Don’t Take That Tooth! Alternatives to Tooth Extraction
by Dr Richard Barry
Many people of a certain age can recall seeing comical illustrations of children – usually little boys – pulling out a bothersome tooth by tying a string between the tooth and a doorknob and slamming that door shut. Appealing as this method may be to a dentist-fearing child, it’s certainly not recommended. Safely extracting a tooth takes more than simply “pulling teeth.” And while it may be a solution to certain dental problems, there are alternatives to extraction that are safe and effective.
When is tooth extraction considered?
The tooth extraction most people are aware of is the removal of the wisdom teeth at the very ends of your rows of teeth. This has been such a common practice for so long that it’s almost a rite of passage to adulthood. Removing wisdom teeth is usually done as a preventive measure, to keep these “extra” molars from pushing other teeth out of place and causing improper alignment or bite.
Wisdom teeth aside, however, removing other teeth is rarely done without a very good reason.
Your adult teeth are meant to last a lifetime, and they usually do. Sometimes, however, what is meant to be, doesn’t happen. There are three common reasons why we might recommend removing a tooth.
Crowding. Think of an egg carton with twelve pockets for the eggs it’s intended to hold. Now imagine what would happen if you tried to add another egg. Not a neat carton of eggs, but a jumble. And likely at least one broken egg. Like that egg carton, your jaw is meant to hold a certain number of teeth that fit well and cause no problems. But occasionally a person’s teeth are too big for their mouth. This can cause misalignment of the entire row of teeth or cause a new tooth to be unable to emerge.
Infection. Yes, your mouth can get infected! If you have significant tooth decay or tooth damage, bacteria can move into the center of the tooth (called the pulp) where the nerves and blood vessels are. Then you have an infection. If not caught early, infections may not respond to antibiotics, so extracting the infected tooth may be the only way to stop the spread of the infection and keep you from losing even more teeth.
Periodontal disease. This is a specific type of infection that occurs in the tissue and bones that surround your teeth, and that causes a tooth to lose the tight support it needs to function properly. A slightly loose tooth may not be cause for an extraction, but once a tooth is loose enough to be wiggled about by you, it’s probably time to take it out, before the infection can reach the tissue that is holding up other teeth.
If I don’t want a tooth removed, what else can be done?
Two procedures that are commonly used as alternatives to tooth extraction are root canal and apicoectomy. While these procedures are similar, and both attack the cause that seems to warrant tooth extraction, a root canal is by far the more common. In fact, you probably never saw the word apicoectomy until you read it here. These two procedures focus on the same result and seek the same outcome, but there are differences.
Root canal. If the nerve of one of your teeth has become infected or the pulp of the tooth has been damaged, your entire mouth is in danger. Without treatment, the tissue around the tooth can become infected and an abscess may form. Left untreated, blood-poisoning infections from tooth abscesses can be life-threatening, even in healthy adults.
When the trouble is caught early, though, such a tooth makes a good candidate for a root canal. During a root canal, the pulp and nerve of the tooth are taken out, and the inside of the tooth is cleaned and sealed. As long as the tooth is still reasonably well supported by gum tissue and bone, a root canal has a nearly 90% chance of working. And don’t worry. When done properly, a root canal procedure is no more painful than getting a cavity filled. (Learn more here.)
Apicoectomy. This is a term we suspect you’ve never come across until now. At least we hope not. Infection can seep into the bony area around the end of a tooth, even after a root canal procedure has saved the tooth from extraction. An apicoectomy is a step we can take after a root canal procedure when the inflammation or infection in your tooth is still around. Considered a microsurgical procedure, an apicoectomy – also called a root-end resection – is more complex than a root canal, and it involves a stronger local anesthetic and a longer healing time.
In an apicoectomy, a dentist surgically opens the gum tissue that surrounds the affected tooth. The now-visible area under the tooth is examined for inflamed or infected tissue, and all such tissue is scraped away. Once the compromised tissue has been removed, part of the tooth’s root is cut away and a small seal is placed over the end of the root canal. A few stitches are put in to help the tissue mend, and, over a period of a few months, the bone heals around what remains of the tooth’s root.
With either procedure, post-procedure discomfort is usually mild and can be handled by over-the-counter medications. Most people return to their normal activities the next day.
The need for a root canal or an apicoectomy is not especially common if your oral health regimen includes daily brushing and flossing, along with regular visits to your dentist. However, If you are experiencing discomfort from your teeth, contact us. Our professionals can determine the cause of your pain and help you decide on a treatment plan that’s best for you.