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?