DENTAL CARE

Jeffrey Gross, DDS, FAGD

Q:I Need This Tooth Removed.

A:I see many patients who introduce themselves with the “tooth removal” statement as their opening remark. Usually, this information is im- parted to them by another dentist, a family member or just an expression of their gut feeling. This discussion happened this week with a patient during a consultation. We discussed a more significant project on a previous occasion. This visit he wanted to start small and deal with a problem that he knew would only cause him much grief if he waited too long. Upon examining the tooth in question, I responded that the tooth does not need removal from the mouth. It can be saved and will continue to function in the way it was intended to work. That’s right, no bridge, no implant, fix the tooth, and it will be fine.

So, the real question is what goes into my decision to recommend tooth removal or for a tooth to remain in the mouth. I will share some thoughts with you on this subject. The outcome of a tooth that is damaged or sick comes down to one concept... the ability to fix it. That sounds simple, but being able to patch, build, or recreate a tooth is really what my job is all about. My goal every day is to keep or put as many teeth as I can back into function. Function in the broader sense of the word means, chewing, smiling and feeling right about our mouths. To get to that point, I need to eliminate the disease that is present and prevent or delay its return for a very long time.

If I cannot fix a tooth, then I look at tooth removal as the direction in which to move to remove the infection and restore health to the mouth. Cavities are typically the cause of tooth infection. A cavity is a large hole that is caused by bacteria eating their way into the tooth. I have discussed in previous columns how bacteria in and around a tooth release acid. This acid creates a hole or cavity in the tooth. Small holes can be cleaned out and fixed with a filling material. Big holes or defects in a tooth require more effort. Depending on where on the tooth is the hole may influence how I can address a tooth problem. The location of the hole caused by the cavity may also influence my decision to remove or keep the tooth. Please allow me to explain a little further.

“Just patch it doc” are the words that I hear all too often. If I can, I will. However, frequently when listening to this request there is nothing for me to patch. There is nothing for me to do. I cannot even do significant work. The tooth is beyond repair and requires removal before it causes serious health issues for the patient. When I saw my patient this week, he saw a doctor who was not comfortable saving the tooth for whatever reason. He informed the patient that removal was imminent. When I examined the tooth, I felt that it was not hopeless. I could remove the infection and follow that up with a repair on the tooth that would allow it to stay in its place without pain or discomfort. It could function the way that it was designed and be part of the entire oral apparatus that we call the human dentition.

Yes, there are times that we have no other choice except for the removal of a tooth. It’s important to know that the extraction of a tooth is the last resort. Dentistry has many ways to fix a tooth and let it stay right where it belongs. If you have a tooth that you were contemplating removing for whatever reason, may I suggest that we take a look at it and see if there are other alternatives for you? Just meeting with talking with me will not cost you anything but your time. The knowledge that you may gain may be invaluable to you. I encourage you to call Megan at 440.951.7856 and set up a time for this important visit. I look forward to meeting you. Jeffrey Gross, DDS, FAGD is an Ohio licensed general dentist and is on the staff of Case Western Reserve School of Dental Medicine.