DETERMINING WHETHER A TOOTH SHOULD BE EXTRACTED OR TREATED

Sometimes patients ask me when they are going to lose their teeth. This is a scary question because I always hope that every patient can enjoy all their teeth for their entire life.   There are of course exceptions.

WISDOM TEETH

Wisdom teeth are usually the first to be lost. Often there is no room for them and the gum tissue becomes inflamed and swollen, a condition known as pericoronitis. Another problem with wisdom teeth is that they are so far back that they are difficult to clean and are more prone to decay. Some of the wisdom teeth have not even erupted but are pressing on the second molars in front of them and can cause decay on the root of those second molars and can even cause bone loss.

BRACES

Sometimes with the application of braces there is not enough room for all of the teeth to fit in the arch. In this case a tooth will be removed to compensate for this lack of room – usually the first premolars. I have noticed that there are fewer teeth being extracted for this. If room is needed the dentist can sometimes shave a little bit of tooth structure (0.2 mm is common) of all of the teeth in the arch. Usually this will be done on the front teeth and that will often provide the needed amount of space. If you can hold on to all of those teeth, that is best!

FRACTURED TOOTH

Another situation is the fractured tooth. If a tooth is fractured a crown can frequently restore the tooth. If the fracture goes into the nerve area a root canal can frequently handle the problem. But if the fracture goes into the root of the tooth all of the above treatments do not work and an extraction is indicated.

Root canal teeth can fail. A re-treatment of the canal is possible and that has a 65% chance of success statistically. Many times this is due to root fracture once again.

I have had patients call up and indicate that their crown has come off and they would like it recemented. On rare occasion all of the tooth structure holding the crown is inside the crown and there is not tooth structure to attach anything to in the mouth; in essence the tooth is level with the gumline. Another sad state of affairs requiring an extraction.

REPLACEMENT TEETH

Fortunately, for those who cannot keep all their teeth, modern dentistry provides many options for replacing missing teeth. Dental implants are becoming more prevalent and offer the greatest chance of restoring your mouth to its most natural form without jeopardizing other teeth in your mouth.

If you have any questions about how to keep all your teeth if possible, or replace some you have lost, give us a call.