Did you know that dentists must make ‘life or death’ decisions every day? That’s right, almost every day a patient will ask me if I can make a decision about their broken or aching tooth. I must decide if I can restore the broken tooth or just need to remove the tooth.
So what goes through my mind when someone asks me if their tooth can be saved or must be removed? The first thing I usually do is ask myself how much solid tooth structure would remain if I were to clean away all of the dead or broken parts of the tooth. Once I can visualize how the remaining portion of the tooth would appear, I look at the proximity of the bone to the diseased area of the tooth. If either too little solid tooth structure would remain after the initial cleaning or if the remaining cleaned defect would be in too close proximity to the bone, I make the decision to remove the tooth instead of offering to restore the tooth to full health and function. One other consideration I make prior to restoring a tooth is asking myself if the tooth would even be in function if it were to be saved. If the tooth is not being used esthetically or will never be in functional use, then usually removal is a good option.
Don’t get me wrong, I hate to remove a tooth unless it is absolutely necessary, but sometimes the patient and I have no choice. Fortunately dentistry has offered some great options for replacing teeth like implants. I have found that helping a patient make a wise decision, even a decision to part with their tooth, is much better than prolonging the pain and inconvenience of a barely salvageable tooth by attempting repair with unproven means.
Pictured above are three teeth. The large white blob on the left is a silver filling. This tooth is in acceptable condition and can be restored, likely with a crown. The two teeth in the middle are questionable to say the least. The black ‘slots’ around the necks of the teeth indicate gross defects. If I were to remove the decay from around the necks of the teeth, very little solid tooth structure would remain. In addition, even if all the decay were removed, the defects that would need to be ‘filled in’ would be too close to the bone holding the teeth in place. A filling or crown this close to the bone would cause prolonged inflammation and discomfort. Unfortunately the two middle teeth would likely be removed.
Once again, just like those cool Docs on TV, I have made a ‘life or death’ decision, but this time, for a tooth.
Dr. Cowan
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