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Pull your tooth or save it? Which is Best?

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Oh no, a sore tooth, a broken tooth, or a wobbly tooth? There are many reasons for visiting the dentist and dental emergencies are one of the most common appointments made. We often are faced with the hard decision of whether or not we should remove a tooth or save it. This decision can be difficult at times as we factor finances, time, or pain. Our goal at True Smiles Dental is to assess the situation and determine what treatment options are best for you and your tooth. Often, the pain from a toothache can dictate our decision making and we turn to tooth extraction as a quick solution in alleviating the said pain. An understanding of the situation and the possible solutions have allowed our team to save many teeth which would otherwise have been extracted.

We’ve listed some of the common issues that arise where patients aren’t sure whether they should save their tooth or not. These issues may arise and cause us discomfort or pain, and once assessed, we are faced with the decision of saving or removing the tooth.


1. Root Canal or Not?

Often, a tooth ache can cause excruciating pain, a throbbing pain that lasts all day and night, it disrupts your sleep and pain killers are not effective. Such pain most likely indicates a tooth that may require root canal therapy. Root canal therapy is an effective way to save your tooth and rid you of the pain you are experiencing. The nerve that lives inside your tooth tells you whether something is hot or cold and when bacteria from tooth decay digs deep enough and encounters the nerve, pain ensues. The pain often dictates our decision and its not uncommon for patients to request the tooth to be removed.

Removing the tooth is an option, but is it the best option? Root canal therapy has been well documented as a viable treatment option for saving teeth. Unfortunately, not every tooth can be saved and after careful examination, the team at True Smiles Dental can ascertain whether your tooth can be saved.

2. My tooth is mobile?
Increased mobility in a tooth can be a result of periodontal disease or a large infection. Many patients believe that a tooth that is moving needs to be removed. In certain situations, this may be true, but with the correct treatment, it is very possible to improve the mobility of the tooth and save the tooth in question. We may need to start periodontal treatment, root canal therapy, or a combination. Mobile teeth are generally trickier to save, but not impossible, with careful investigation and the right approach, we can make the impossible possible.

It is very important to seek advice from your dentist to aid in making the important decision of saving or removing a tooth. At True Smiles Dental, we employ the latest x-ray technology to assess your teeth and make the most accurate diagnosis for you. This allows us to confidently tell you what the problem is and how we can address your issue.

Some factors we take in to consideration when assessing if a tooth can be saved or not:

– How big is the hole or cavity?

o Some teeth are heavily decayed and unfortunately have lost far too much tooth structure for long term success. Even with root canal therapy, the pain may improve, but the underlying issue of a large cavity in the tooth may deem the tooth hopeless. Unfortunately, such teeth would require extraction despite our best intentions. Thankfully, most teeth with cavities can be restored. And so, treating the tooth with root canal therapy and the placement of a crown on completion should allow us to save your tooth!

– Is the tooth functional?

o Is your tooth utilized in biting and chewing? This determines if a tooth is ‘functional’, and plays a large role when deciding what to do with your tooth. If the tooth of concern does not serve a purpose in normal mastication. Then often, we may consider removing the tooth as opposed to saving it.

– Mobility of the tooth?

o Teeth can often become mobile due to a large infection or because of periodontal disease. These situations are challenging and commonly lead to extraction due to difficulties in saving the tooth. However, if you are willing to try and save the tooth. Treating a mobile tooth with root canal therapy can often save the tooth and stabilise the tooth.

– How large is the infection?

o The bacteria that colonises in the tooth from tooth decay generally spreads to the apex of the tooth root. Some infections can be quite large and weaken the surrounding bone that holds your tooth in place. The extent of the infection can be seen in x-rays and often dictate the success of treatment.
Reasons for saving your tooth

We’ve listed the many reasons for when we need to make that important decision of saving your tooth, but it is just as crucial to address some important points as to why we should save your tooth.

– Preventing migration of teeth

o Teeth tend to tip or migrate forward as we age. Removal of a tooth allows for teeth neighbouring to start to move or tip over. Teeth that sit adjacent to the offending tooth can tip into the space of the to-be extracted tooth which can lead to issues with biting, food trapping, tooth decay, and periodontal disease.
o Overeruption of opposing teeth can occur after the removal of a tooth. The opposing tooth (the tooth that comes into contact when biting) can start to over-erupt – meaning the tooth can start to come down or up further than its neighbouring teeth. Since there is no longer a tooth to bite on, the opposing tooth tends to move upward/downward. This can lead to cheek biting, food trapping, along with tooth decay or periodontal disease. Consequently, with time, the opposing tooth may need to be removed also.

– Loss of facial height

o Did you know that your teeth dictate the height of your face? Losing multiple back teeth can lead to a reduction in your facial height. This tends to make one look older than they are.
– Eating and chewing
o Loss of teeth will ultimately change the way we bite. Believe it or not, but every tooth serves a purpose when we eat and chew. Your incisors are for biting into food, your canines are for tearing apart food, premolars and molars are for tearing, grinding, and crushing food. Loss of one or more teeth will affect how we eat or chew going forwards.

– Increased risk of fracture/damage to remaining teeth

o When teeth are taken out, the remaining teeth will have to undergo further stresses due to the reduced support from the extracted tooth. If your existing teeth have large fillings, then it is very common for issues to arise after the removal of a tooth. The increased pressure, and reliance of the remaining teeth increase their risk of issues that can develop.

– Keeping your own natural teeth

o Your natural teeth are exceptionally strong and outperforms any dental filling. The natural feel of your tooth is also important, and many patients prefer to keep their teeth to maintain this sensation.
– Cost saving
o Removal of a tooth may seem like the easier option at times. But replacement of a missing tooth can be costly and more time consuming than trying to save the tooth.

Reasons for removing your tooth

At True Smiles Dental, we feel your teeth are very important and we do our utmost to save your natural tooth where possible. Unfortunately, not every tooth can be saved, and tooth extraction may be the only option. Below are a few examples of teeth that can’t be saved and require extraction:

– Cracked tooth

o A cracked tooth is one of the most commons reasons for tooth extraction. A split in the tooth can travel toward the gum or into the roots of the tooth. We call this a vertical root fracture, and to prevent the harboring of bacteria and infection, unfortunately, the best solution is extraction.

– Severe periodontal disease

o Periodontal disease if left untreated, can result in tooth pain, tooth mobility and infection. When severe enough, treatment would provide no benefit and to prevent further damage to surrounding structures, tooth extraction is recommended.

The removal of a tooth is a multifactorial decision, and each situation is unique. We’ve listed the common reasons for saving a tooth and when to pull the tooth out. To aid your decision, the team at True Smiles Dental can make a thorough assessment of the tooth and consider all factors to help you make the right choice. It is our goal to ensure everyone understands the rationale behind the treatment and we strive to make it as pain free as possible. Reach out to us at (02) 7228 7272 or book online at