In general, dentists want people to keep their natural teeth as long as possible. We provide education, preventive measures, and treatments to maintain healthy teeth in the mouth. Yet, we still extract teeth every single day.
There are some cases in which pulling a tooth is better than keeping it. At Rockland Dental Specialists, we believe our role in providing the best dental care for every patient includes giving you the information you need to make decisions for your best long-term health. For that reason, we will recommend extracting a tooth that has a poor chance at functioning well for many years.
This article describes several of the situations in which an extraction provides a predictable solution for a tooth with an unlikely lifespan. In each of these scenarios, saving the tooth is possible through extensive and expensive dental treatment. Even with treatment, though, its long-term success remains questionable.
Multiple Root Canals on the Same Tooth
Many people do not know that a tooth can undergo multiple root canal treatments. The purpose of a root canal treatment is to remove all of the soft tissue within a tooth (the nerve, blood vessels, and infected material). This soft tissue inside the hollow center of each tooth, called the pulp, is unable to heal itself or respond to antibiotics. For this reason, when an infection develops in the pulp, we must remove it in order to keep the tooth in the mouth.
Root canal treatments can fail. A failure may result from residual pulp or infected tissue inside the tooth, new bacterial leakage into the roots, or a crack allowing bacteria to penetrate inside. When a root canal treatment fails, we can re-treat it. It is important to understand that with each re-treatment, the long-term success rate goes down. If a tooth undergoes multiple root canal treatments and continues to fail, you should consider pulling it.
Tooth Fracture extending onto the Root
Cracked teeth can be difficult to diagnose and even more difficult to treat. Fractures do not appear on dental x-rays until they are severe. Most cracks move vertically toward a tooth’s root. Because the root is encased in bone and gums, we cannot see a crack that extends onto the root. In some cases, an endodontist (a root canal specialist) can see a crack from the inside of the tooth using a microscope.
When a crack extends onto the root’s surface, it is impossible to seal it in order to prevent future bacterial contamination. This means that all dental treatment will eventually fail because of the continual penetration of bacteria.
Loss of Most or All of the Exposed Tooth
When a tooth suffers from extensive decay or a traumatic injury, it may lose a significant portion of the exposed tooth structure, even while maintaining a strong, healthy root. The root provides a firm foundation to rebuild and restore a tooth for function. However, we also require enough anchorage on the tooth itself to hold any dental restorations.
If the entire exposed portion of a tooth breaks off, leaving only the root, we can rebuild it, but we do not recommend it. The expense attached to such restoration is quite high (several thousand dollars), and the payoff, or long-term use of the tooth, is poor. Rather than investing in something so questionable, we prefer to offer you a treatment that will give you many years of successful appearance and function, such as a dental implant.
Severe Looseness/Bone Loss
Severe gum disease destroys the supporting tissues surrounding the teeth. You can have beautiful and healthy teeth, but if you do not have healthy bone and gums to hold them in place, you will lose them. When the teeth lose enough surrounding attachment to become noticeably loose, the outcome of treatment becomes more questionable.
As in the previous situation, this also requires expensive periodontal treatment without providing a high long-term success rate. We would rather provide our patients with a predictable tooth replacement that allow you to invest in treatment that is unlikely to succeed.
Patients with severe gum disease are pleasantly surprised to enjoy the restored chewing force and function of dental implants after having loose teeth removed.
More Questions about When to Consider Pulling a Tooth?
Call Rockland Dental Specialists today to schedule a consultation with our dental experts. We can assess your unique situation and make recommendations for the treatment we believe to provide you with the highest long-term success.