Many people think that any time a tooth aches, you should pull it. Unfortunately, pain is not a great indicator of the need for tooth extraction. Severe toothaches do not always require extraction, and sometimes teeth with no pain at all do. This blog will outline some of the signs that a tooth does, in fact, need to be pulled.
Not Enough Tooth Remaining Above the Gums
In order for your dentist to restore a tooth back to normal form and function, there must be a certain amount of tooth structure above the gums. We frequently see teeth with crowns that break off and leave almost nothing above the gums. Sometimes these teeth have had prior root canal treatments; sometimes they have not.
The same reasoning goes for a tooth that suffers severe breakdown due to a large cavity. As decay works its way through a tooth, it softens the enamel and underlying dentin into a mushy substance that can easily crumble away. When left untreated, cavities can work their way across an entire tooth, leaving little but the roots remaining.
We can affix crowns to posts that anchor within the root of a tooth that is broken down to the gumline, but their long-term prognosis is poor. They have a high risk of fracturing off again in the future. Because of this low success rate, you can make a better investment in your smile by removing the remaining root(s) and replacing the tooth with a dental implant. If have a tooth that is broken off to the gums, you should pull the tooth.
Renewed Infections after One or More Root Canal Treatments
Root canal treatments remove the nerve and blood vessels from the hollow chamber within a tooth. They are necessary when these tissues become infected or unable to heal from injury. When a tooth that has already had a root canal treatment gets another infection, the long-term prognosis of further treatment worsens. With each subsequent treatment, the success rate decreases. So if you have a tooth that has had one or more root canal treatments and gets another infection, you should pull the tooth.
Fractured teeth are increasingly common. The reason may lie in increased stress causing more people to clench and/or grind their teeth while they sleep. Whatever the cause, we are seeing cracked teeth on a daily basis. The extent of the crack (or how far the crack goes into a tooth) is what determines the appropriate treatment. A filling or dental crown may suffice to treat superficial cracks. Those that reach the nerve inside a tooth require root canal treatments and a crown covering. The furthest extent of a tooth crack is one that extends onto the root.
A root fracture gives a tooth a hopeless prognosis, meaning there is no treatment that will be successful long-term. This is because the fracture continually allows contamination of the internal structures of the tooth, so all treatments will eventually fail. If you have a root fracture, you should pull the tooth.
Teeth are held within the jawbones by a connection of ligaments and gum tissue. In cases of advanced gum disease, bacterial toxins in plaque and tartar buildup destroy that connection. This allows the teeth to become looser and looser over time. It is similar to the way that soil erosion around the roots of a tree will allow that tree to fall over in time. The roots must have adequate attachment to the bones in order for the teeth to remain stable.
Mild and moderate gum disease respond well to treatment, allowing you to keep your teeth for many years. Severe gum disease is a bit trickier. If the teeth are so loose that you can “wiggle” them with just tongue pressure, their long-term prognosis is poor. It is almost impossible to regain attachment on teeth that have loosened so much. If your teeth are this loose, you should pull them.
In some cases, infections in and around the teeth put you at risk of dangerous swellings. As an infection spreads from a tooth to the surrounding gum and bone, often it can lead to swelling underneath the tongue. This poses a risk to your airway. If the tissue swells so much that the airway closes, you can die.
Removing the tooth that is the source of a dangerous infection like that described above is the fastest route to healing. You can sometimes save these teeth by performing root canal treatments, but there remains a slight risk of residual bacteria. In order to remove the infection as quickly as possible, you can simply remove the tooth.
More Questions about Which Teeth Need Extraction?
Call your nearest Premier Dental of Ohio location today to schedule a consultation with one of our Central Ohio dentists. We can evaluate your current situation and give you a prognosis on the various treatment options available to you.