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i have had several opinions on the below work that needs to be done. initial breakdown on 4, 5 , with #19.. my feeling is id rather not touch until i need it.. xrays show fine, clinically you can see beginning.. but every time a tooth is touched, you aggravate the nerve, pulp, do you recommend i wait so i can get max use of current restoration? Recommendations (in order): tooth # 19, crown #,4 ,5 replace with composite or crown
As mentioned by my colleagues, it is very difficult to make a solid statement on this situation without having x-rays and performed the exam in person, but here are some things to think about:
- #3 (upper right molar) you are having symptoms, so address this tooth first. Trying to prepare the tooth and make a temporary crown is a good idea to assist in figuring out if you have a fracture that is causing the problem
- #4,5,19 are there old mercury fillings present? Did x-rays reveal decay? Are you at high risk for decay?
You may wish to address #3, complete the work with the tooth and then begin to replace old fillings in #4,5,19 one at a time. Yes, there is always the risk of the nerve inflammation when a tooth is treated but this must be balanced with a consideration of the other issues the tooth has. If there are really old, worn "silver" mercury fillings in the teeth, they are compromising the structure and probably allowing decay to form, so replacing these fillings would be a good choice.
As mentioned before, if there are things on the treatment plan that you ignore or wait too long to address, they can turn into bigger problems later.