Can you just pull it? This is a question I hear multiple times a week as a dentist and as much as I wish the answer would be as simple as a yes or no, it rarely is that black and white.
Dentists are trained to save teeth whenever possible. The challenge is judging how likely the treatment needed to save a tooth is to be successful. Another way to put it in the famous Kenny Rogers lyrics – “You've got to know when to hold 'em and know when to fold 'em.”
In this article, I’ll review some of the factors a dentist takes into account when making a recommendation whether or not to save a tooth. As a patient, it is ultimately your decision whether to accept the recommendation after having a discussion with your dentist about the pros and cons of saving a tooth. There are also rare situations where the dentist is not comfortable pulling a tooth and has no obligation to carry out treatment they feel is not in the patient’s best interest.
The most common situation that dentists get asked to pull a tooth is when children have cavities in baby teeth. Given that baby teeth eventually fall out, there is a common thought process that it isn’t worth saving the teeth. The challenge is that extracting a baby tooth too early can alter the eruption pattern and cause teeth to tilt causing orthodontic challenges. At the same time, baby teeth are more likely to abscess due to larger root canal anatomy, so there is a balance in determining the proper treatment.
Painful or infected teeth are the next most common situation where pulling a tooth is requested. Pulling a tooth is a solution to pain or infection but not without possible side effects and risks. Similar to baby teeth, the bite often times will change if a tooth is pulled. The loss of a tooth can affect chewing, speaking and the attractiveness of a smile. Oftentimes, the extent of those effects can’t be known until the tooth is out. Therefore, dentists attempt to save a tooth to prevent the patient from experiencing irreversible problems. When determining if it is worth it to save a tooth, the dentist must weigh how likely it is for the treatment to be successful. Unfortunately, there is no dental procedure or material that is 100% successful. So, no matter what, there is an element of risk in saving a tooth that must be weighed agains the risks of pulling a tooth. Be sure to ask questions and make sure you understand the pros and cons the dentist discusses with you when making a final decision whether to pull a tooth.
If you do need to have a tooth pulled, thankfully we do have options to replace teeth that are greatly improved in the past generation. Those options usually involve greater expense, treatment time, and will never be the same as natural teeth - though some are close.
It wasn’t too many generations ago that it was considered a gift to have teeth extracted and dentures made. This would be a graduation or wedding gift at times! Thankfully that isn’t a common occurrence anymore, but there are many individuals who choose not to focus on preventative or restorative dental care. Instead, they wait for problems to occur and extract those teeth with the plan to eventually have dentures made. This sometimes works out if the person is extremely adaptable and doesn’t loose muscle control and strength in their lips and tongue to adapt to a denture. As we age, those abilities decrease and it is a challenge to adapt. That is why generations ago, young people were much more likely to adapt and tolerate dentures. Dentures also have the challenge of decreasing chewing forces by up to 90%
Hopefully you are never in the situation to save or not to save a tooth. But if you are, be sure to listen to the recommendations and options presented by the dentist so you can enter into a conversation to make the best decision for your individual situation.
Blog post written by Dr. Joiner to be published in the Capital Democrat September 2024
Comments