OT Damn, broke a tooth! Options

[seanery]

Hey doc, what do I do?
Broke the top farthest back tooth while eating a french fry. Missed the morning session at Putnam this morning.
A friend told me I'll need to get it pulled. I don't know if that's true, but the inside face is basically gone, the top is mostly there though. She told me the inside of the tooth isn't protected and will rot and hurt like hell if not pulled.

Izat true?

Thanks in advance.

[DNHunt]

Sean

Here's the skinny. Your dentist may or may not tell you all of this cause we all do things a little different. My practice is real blue collar and I often have to cobble things together so I would consider the first 2 while many dentists might not even mention them. Course I haven't seen your tooth but usually when that tooth breaks it's because of clenching or grinding and there is very little decay to remove. If it just busted then here are your choices.

1) Composite filling - don't waste your time these are no good in large fillings and you will do it over very soon.

2) Silver amalgam filling - cheap and quick, your dentist will not want to do this cause there isn't much margin. It can work pretty well but there are no guarantees. If you do this and want a crown in the near future (a couple of years) you can use this as the foundation for that.

3) Gold onlay - like a bikers skid lid, it only covers the top (biting surface) of the tooth. Saves a lot of enamel. My favorite cause I know I can't make anything as good as nature did and the gums love enamel not gold or porcelain.

4) Porcelain onlay - same as above but solid porcelain. Probably, the treatment of the future. It's a little more risky than gold cause it can crack and sometimes the cement fails and the tooth gets real sensitive.

5) Gold crown - old standby, it has the longest history. It will work well. The dentist probably will like this. Easy and pretty good profit.

6) Porcelain bonded to metal crown - looks better than gold. Dentist really loves this $$. Probably will work well.

My preference, use gold over porcelain cause it is better to bite on in the back tooth. It will not break and the wear rate over the years will match the rest of the teeth. The porcelain on the porcelain bonded to metal crown will wear down the opposing tooth if you grind your teeth at all and most people do. Porcelain onlays wear the opposing tooth less but are more likely to break.

How much decay is in the tooth is the kicker. If there is none all of the above probably can be considered but, as the decay increases, the choices decrease until you have to chose between the crowns. Lots of decay equals root canal. Lots and lots of decay and you need the tooth taken out.

Sorry for your bad luck

Dave