So, you’re having a problem with a tooth, and as fate would have it, it’s a pretty big problem. Maybe the tooth broke below the gumline, or it had root canal a while ago and for some yet to be determined reason has become problematic, or perhaps you developed an abscess on a tooth that was already weakened by previous trauma or gum disease.

Whatever the reason, complex dental problems can and do occur for a variety of reasons and can manifest themselves in a myriad of ways.

And now your dentist has explained the nature of your problem and the treatment necessary to save your tooth is more complicated than any dental care you have received in the past (especially for one tooth.) Your doctor has outlined a course of dental care that will require multiple procedures, which may include some form of oral surgery.  

And then there is the cost of said treatment, which is considerable – due to the complexity of the problem. 

When confronted with such a situation, the more relevant question is not, “Can your tooth be saved?” but rather, “Should your tooth be saved?” 

There was a time in dentistry when dentists did everything clinically possible to save a tooth. But today, in many cases, the most prudent, predictable, and conservative treatment approach is to remove the tooth and replace it with a dental implant.

For purposes of clarification, I am not talking about an otherwise healthy tooth that needs a root canal because of a deep cavity and now needs a post/core and crown. Admittedly, it a costly investment, but one resulting in a healthy tooth that will likely last for many years.

Five common dental maladies can transform your previously healthy tooth into a tooth that’s in peril and opens up the question of whether it’s worth trying to save.

1. Your tooth is cracked, severely broken, damaged in an accident, or possibly even knocked out of position.
2. You’ve developed an abscess (an acute infection) due to an infected nerve, a failed root canal, or gum disease.
3. Your tooth has a large cavity. The cavity is so large, in fact, that it will not only require root canal but because of the extent of the decay, the very structure of the tooth is severely compromised and weakened – something that root canal cannot remedy.
4. Your tooth has a cavity that extends under the gum and neighboring bone, which makes gum surgery necessary to remove the decay.
5. You have extensive bone loss due to gum disease.

Serious Dental Problems Can Emerge Seemingly Out Of Nowhere

I can’t begin to count how many patients call for an emergency appointment because they unexpectedly bit into something hard like an unpopped corn kernel or an olive pit. Everything was fine, then just like that, what was once a healthy tooth is now an acutely painful jagged and sharp fragment of its former self.

Unexpected toothaches are also the cause of many emergency visits. You will be drinking something hot or eating something cold when suddenly and unexpectantly the feeling of intense, jaw-dropping pain radiates seemingly from out of nowhere.

Then, there’s this common scenario: you were kind of aware something was brewing for some time but tried to wish it away until wishful thinking evaporated prompting an unplanned call to the dentist.

Can Your Tooth Be Saved? Should Your Tooth Be Saved?

Back to your problem. You have a choice to make, should you try to save your tooth? Or is it a better option to have it removed and replaced with an implant.

How do you go about making the decision?

Let’s take emotions out of the equation for a second, which is not so easy if the tooth in question was one of your beautiful upper incisors that were shattered by a wayward baseball and thus smites your previously pristine and dazzling smile.

This is where you must depend upon your dentist’s prognosis. Prognosis, according to Merriam-Webster, is “the prospect of recovery as anticipated from the usual course of disease or peculiarities of the case.”

Ask Your Dentist These Three Questions

1. “If you can save my tooth, how long will it remain healthy?”
   Tip: It probably doesn’t make sense to try to save it if the tooth lasts only for a few years. A 25-year old will likely view a three- to five-year prognosis much differently than an 89-year old who is in somewhat fragile health.
2. “If you can save my tooth, how will it feel?
   Now, we don’t usually think about how our teeth feel unless there’s something wrong. Will it feel as strong as your other teeth? Will it feel strange to your tongue because it’s shaped differently or is longer than it once was?
3. “If you can save my tooth, how will it look?”
   If your front tooth is broken at the gum line, it can probably be saved, but sometimes it doesn’t look exactly like your neighboring teeth, especially if you have a gummy smile.

To Save Or Not To Save Your Tooth – Your Options

Today’s modern dentistry affords a skilled dentist very reliable and predictably successful treatment options to address an ailing tooth. Today’s periodontal and surgical advances, combined with the advanced restorative materials available, allow for a tooth that is broken or decayed under the gum to be restored back to its original form and function.

From a dentist’s perspective (yours truly), advances in science, technology, and research make this an exciting time to practice dentistry. Today, I can save many ailing mouths, which in an earlier era would have been hopeless.

So, let’s get back to the original premise of your tooth problem, shall we? Let’s look at it from a different perspective.

Maybe Your Tooth Shouldn’t Be Saved

Even if your damaged tooth could be saved, there’s a good possibility that it won’t stay intact for very long, it won’t feel like your natural tooth, and it won’t look the same as the surrounding teeth.

That’s why more and more, a dental implant is the smarter option. An implant can be placed in your bone and topped with a crown that feels and looks just like one of your natural teeth. And, with all things being equal, the success rate of implant placement is around 96%.

Moreover, if you’re thinking about cost, conventional methods used to save a damaged tooth that includes periodontal surgery, root canal therapy, orthodontic treatment, post and cores, and crowns are not only costly in dollars and cents but in time, as well. The implant approach to care may very well be less costly.

In Conclusion

So, getting back to whether it’s worth it to try to save your tooth, you must consider cost, time, prognosis, and the final outcome. After your dentist conducts a thorough evaluation, have an open and candid discussion, and if you don’t feel 100% comfortable with his or her prognosis, get a second opinion!

(Note, this discussion does not apply to wisdom teeth, but this one does: Do Wisdom Teeth HAVE To Be Extracted? New Research)

Michael Sinkin practices cosmetic, implant, and restorative dentistry in New York City. He is known for the wonderful care he provides to his patients, and for his wicked sense of humor! To contact Dr. Sinkin, click here.