Dr. Frank Vascimini, Sound Bites, 02/21/12

Q: I am a 62-year-old and have a very loose tooth on the bottom in the front.

In the past, it had a root canal and then a surgery to remove some infection. I have been to the dentist and he told me the tooth is not savable.

When I asked him how to replace it, he told me to remove the other three front teeth and make a bridge from one eye tooth to the other. I am not sure I want to remove those three teeth to replace the one giving me a problem now.

Can you shed some light on this for me? I would really appreciate it, and I enjoy reading your column.

A: Thank you for your thorough description. I feel as though I know exactly what you are talking about and will address some of your concerns.

Incidentally, your concerns in this matter are very similar to everyone’s concerns with the same circumstances.

As you have mentioned, it seems clear the loose tooth needs to come out. The three teeth beside this one are your lower incisors. These teeth have very small roots that are not very supportive.

What your dentist may not have discussed with you is that there may be decay in these teeth or they may be periodontally compromised (that is, they do not have a lot of bone support around them). Such a situation would not be surprising to me.

If this were the case and you were going to make a bridge from one eye tooth to the other eye tooth, it wouldn’t make sense to include the compromised incisors. In all likelihood, the incisors would fail and need extraction before the eye teeth needed treatment. In fact, a bridge made from eye tooth to eye tooth should last a very long time if done properly.

To recap — I feel as though your dentist is right on target with extracting the four incisors and making a bridge from eye tooth to eye tooth. If my assumptions are correct. This is a very common and predictable restoration that should last you many years.

Please don’t forget that your responsibility in this is good home care to include brushing and flossing, as well as regular visits to your dentist. The one place this can fail is at the junction of the bridge and the tooth. If not kept clean, it could decay and require repair, replacement or be lost in the future.

If, on the other hand, those remaining incisors were in good shape both from a decay standpoint and bone support, you might want to consider an implant. We now have small-diameter implants available that work very nicely in an area where there was a tooth with a very small root. Please remember a decision like this needs to be made with all the information available — something I do not have.

If you are still uneasy about this, you should voice your concerns to you dentist. I am sure he will be happy to explain it to you in terms that are specific to you.

If you are still not comfortable, perhaps a second opinion is in order. I hope I have helped in some way.

Dr. Frank Vascimini is a Homosassa dentist. Send your questions to 4805 S. Suncoast Blvd., Homosassa, FL 34446 or email them to him at info@MasterpieceDentalStudio.com.