you feel you must have sedation or GA, get it done in a hospital.

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    • Posted

      Hi Lily

      Thanks for your help. My tooth being quite a small procedure won't require twilight or GA but there are people visiting him that have phobias and do require to be put under. Also with the wisdom teeth extractions he uses both twilight and GA. You sit in a chair. I guess for GA he must have an anaethetist. Reason being people save on the cost, that is all. Funny though he has been well reviewed on the net in Canberra (where I live) but then dead patients dont talk..

      I did not like what he said about infection being irrelevant and also not doing an xray seemed slack as I know I made sure it was in the notes before I went in. rgds.

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    • Posted

      Hi Jonathan,

      Glad to hear you're not considering sedation/GA.

      I know procedures and legislation vary widely from one country to another. However, where I live the very fact that a dentist mentioned he used either in his office would immediately throw up a red flag that he was dodgy and cause most patients to run a mile! And it wouldn't make much difference even if he was using a fully paid-up anaesthetist (which isn't the case in the UK). Unless the dentist's office is physically in a hospital, the emergency back-up wouldn't be available in the short time-scale required. In the cases I saw, the dentist immediately called an ambulance, but it still wasn't enough to save one poor woman, and one of the men ended up with slight brain damage.

      Get a second opinion. Are you able to make an appointment yourself with a dentist or oral surgeon at a hospital in Oz, or do you need a GP/dentist referral, like the UK? Over here we can self-refer for most things, so if ever I have a dental problem I think might be serious, I go straight to the dentistry department of one of the university hospitals in this city.

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    • Posted

      Agreed it is an accident waiting to happen, if it has not already..

      I have not checked exactly as my teeth have been pretty good. I think I may need a referral and also am not sure how the oral surgeons work. I know many of them deal with trauma etc. and work in hospitals as well as in private practice. Does not seem to be many of them though in this place. They are also some of the best paid people around in this country.

      There is no pain or swelling so I will wait til I get the right advice. I also sometimes am in the UK which in another possibility though I am not sure if it would be any better or cheaper than here. I have a friend in USA who is a dentist which is why I wanted the xray done so I could ask for her advice. You said what I thought, the guy is dodgy. Shares the same name too as a Sicilian Mafia Family. Just saying..

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    • Posted

      Jonathan, don't go to the UK for dental treatment, whatever you do. With a few exceptions, the dental service there is terrible these days. There seems to be no limit on what they're allowed to charge, and there are always stories on news sites of people pulling their own teeth out!

      If you can get across the Channel from the UK to Belgium, that'd be a different story of course...wink

      It's true that oral surgeons work with trauma, but they also handle more complicated dental work. In both cases involving my teeth the infection had spread to the bone - severely so in the first case - so a stomatologist was automatically involved. I admit I'm not entirely sure of the nomenclature. A stomatologist is literally a mouth surgeon, and it was a stomatologist who removed the first tooth. However, for the second one my dentist made an emergency referral to maxillofacial outpatients. (It was only an emergency because the swelling from the abscess was spreading under my tongue, with a theoretical risk of asphyxia.) I think they're the same thing though.

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  • Posted

    to clarify I was not told I need GA or twilight sedation for the work quoted, but it is offered in the chair if you want it, seems..
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