Does the Tooth Really Need to be Extracted?

You have a tooth that is comfortable. You are told that you have periodontal disease and that ultimately the tooth will need to be extracted. Why not extract it now before the bone deteriorates further?

Sounds logical. But is it true?

Periodontal disease does result in loss of bone support for the tooth. If periodontal disease continues, the result is that the tooth will get loose and come out.

So here are the two assumptions:

• The periodontal disease will continue.
• The loss of bone will prevent you from getting an implant.

Both assumptions are wrong.

Periodontal disease is a very treatable disease. I can’t count the number of people who have seen us for a second opinion when they were told that their teeth needed to come out. Very often, they didn’t need to be removed. It was a matter of diagnosis and correct treatment. The results are that many patients kept their teeth over their lifespans. Studies by our periodontal colleagues who track their data show the same thing. And that is the key. If you have periodontal disease and it is not resolving in your dentist’s office, the next thing that should happen is referral to a periodontist. Specifically, that means that the problem should resolve in a matter of weeks after treatment in your dentist’s office. Your dentist does the treatment. In six weeks, you should have a periodontal reevaluation. At that point, bleeding upon probing should be gone. Breath should smell better. The periodontal pockets should be markedly improved. If not, then you need to see a periodontist right away.

With regard to dental implant therapy, the bone is dictated by the genetic presence of bone volume. Some people have more bone volume than others. A CT scan or a clinical examination should help you determine whether you are a “thick bone case” or a “thin bone case.” A thick bone case will retain its bone volume despite the periodontal disease. A thin bone case may not as the bone volume was never there genetically. However, in either case, the periodontal disease may be treatable. Refer yourself to a periodontist if there are any questions.

Lee N. Sheldon, DMD