Q: I so enjoy your column and decided to ask you your thoughts on my present problem. I lost my lower right first molar about six months ago. Healing seems to have been normal and at this point I am chewing with no particular problem. My dentist feels I should replace this tooth with an implant. I am very lucky in that the cost is not a factor but he estimates an approximate fee of $7,000 to $8,000 from start to finish. I know there are no guarantees of success but he seems very confident that it will work out. I think it probably is the right thing to do but when you consider my 80-years of age and the fact that I am eating now with little if any problems, I am starting to rethink if this is a good place to put that time and money. I have read a lot on the internet but am still a bit unsure. Can you add any thoughts that might help making a decision? - M.L.
A: In all honesty, I believe that if the cost does not encumber you in any way and you are willing to go through the surgery as well as the wait for healing and then the two, three or more visits to place the tooth on the implant, then I see no compelling reason not to.
As you are familiar with my column however, I am sure you know that I will have a few thoughts.
One factor to consider is your general health. You do not mention your medical history. I assume there are no significant problems since you do not mention any. That is very fortunate as I am sure you are aware especially for an 80-year-old. I believe statistics would project another 15 years of expected good health and longevity. Based on that alone, the implant would be worthwhile.
Another factor is the health of your other teeth. The lower right first molar usually has a tooth or two behind it. If that is the case and no other teeth are missing in the lower right area of your mouth then it is certainly not mandatory to replace the missing molar. I do not know what the reason was that was given to you but if it had anything to do with movement of your other teeth if you do not replace, I would question that. After all these years, if your lower right teeth are opposed by teeth in the upper right, I would predict no movement to take place. In that same regard, assuming there are one or two teeth behind this space and you have adapted well in the past six months to chewing comfortably on both sides, then again you can consider leaving the situation as is. If however, the teeth or tooth behind the space and even the one in front of the space are in fair to poor health then the implant is much more important. You do not want to put excess stress on teeth that have been root canal treated or heavily restored.
For your general information, the tooth you lost and the one in front of it, the first bicuspid, are ones that do about 60% of the function on each side of your mouth. Therefore, if you lose one, as you have, you will usually notice a compromise in function. You have not, so you have adapted well. I would ask your dentist of the health of the teeth around the space and the healthier they are, the better the chance that you will live out your life with no further dental compromise and no reason to replace and invest that sizeable amount of money.
In terms of the cost of the implant procedure, I have little to say since I do not practice in your area but I would say for others reading this column that around the country, I have heard of as little as $3,500 for the total procedure but again that depends on what is reasonable and customary for the area you live in. If money were to be a factor and if any of you out there live in reasonable proximity to a dental school, that would be an excellent alternative for treatment as it is usually well supervised and far less expensive than private practice.
I would also refer you to other columns I have written that are available online: https://bit.ly/2FNLjLH.
As I have said in previous columns there are other ways to replace missing teeth other than implants and some of these have served our population very well for many years. They have some disadvantages that a single implant replacement does not have but they are also far less expensive. I would advise discussion of all the alternatives in detail with your dentist prior to your proceeding with the recommended course of action. Those questions with good thoughtful answers that are easily understandable should put your mind to rest when you have come to your decision.
Thank you so much for your question and to all others that may be reading, my sole purpose in writing this column is to make you all more educated consumers and ones that recognize that blind acceptance of any type of medical, dental or other health professionals especially in this day and era is NOT the prudent approach.
Dr. Richard Greenberg of Ipswich practiced dentistry for 45 years after having attended dental school at Columbia University, where he was later an associate clinical professor of restorative dentistry and facilitator of the course of ethics. Do you have a dental question or comment about the column? Email him at firstname.lastname@example.org.