Seeking advice for chronic decay issues

[MatthewD23]

Hello,

I'm here on behalf of my wife, a person who unfortunately has been plagued with tooth decay issues most of her adult life. She is 44 and has had 7 root canal treatments, along with too many cavity fillings to count. I don't think she has many untouched teeth left in her mouth at this point.

Right now she once again has several teeth hurting her, and while we're hopeful these might just require fillings, the thought of one of them needing another root canal is weighing heavily on our minds. It's a painful procedure for her (she also has fibromyalgia and has a low tolerance for pain).

We're considering some other options in the event she is told she needs another root canal treatment, such as dentures or implants. She really doesn't want dentures, but that is a lot more doable for us financially. Implants are a much more attractive option, but while we could afford to do one implant or maybe a few at a time, doing a large number of implants at once is probably out of our reach financially. Note that we've kept up on her teeth, treating them either with fillings or root canals (full restore with mounted crown in all cases) as they need them, so it isn't like she would need a whole bunch of teeth done at once. But, the problem with doing implants one by one is the pain involved - she would prefer to just have one big procedure instead of a bunch of smaller ones.

What my wife wants at this point is just to be done with the whole thing. She's reached a level of frustration with her teeth where she wants to pull all of them out and get them all replaced, either with dentures, or, ideally, with implants. And this at last brings me to my question:

Do dentists ever proactively extract and replace teeth based on a patient having a chronic history of tooth issues, with the idea being to just kind of get it over with, and eliminate the potential of future issues? I'll admit I have a lot of reservations about the thought of pulling teeth which are either healthy, or which have had a full root canal with crown restoration. But the problem is, based on her history, we can reasonably expect her to continue to need a root canal probably every few years, if not more often. In this scenario, would it be recommended to just pull all the teeth out and be done with it?

Note that there is a genetic history of horrible teeth in my wife's family. Her grandmother and mother both ended up having a lot of teeth replaced (her mom actually has full snap in replacements with posts mounted into the jaw bone). We think this explains the high level of decay she suffers from, but any suggestions on how to help prevent that are also welcomed.

I'm sorry for the very long-winded post. This is many years of our life I'm kind of pouring out here, and I really do appreciate any advice or suggestions. Thank you so much.

- Matt

 

[MattKW]

Unfortunately it sometimes comes to this. Financially and emotionally it can become a burden for the patient. Even so, I would advise about taking out all teeth. There are usually a few strategic teeth that can and should be saved, e.g. canines , at least a molar in each corner of the mouth, and lower front teeth. This will allow her to have partial dentures that are manageable during the transition. If necessary, the remain9ng teeth might be removed in later life, but it'll be easier to cope with the changes after this introduction. People who have had lots of decay need careful assessment for implants - the implants require more care than normal teeth because they are more liable for gum infections and failure if hygiene and diet is poor. So don't assume she will automatically stick in implants and everything will be hunky-dory.
Go have a good heart-to-heart with a few dentists for differeing opinions.

 

[MatthewD23]

Thanks, MattKW. I had seen your replies on other threads before posting, and was hoping you might answer mine. This is exactly the sort of advice I came here seeking, and has given me and my wife a lot to consider. Thank you.

 

[honestdoc]

When teeth are extracted, the jaw bone flattens continuously. It becomes more and more difficult to restore function due to decreased retention for dentures, available bone for implants and bone strength for bridge abutments. This is more pronounced in the lower jaw where dentures and partials become so ill-fitting that people refuse to wear them after it is fabricated.

When I hear people say they want all there teeth pulled just to be done with it, I see red flags with unrealistic expectations. Like Dr. MattKW mentioned, implants require more care and maintenance than natural teeth. People do not consider costs, trauma, lack of function (dentures & partial dentures), and high need for maintenance until after the fact. Just like cars, people's mouths will never be maintenance free.

I would suggest finding a dentist you trust and have a thorough session to discuss health history (heart conditions, diabetes, and any medications that causes dry mouth, excess bleeding, and/or bisphosphonates which will cause bone damage), parafunctions such as grinding/clenching, diet and full treatment plan. If saving teeth is realistic, then there should be full expectations on maintenance not just "I brush and sometimes floss." Many factors contribute to bad teeth and those need to be identified.

 

[MatthewD23]

Thank you, honestdoc, this is more really great info. And both your response and the earlier reply from MattKW confirmed what I suspected (that "just ripping them out and being done with it" is not the easy, albeit expensive, answer someone might think it is).

I'm so glad I found this site, and appreciate these thoughtful replies =)