Alternatives to Tooth Extraction

Tooth extraction is normally recommended as a last resort when other treatments have failed or are very likely to fail. However, there are cases when pulling a tooth is simply a cheaper and faster option than other procedures. Not every tooth extraction is necessary. If you aren’t sure what your options are, you should seek a second opinion from another dentist to explore any additional alternatives. Here are some examples of situations where you might have other options:

Pericoronitis

This is a gum infection that often occurs around a wisdom tooth when a flap of gum is partially covering the crown of the tooth. The inflammation and irritation caused by bacteria and food debris trapped in the gums can be uncomfortable. Left untreated, the infection may lead to an abscess in the gum or other complications. Since wisdom teeth are not usually needed for proper oral function, removal is the traditionally recommended treatment to permanently resolve the infection. However, pericoronitis can also be treated quickly and effectively over the short term with antibiotics and salt-water rinses. It usually only takes a week or so for the gums to respond to this treatment. If the infection is recurring (which is often the case), you can also explore having the flap of gum removed instead of the tooth itself. If the gum does not grow back, your pericoronitis problem may be solved.

Severe Decay

A tooth with significant decay may be a candidate for removal rather than traditional restoration. In some cases with large cavities, a metal amalgam filling can weaken the structure of the tooth and make it more likely to fail in the future. This means the tooth would eventually need to be extracted anyway once it breaks. However, a porcelain onlay can sometimes restore even a large area of decay while actually strengthening the affected tooth. This means a tooth that would have been pulled in the past could potentially be saved with modern dental materials and restoration techniques. Of course, you will need to stop the progress of dental caries (cavities) to keep the rest of the tooth strong. A porcelain onlay can cost more than $1,000, which is why some patients choose extraction or a metal filling instead.

Orthodontics

In adult orthodontics, it is a common practice to remove one or more teeth prior to fitting braces. The goal is to allow room for the remaining teeth to move into the desired position and to prevent the teeth from moving back into their former position after treatment. This is not always necessary depending on the amount of correction you desire and other factors. You need to see an orthodontist who specializes in treating adult patients to explore all your options. An orthodontist should always explain why he recommends extraction as part of the treatment plan.

In some cases, adults may be candidates for jaw expansion surgery to create more room for their teeth. However, jaw surgery has a much more painful recovery time and carries a higher risk of serious complications than a simple extraction. In the case of children, orthodontists usually recommend options such as palatal expanders which can provide more jaw room without extracting teeth.

Failed Root Canal

Extraction is one potential treatment if a root canal does not resolve a tooth abscess. However, there are several other procedures that may be tried as well. A re-root canal is basically the same procedure as a root canal but is more extensive. It may be done if there are areas of infected tissue that were missed in the original treatment. A root end resection (apicoectomy) is another option. This is an endodontic surgery that involves removing the very end of the tooth root and replacing it with a filling. This treatment does not always resolve the infection, in which case, dental extraction may still be needed.

Bone Grafting

This is a potential treatment in cases of periodontal disease (gum disease) that has eroded the bone and left the tooth loose in its socket. Usually, a dentist will recommend extraction of the existing tooth to help halt the gum disease, then bone grafting for restoration, followed by replacement with a dental prosthetic such as an implant. However, you can ask whether it is possible to do the bone restoration without dental extraction. This approach may be more difficult and prone to failure which is why it is not standard practice.

Other Alternatives to Tooth Extraction

In some cases, you may simply:

• Delay treatment as long as possible
• Take painkillers or anti-inflammatory medications to mask symptoms

However, the types of dental problems treated by tooth removal do not simply go away. They tend to get worse over time, leading to complications and higher risk extractions. Practicing good oral hygiene, seeing your dentist regularly, and seeking early intervention for problems like cavities and periodontitis is the best way to avoid dental extraction.