When To Extract A Tooth
All dentistry fails.
I hate to be the bearer of bad news. NOTHING dentists place lasts forever. Some things fail more slowly than others, but if you expect your dental work to last the rest of your life, get used to disappointment (extra points if you know what movie that is from. Don’t cheat and Google it).
Root canal teeth get retreated or pulled
When a tooth that had root canal therapy fails, a few things can happen. Failure can mean that the root canal system, despite being sealed, got a bacterial infection again. In some cases, retreating them (much in the same way as done originally) can be done, but this requires more removal of tooth structure.
A hollower tooth is a more brittle tooth, so these are more prone to fracture. At that point, the tooth simply needs to be removed. If retreating is not an option, a procedure called an apicoectomy might be done. This means the tip of the tooth is removed, but this can lead to a much shorter tooth or bone loss around the tip of the root. This may spell bigger trouble in the future.
Generally speaking, retreated root canaled teeth have a low success rate, and teeth that have already been retreated should simply be removed when that treatment fails.
Failure of a root canal treated tooth can also mean that the tooth was fractured. Fractured root canal teeth means, with 100% certainty, that the tooth needs to be pulled.
After tooth removal, what then?
With a missing tooth, deciding what to do next is important. Often, when dealing with second molars, replacing is not considered. The challenges to do implants correctly or removable prosthetics simply are not worth the time and money involved. From first molar forward options for replacement should include dental implants, bridges and removable prosthodontics (dentures or partial dentures).
Deciding WHEN
WHEN to remove is a challenge to decide and can only be decided by the patient. Enough information about the condition of the tooth needs to be shared and understood between the dentist and the patient, but ultimately the decision is the patients’. When considering costs now, future costs and the efforts and success rates for each, most patients can make the right choice.
