Monday, September 27, 2010

The problem tooth: when should we pull the plug?

“Herodontics” is a term used by some to describe measures far beyond reasonable to salvage a failing tooth. After all, the oath traditionally taken by dentists is to save the tooth, no matter what it takes.

For example, let’s say you have a tooth with deep decay and your dentist tells you that, sure, it can be saved — but only with a root canal, some bone and gum tissue removal to create space for the crown, and a large post and build-up to support it.

Or perhaps your tooth was twice treated with root canal…and you are still in pain. Of course, you would hate to lose a tooth that you’ve already spent so much money and time on. So your dentist suggests a root surgery and maybe a root amputation and then a new build up and another crown. And he gives it a 50/50 chance of long-term success.

Heroics like this are costly, time-consuming, difficult to perform, and, sadly, ineffective in the long run.

Thankfully, current industry knowledge and technology have created a paradigm shift in treatment recommendations. Today, if a tooth is significantly compromised, we can take a longer and broader view of the available options and outcomes. Even when we can perform procedures A, B and C to save the tooth, as dental professionals dedicated to the health of our patients, we have to ask ourselves, “Should we?”

Sometimes, saving the tooth for the short term may cause more complications in the long run, as with herodontic procedures such as root hemisection, aggressive crown lengthening, apicoectomy of a tooth previously treated with root canal, and even crown supports on teeth with massive missing structure. Of course we can perform these procedures, but the onus is on us to determine if there are better, more successful, evidenced-based treatments that may not include actually saving the tooth. Sad as it seems, chances are that we’re only saving the tooth until the next necessary procedure.

I say it’s time to pull the plug on that problem tooth and spare patients the pain, frustration, and disappointment of fix after fix that only prolong the inevitable. In fact, I propose that dental professionals start practicing “simpractidontics,” simple and predictable dentistry that’s current, successful, cost-effective and longer lasting. I want to educate my patients about all of the possibilities — short- and long-term — and engage them in making better decisions for their overall oral health. Now, don’t you think that’s an entirely different kind of hero?

45 comments:

  1. My friend had some tooth problems that does not only had caused him pain, but as well a lack of confidence. He had this motor accident before that fractured his tooth. He didn't go to a dentist to have it checked. After some years, the tooth started to darken. I told him to see a dentist again, yet he refused. Not too long, the tooth caused him pain. He went to see the dentist, and advised him to have it removed. The pain was gone yet my friend also decided to have dental implants. (St Petersburg) dentists had done him good implants. Now my friend had his confidence back. He can smile now, without any aches and with a brand new tooth.

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  2. Sometimes it is better to have the tooth pulled if tooth problems are always on your way. But the problem in pulling the tooth is that a whole would be left on your gums and bacteria might be happy to live there. The solution is Chicago Dental Implants. And if you have dental trauma, there is sedation dentistry (Chicago) that would ease the pain and your trauma.

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  4. Very good blog and one thing I want to tell that it has been written in a very friendly way.

    One very important aspect of present day dentistry is root canal therapy.

    Root canal therapy is needed when the nerve of a tooth is affected by decay, infection, trauma, or a crack. In order to save the tooth, the pulp (the living tissue inside the tooth), nerves, bacteria, and any decay are removed and the resulting space is filled with a special dental material called gutta percha, which hermetically seals the root canal space from bacteria.
    It gives a complete solution to the problem.

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  5. Another great article. I like that you are very honest and direct to the point.

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  6. This is definitely a great and helpful approach. I am sure patients will be happy about this this kind of approach to them regarding oral care. My best wishes to you. Stay in touch and keep posting.

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  7. Yeah, there is no doubt that dental implant has surely helped in changing the face of dentistry. This implant dentistry requires proficiency in field of surgery and tooth re-establishment.

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  8. Very informative, thanks for the post! Growing up, I remember my mom having dental problems, and going in for multiple procedures to fix the same problem. I'll bet she wishes she could've had it over with quickly, as described here! http://www.oralsurgerycenterchicagoheights.com/our_services/ANESTHESIA_-_Pre-Operative_Care.htm

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  9. Thanks for the post! It is very informative. Many people get scared to see a dentist, but i would suggest if you face any dental problem then do visit a dentist at the earliest before you face more problems. My dentist in Duncan is very helpful, experienced and friendly too.

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  10. Yeah what is the right time of pulling the plug can be known only by a professional. We as normal should not decide it. Denturists and dentists are the one who are extremely brilliant in this.

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  11. I was searching some good dentist for a root canal therapy in Orleans, thanks for sharing the article got some more points to refer before going for the procedure.

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  15. I really think that those problem teeth should come out sooner rather than later. I didn't know that dentists were sworn to save a tooth no matter what it takes. Of course, there are times when they can't save the teeth. I guess that's when they suggest dental implants. http://www.drruda.com/dental-implants/dental-implant-information.aspx

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  16. I'm getting an implant in a couple of weeks, and I'm really starting to worry about it. I just don't want my age to interfere with the operation. Well, at least this article helped calm me down, and now I'm not nearly as scared as I was before.
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  18. I have been battling with some of these "problem teeth" myself. One thing i have been considering is whether or not I should get dental implants. I think it would be a valuable thing to replace the teeth that I may need to remove. I don't know too much about the actual implants though. I would be interested in seeing the way that they have or haven't worked for others before making a decision.
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  19. This is a question that I have been considering for some time. I have a tooth that has already had two root canal procedures. It seems that tooth is just more susceptible to problems. I think it is time to have it pulled. I hope that my insurance will cover the surgery.

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  22. I had a tooth pulled when I was a kid. I remember the tooth hurting really bad before it was pulled, and it felt great when the tooth was gone. Ever since then I have made sure to take care of my teeth. I visit my dentist all the time to make sure that my teeth are healthy. http://www.naasfamilydentistry.com/about

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  23. I actually didn't know there was a term for this. I've had a problem tooth for years now, and I think it's finally on its way out. Like you mentioned, some of the short-term work that was done actually didn't help in the long run. At this point, I'd actually prefer the tooth to be gone. Then I could get an implant and be done with it. | http://www.fourcornersdentalgroup.com

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  24. If you have a problem tooth, I would suggest consulting with your dentist first before deciding on whether to get it removed or not. I wouldn't want to wait until it became a bigger problem. Mainly because if you did, then the procedure to remove it might be more costly and time consuming for you. http://www.saintcloudmndentist.com/

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