The oath traditionally taken by dentists is to save the tooth, no matter what it takes. “Herodontics” is a term used by some to describe measures far beyond reasonable to salvage a failing tooth. Can the term be justified in this age of implant dentistry?
For example, let’s say you have a tooth with deep decay and your dentist tells you that it can be saved. However, only with a root canal, some bone and gum tissue removal to create space for the crown, and a large post and build-up to support it. Or, perhaps your tooth was treated twice with a root canal…and you are still in pain. Of course, you would hate to lose a tooth that you’ve already spent so much money and time. So your dentist suggests root surgery, maybe a root amputation, a new build up and another crown. After going through all of these procedures, he gives it a 50/50 chance of long-term success! This type of heroics is costly, time-consuming, difficult to perform, and, sadly, ineffective in the long run.
Thankfully, current implant industry knowledge and technology have created a paradigm shift in treatment recommendations. Today, if a tooth is significantly compromised, dentists can take a longer and broader view of the available options and outcomes. Even when dentists can perform procedures A, B and C to save the tooth, dental professionals who are dedicated to the health of their patients should always ask themselves, “What is the best treatment approach for my patient?”
Sometimes, saving the tooth for the short term may cause more complications in the long run, as with herodontic procedures such as root hemisection, aggressive crown lengthening, apicoectomy of a tooth previously treated with root canal, and even crown supports on teeth with massive missing structure. Of course, dentists can perform these procedures, but the onus is on the dentist to determine if there are better, more successful, evidenced-based treatments that unfortunately may not always lead to saving the tooth.
It’s time to pull the plug on that problem tooth and spare patients the pain, frustration, and disappointment of fix after fix that only prolong the inevitable. In fact, Dr. Kazemi proposes “simpractidontics,” to dental professionals to start practicing simple and predictable dentistry that’s current, successful, cost-effective and longer lasting. Dr. Kazemi wants to educate his patients about all of the possibilities — short- and long-term — and engage them in making better decisions for their overall oral health. Now, don’t you think that’s an entirely better kind of heroism?