Is it always correct to save teeth?

Do you remember how often your dentist pushed you to save a tooth? It seemed like saving teeth was the thing to do and at that time it was. We developed whole specialties of dentists whose jobs it was to save teeth. Periodontists, people who specialize in gum disease, were there to help you save your teeth from the ravages of gum disease or periodontal disease. Endodontists did root canals on teeth whose nerves had died as a result of deep decay. This was good and gave many people the opportunity of chewing on teeth for a much longer period of time than they ever had before. We have lots of periodontists and lots of endodontists who do that today. I am one of them. But the emphasis on saving teeth has changed.

While it was almost save a tooth at all costs, that isn’t the way it is anymore. The simple reason for that is that if you try to save a weakened tooth at all costs, there are times when all costs may mean you will lose the tooth and that really costs.

Let’s assume that a tooth has periodontal disease, has decay, and is fractured. That tooth would then need a periodontist, an endodontist, and a restorative dentist doing procedures on a tooth to save it. There can be up to four different procedures done on a tooth by these three individuals to save that tooth. So you would have a tooth that is weakened by gum disease, that is weakened by decay, and has a dead nerve. Picture a wall in your shower that has tiles coming off, water soaking through the drywall, a plumbing leak, and rotted 2x4s. How much repair can you do to an old pipe, to old studs, to old drywall, and to old tile? There is a time when you just have to replace the wall, right? A tooth is no different. Sometimes a tooth is so weakened that there is only one thing you can do, and that is to replace the tooth.

The reason we don’t save teeth as much as we did in the past is simply because we have a better solution in many cases, and that is dental implants. After all, a dental implant is a replacement for a rotted root. A root of a tooth that has been ravaged by periodontal disease or has been ravaged by decay, or is brittle because of a dead nerve can almost always be replaced with a root that is made out of titanium, a biocompatible metal, that doesn’t decay, that won’t break down, and for all practical purposes is much stronger than a rotted root no matter how well restored.

So while it is customary to think about saving a tooth, you should ask your dentist the question how much will it cost to save the tooth and how reliable will all of those treatments be? Will a dental implant be more predictable and less costly? Will a dental implant more likely preserve the bone than all of the procedures that are necessary to save the tooth?

If we ask those questions, we may not only be in a better position to make a decision, we may have something that is as long lasting as possible.

Lee N. Sheldon, DMD