When is a tooth beyond saving?

When is a tooth beyond saving

You often wonder why you need to remove your tooth despite the modern methods of treating and saving the tooth. It is essential to understand that any damage to the teeth is irreversible, but it can be repaired. Also, there are certain circumstances where a tooth can’t be fixed, no matter what. Here, i’m going to answer the reasons, when a tooth is beyond saving and requires extraction.

When is a tooth beyond saving?

Following are the reasons, when a tooth is beyond saving and needs removal:

  • A dental cavity
  • Periodontal or gum disease
  • Root resorption
  • Trauma
  • Fracture to the tooth
  • Internal bleaching

Dental cavity

Dental cavity is the most common worldwide disease that can lead to tooth removal if left untreated. In most cases of tooth decay, pain with or without swelling is the primary factor that brings patients to the dentist and the reason for saving it.

When the tooth starts hurting badly, it means that the decay has penetrated the innermost layer (pulp) of the tooth. At this point, the tooth can be saved with a root canal therapy. 

Due to the increased cost of dental treatment, patients often try to treat cavities at home using over-the-counter pain medications and home remedies. The prolonged use of medicines may temporarily relieve the toothache. Still, the destruction of the tooth continues to the point that it becomes weak, and its walls start to fall apart, making it unrestorable.  

The bar length shows the percentages of each reason for tooth removal. The longer bars represent more patients undergoing extractions.  

When the tooth decay extends to the tooth’s root or the floor of the pulp chamber, the tooth cannot be saved.

It is, therefore, advised to consult a dentist as soon you notice a cavity, pain or swelling in the tooth.  

Look at the right-sided tooth: The two large black areas, one on the left side of the tooth and the other in between its roots show the level of destruction on the tooth and bone. Such teeth are difficult to save and require removal. If saved, the chances are they may not last for so long. The other two teeth are less destroyed and need a filling. If you see a cavity in your teeth, get an appointment with your dentist before it’s too late. 

Gum disease 

Periodontal or gum disease is the second most common reason for tooth extraction. It is the disease of supporting tissues of the teeth that includes cementum, attachement fibers and the surrounding bone. These supporting structures are known as periodontium and the disease is known as periodontal disease.

Accumulation of plaque and tartar on the teeth due to improper or irregular brushing and flossing can inflame gums surrounding the teeth. If dental plaque and tartar are not properly removed for long periods, the bacteria in the plaque destroy the tooth-supporting tissues leading to bone resorption and loss of tooth attachment fibers.

Patients with uncontrolled diabetes often experience tooth loss. High blood sugar aggravates gum disease and allows rapid destruction of the tooth supporting structures leading to the multiple loss of teeth. 

Robert J. Genco

The loss of periodontal support appears as receding gum lines and teeth appear longer than usual. The teeth can be saved if the disease is intercepted early.

Untreated or uncontrolled gum disease may destroy the supporting tissues to the extent that teeth become loose and require extraction.  

Dental trauma 

Trauma to the teeth frequently occurs in children and young adults and constitutes 5% of all injuries. According to an estimate, nearly 25% of young children and 33% of adults experience some form of dental trauma. 

The degree of impact on the teeth determines the fate of the tooth. Some injuries are so severe that they may require tooth extraction. Let’s see which injuries can lead to tooth extraction:

Fracture of tooth or jaw after an injury

A tooth fracture resulting from a fistfight or automobile accident may require extraction if the fracture occurs below the gum line.

Also, the lower jaw fracture from a car crash needs extraction of the teeth lying in the line of fracture as the teeth can infect the fracture and impedes its healing.  

Front tooth injury in children

In cases of direct impact on the upper front teeth such as fall injuries in young children, the blood supply of the teeth is cut off, making them dead.

Over time, the tooth discolors due to the release of breakdown products of blood hemoglobin. The damaged vessels also release enzymes that can lead to resorption (dissolution) of the tooth from inside. This phenomenon is known as internal resorption and severe resorption requires extraction of the affected tooth. 

Avulsion injuries (a tooth is beyond saving if not placed within 30 min)

A blow to the face can lead to tooth avulsion. In other words, the tooth comes out as a whole with the fibers attached to the intact root.

Avulsed teeth must be placed in saliva or milk to keep them vital. If the teeth are not kept in saliva or milk and are left out of the mouth for longer than 30 minutes, the teeth can not be placed back in their sockets. These cases also require tooth replacement.

External cervical resorption (dissolution of tooth just below the gums)

It is the dissolution or removal of hard tissue from the neck of the tooth, just beneath the gums. The resorption appears years after the exposure to the inciting factor as pink spots near the gums.

These resorptions result from traumatic injury, orthodontic treatment, internal bleaching, habits of clenching or grinding teeth, and bad oral hygiene. Some diseases, such as hypothyroidism, hyperparathyroidism, or Paget’s disease of bone, etc., also cause root resorption. In most cases of cervical resorption, a combination of the factors listed above play a role in its development.

when is a tooth beyond saving
The bar length shows the percentages of each reason for cervical root resorption. The longer bars represent more patients undergoing resorption.  

Teeth with extensive tooth resorption can’t be saved and require extraction. 

Let’s see how few of these factors induce cervical root resorption on the teeth:

Orthodontic treatment

Use of force that exceeds the functional capacity of teeth during orthodontic treatment or prolonged duration of treatment can lead to external cervical resorption. A 150 gm force is required to move a tooth, and any pressure greater than this can induce external resorption.  

Internal bleaching

The root canal treated teeth that undergo internal bleaching may develop cervical resorption. During internal bleaching, the bleaching agent is placed inside the root canal treated tooth, and the patient is sent home.

