The Cost of Neglect

I have been thinking recently about the cost of neglect. This post is prompted by my recent examination of a 46 year old woman who has lost a root canal treated upper first premolar to biomechanical failure. That is not an uncommon occurrence in my implant practice. I would say that at least half of the implants that I place are replacing teeth lost to fracture or infection subsequent to root canal treatment.

When we were taught root canals in dental school, there was a sense that we had saved that tooth forever. That is just not true. I have been hunting for research statistics to verify my observation that 20 years is about the norm for root canal success. When we perform a root canal, we remove not only the nerve of the tooth, but also the blood supply. In time, these teeth become brittle and less capable of handling the normal chewing forces, and they fracture off at or near the gum line.

What got my attention for this woman, was that she had one three tooth bridge in the lower right, to replace a lost root canal treated tooth. And she had ten other root canal treated teeth. She has over $20,000 invested in her mouth, in various stages of failure. She is waiting for her income tax refund to replace the one premolar fractured now. I asked if she realized that, at her age, she was likely to lose all of the rest of the root filled teeth before she dies. A little arithmetic stunned her at the cost of the implants she would be needing. In today’s dollars, she will be facing over $40,000 in implant replacement. That is a lot of tax refunds.

In today’s economy, some people are delaying visits to the dentist because they are not having pain. Is it not obvious what a false economy that really is? The delay of the diagnosis of tooth decay often results in pain, as the decay progresses undiagnosed and untreated. For avoiding the dentist to save some money, the problem has progressed from the need for a filling at around $200, to the need for a root canal and crown for over $2000. That is bad enough, but that root canal tooth is likely to be lost twenty years down the line, requiring an implant at double that cost. Now for the delay, the cost has multiplied 3000%.

But what makes this even worse is the reality that all of this destruction is entirely preventable. By treating the causes of the decay in the first place, transmissible bacteria and low pH, we could prevent most or all of that destruction.

The cost of dental neglect is far higher than any other means of budget cutting.

Risk Assesment cont.

I have seen older people who have started taking medicines for chronic illnesses that dry up the protective saliva. This has become so common that it has been called, MIX, for medicine induced xerostomia (dryness of the mouth.) When you eat, your mouth becomes acidic (low pH) as the beginning of the digestive process. The saliva buffers the pH of the mouth, so that in a normal mouth, the pH returns to normal within about a half hour of a meal. But in a person with a dry mouth, it can take hours. Indeed for the person with a dry mouth, the mouth can live in a highly acid environment from breakfast until hours after bedtime, because by time the limited saliva has had a chance to buffer the mouth from the last meal, the person has eaten again.

Type of bacteria and saliva amount (and pH) are predictors of risk for cavities. It is possible for dentists to evaluate you for that risk by testing the saliva. And it is possible to treat the saliva of those people determined to be at risk for cavities to reduce the risk, before the damage is done to the teeth. This is done with a series of mouth rinses that over a period of time lower the acidity of the saliva.

Risk for gum disease can likewise be assessed by determining the bacterial make up of the fluid next to the teeth at the deepest invaginations of the gums. The unhealthy bacteria, are anaerobes, or bacteria that prefer an environment that is without oxygen. The bacteria can be observed and generally identified as unhealthy with the use of a microscope. The exact make up of the gum disease-causing bacteria and the approximate numbers can be determined by a test called DNA-PCR, (DNA-polymerase chain reaction)

The presence of the unhealthy bacteria can be determined before the damage has started from the inflammatory process that results from gum disease. And science is finding that the damage to the body goes well beyond the teeth and gums.