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When to Extract a Tooth?

A Tooth Requires Extraction If:

  • It is significantly damaged and restoration is not possible.
  • It has severe decay (caries) that makes restoration very difficult or impossible
  • It has a deep crack or fracture below the gum tissue or bone
  • It has significant loss of bone
  • It has advanced periodontal disease with loss of significant support
  • Root canal treatment is not advised by your dentist or endodontist
  • There is significant infection with swelling or drainage

Potential Problems if Not Extracted:

Pain and infection are the main concerns if damaged teeth are not extracted as soon as possible. Infection can become dangerous if it spreads to the face and neck. It can also cause gradual loss of jaw bone surrounding the tooth, not to mention severe pain. Immediate extraction is recommended to avoid such complications.

Other Treatment Options:

  • Restoration: If a tooth has suffered minor decay or fracture, it can be often restored.
  • Root canal treatment with build up and crown: In cases of moderate fracture or decay involving the nerve of the tooth, it may be possible to save the tooth, most likely requiring a root canal procedure, and possible build-up. Then a full coverage crown is made. On occasions, an additional gum and bone tissue reduction (crown lengthening) may also be necessary to allow proper placement of the crown margins. While these procedures may be successful, the overall prognosis which is based on the severity of the problem, should be fully discussed. Your dentist and endodontist can provide you with prognosis and whether it is advised or not. In many cases, an extraction and replacement with a dental implant will offer more predictability and better long-term prognosis.

A note about crown lengthening: this procedure involves removal of healthy gum and bone tissue around a tooth in order to create space for placement of a crown. Unfortunately, this procedure compromises the supporting structures often shared by adjacent teeth. Also it results in very ‘long’ teeth. Crown lengthening may be an option only if it very minor and it does not damage bone and support of adjacent teeth. It is not advised otherwise and considerations should be given to extraction and replacement with a dental implant.

  • Hemisection and root amputation: This procedure involves sectioning one or more roots of a tooth that has suffered damage through decay, gum disease, or abscess. The damaged root is then amputated and the remaining root is maintained to support an overlying crown. This procedure was traditionally tried as a desperate attempt to save a tooth, but it was often short lived. The remaining root of the salvaged tooth often suffered additional fractures, decay, and further loosening and often required extraction anyway. Hemisection is not a recommended treatment as it offers very poor long term prognosis. Extraction and replacement with a dental implant is the ideal treatment approach.

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