The patient is recalled either the next day or after a week (depending on the concentration of the bleaching agent) and the bleaching agent is replaced. The whole process is repeated until the desired tooth color is achieved.

Young patients are at a higher risk of getting cervical root resorption, as wider dentinal tubules in the tooth may allow bleaching agents to diffuse into the gum space. The irritation or damage inflicted by peroxide (bleaching agent) may result in resorption.

S. Patel.

The incidence of root resorption following internal bleaching is 1-13% and appears years after the treatment. 

Traumatic injury

Avulsion or injuries to the teeth that may or may not displace them but cause damage or rupture to the tooth-supporting tissues can initiate the process of cervical root resorption.

fracture of the tooth

A tooth fracture generally occurs in root canal treated premolars (tooth no 4 and 5 from the center). The thin walls of the root canal treated premolar with a post exerts a wedging force on the tooth, splitting it into two.

Due to the high risk of fractures in premolars, it is recommended to cover them soon after the root canal treatment with a crown.

Impacted or infected wisdom teeth 

Impacted teeth are the teeth that remain hidden in the bone or beneath the gums past their age of eruption. Wisdom teeth are the most commonly impacted teeth as they are the last ones to erupt. The lack of space or improper position of the wisdom teeth accounts for their impaction. 

Eruption of wisdom tooth when there is not enough space in the jaw

In fewer cases, if the space is not enough for the wisdom tooth to come in its place, one the two things can occur:

  • The pressure from the erupting lower wisdom tooth may cause the teeth to shift to make room for the wisdom tooth, resulting in crowding of the lower front teeth. Such a scenario requires removal of lower wisdom teeth to remove undue pressure on the front teeth. 
  • The erupting wisdom tooth may emerge in a slightly outward position. Such a tooth remains partially covered with gums and leads to recurrent infection due to plaque deposition in the gum pocket covering the tooth. The gum tissue may require surgical removal to prevent infections, but the gum tissue often grows back. The outward-positioned tooth also hurts the cheek while chewing. Therefore, tooth removal may be required to resolve both the issues. 
Look at the last tooth next to the fingernail: This wisdom tooth has erupted outward in relation to the other teeth and is likely to hurt the cheek on chewing. It may also develop an infection from food entrapment in the surrounding collar of gums and, therefore, requires removal. If you are in a similar boat, book an appointment with your dentist.

Deep infection of wisdom tooth

The infection of erupted wisdom teeth is common. The distant location of these teeth in the mouth may not allow thorough removal of plaque by a toothbrush, especially from its back surface, leading to cavities. The deep infection in wisdom teeth requires extraction due to their variable and complex root canal structure.   

Root canal failure 

Root canal failure is another reason for tooth extraction, and 8.6% root canal treated teeth undergo extraction. 

The success rate of endodontic treatment is pretty high, i.e., 86-98%. However, root canal failure can occur due to incomplete removal of infected tissue, poorly filled root canals, over-filled canal, broken instrument, perforations, or missed canals.

Click on the link for full article on, What causes root canal failures (7 proven causes).

An experienced endodontist can correct these problems by re-treating the tooth using the latest equipment and techniques. 

Regardless, it may not always be feasible to retreat failed root-treated teeth in all dental practices and cases. For instance, patients with a missed root canal often have to go for an expensive Cone beam CT scan which provides a three-dimensional image of the root canals for the re-treatment. 

Mikiyo Yamaguchi

Furthermore, fractured root canal-treated teeth cannot be saved and also require extraction. Patients’ general health, age, and affordability also account for attempts to re-treat the tooth. 

braces or orthodontic treatment 

Fixed orthodontic treatment may require the removal of healthy premolars (tooth 4 or 5 from the center) in crooked teeth to create space for the alignment of teeth. You will be told before the placement of the orthodontic appliance that your case requires removal of healthy teeth. The orthodontist will go ahead with your consent for your premolar extraction.

In my view, it is best to go for the extraction because straight teeth are easy to clean with fewer chances of getting cavities. So, extraction of few teeth will improve your smile, facial appearance and give longer life to other teeth in the mouth. 

Orthodontic treatment is not associated with any side effects if a qualified orthodontist does it and good oral hygiene is maintained during and after the treatment.  

How to replace a tooth? 

There are several ways to replace a tooth. These include partial dentures, bridges, or implants. 

Partial dentures

Partial dentures are the most widely used method for replacing a missing tooth due to their lower cost. However, the acrylic portion of the denture covering the roof of the mouth or the inner side of the lower jaw initially interferes with the speech, and patients take time to adapt to this new change.

The artificial teeth of the denture rests above the gums of the missing teeth. The removable appliance or denture is stabilized by the small curved wires encircling the adjacent teeth called clasps. The clasps and acrylic portion may be uncomfortable to the patients for first couple of weeks but, eventually they get use to it.

Bridge

A bridge is another way to replace the extracted tooth. It involves cutting the adjacent healthy teeth to support the missing artificial replacement. 

Dental implant

A dental implant is the best way to replace a tooth. It resembles a natural tooth as it has a root that integrates with the bone and the upper portion resembling the tooth crown. Because of its cost, most people usually opt for other cheaper alternatives.  

Summary 

In this article, when a tooth is beyond saving, I have explained in detail all the reasons that can lead to tooth removal. 

In a nutshell, a massively destroyed tooth involving its roots is difficult to save and requires extraction. Extensive dental cavities and gum disease are the two most common reasons for tooth extraction. Other less frequent causes are injuries, root resorption, orthodontic treatment, root canal failure, and impacted or infected wisdom teeth. 

The extracted teeth can be replaced by a partial denture, bridge, or dental implant. 

Comment below if you find this article informative. 

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