One of the most difficult decisions we make in dentistry is whether to try to save a tooth that is deemed fair, guarded or having a poor prognosis. One question I ask myself and communicate with to the patient is this: Is it worth the additional time, labor and cost to save a tooth that may need to be extracted later?
If there is periodontal bone loss over 50%, it may be better to extract the tooth, especially if there is active infection or the person isn’t coming in regularly for their periodontal recare. If there is deep decay near the bone or extensively throughout the tooth, it may not be worth the additional surgical procedures and loss of bone to do crown lengthening procedures or root canal procedures with posts and cores, etc.
If there are cracks that are located within the confines of the tooth, then many times a crown and build up can be placed and will solve the problem or a root canal if there are symptoms. But, if the crack extends down onto the root, then the prognosis is generally hopeless and it will be better to extract the tooth as it cannot be saved no matter what we do. This is the main criteria for removing a tooth with a crack and it is sometimes a difficult diagnosis and a hard decision to explain to our patients. Many of these also have the telltale sign of active infection along the crack extending down the root, but some do not.
Our 3D cone beam X-rays can help in the diagnosis and decision making. We are seeing many more of these “cracked tooth syndromes” in our practice as people are under a lot of stress and tend to bruxism, the clenching and grinding, of their teeth. The best approach is prevention and trying not to place any fillings in the tooth if possible so as to weaken it.
Regular preventative maintenance hygiene visits, check ups and dental X-rays go a long way to accomplishing this. When the decision arises of whether to save or not to save a tooth, many times the decision will be obvious (and many times it won’t) and a discussion with your dentist as to the short and long term prognosis, advantages, disadvantages, cost, labor and time will go a long way to help in this difficult decision making process. If you would like to schedule a consultation with Dr. Vaughn at Two Rivers Dentistry in Vancouver, Washington, we welcome you to call us today at 360-256-1202. Your smile will thank you!