Should I Extract My Tooth or Opt for Gum Surgery? Expert Dental Advice

Please advise the physician?

Hello Dr.
Huang: I have three connected crowns on my upper right side teeth (FDI numbers 13/14/15).
The dentist at the clinic said from the X-ray that the tooth underneath the crown (FDI 15) has severe decay and needs to be extracted after removing the crown, followed by the placement of a bridge with four artificial teeth.
Today, I went to Chung Shan Medical University Hospital for a consultation, and the doctor mentioned that if I do not extract the tooth, I would need to undergo surgery on the gums for treatment.
I asked the doctor which method is better, and whether the gum surgery without removing the crown could lead to the deterioration of tooth 13, but the doctor said they could not be certain.
I would like to know if gum surgery is superior to tooth extraction, or if it would be better to perform gum surgery and then redo the three crowns (FDI numbers 13/14/15).
Thank you for your clarification.

Lydia, 30~39 year old female. Ask Date: 2016/07/18

Dr. Huang Tingfang reply Dentistry

Dear Lydia,
Hello! Based on what you've mentioned, both medical institutions have provided very reasonable and practical suggestions.
FDI 15 appears to be severely decayed, and extracting it to create four dental prostheses is a viable option.
The second institution seems to want to preserve FDI 15 and is considering surgery, but if the decay is too deep, it could affect the health of the surrounding teeth.
Each option has its pros and cons, so it would be wise to evaluate them carefully.
Thank you! Wishing you peace and safety!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2016/07/18

More Info

Dear Patient,
Thank you for your inquiry regarding your dental situation involving your upper right teeth (FDI numbers 13, 14, and 15). It sounds like you are facing a complex decision regarding whether to extract the affected tooth (FDI 15) or to pursue gum surgery. Let’s explore both options in detail.

Understanding the Options
1. Tooth Extraction:
- Indications: If the tooth (FDI 15) has severe decay that cannot be restored, extraction may be the most straightforward solution. This would involve removing the tooth and potentially placing a bridge to replace the missing tooth, which would involve the adjacent teeth (FDI 13 and 14) as anchors.

- Advantages: Extraction can eliminate the source of infection and pain, and it allows for a definitive restoration plan (like a bridge) to be implemented without the risk of further complications from the decayed tooth.

- Disadvantages: The loss of a tooth can lead to changes in your bite and jaw alignment over time. Additionally, if not replaced with a bridge or implant, the adjacent teeth may shift, leading to further dental issues.

2. Gum Surgery:
- Indications: If the dentist suggests gum surgery, it may be to treat periodontal disease or to access the tooth for further treatment. This could involve cleaning out infection or decay around the tooth without removing it.

- Advantages: Preserving the natural tooth can be beneficial for maintaining your bite and jaw structure. If successful, it may allow you to keep your tooth and avoid the need for a bridge.

- Disadvantages: Gum surgery can be invasive and may not guarantee the health of the tooth. If the underlying issue (decay or infection) is severe, the tooth may still need to be extracted later. Additionally, there is a risk that the adjacent teeth (FDI 13) could be affected if the infection spreads or if the surgery does not resolve the issue.

Considerations for Decision-Making
- Severity of Decay: The extent of decay in FDI 15 is a critical factor. If the decay is extensive and the tooth is not salvageable, extraction may be the best option.

- Long-term Health: Consider the long-term implications of both options. If the tooth can be saved through surgery, it may be worth the effort. However, if the prognosis for the tooth is poor, extraction may ultimately be more beneficial.

- Consultation with Specialists: It may be helpful to seek a second opinion from a periodontist or an oral surgeon who specializes in gum disease and tooth extractions. They can provide insights into the potential outcomes of both options.

- Impact on Adjacent Teeth: You raised a valid concern about whether gum surgery could negatively impact FDI 13. If the surgery does not adequately address the decay or infection, it could lead to further complications for that tooth.

Conclusion
In summary, the decision between extracting the tooth or opting for gum surgery should be based on the severity of the decay, the overall health of the adjacent teeth, and your long-term dental health goals. If the tooth is deemed non-restorable, extraction followed by a bridge may be the most prudent course of action. However, if there is a chance to save the tooth through gum surgery, and if you are willing to accept the risks involved, that could also be a viable option.

I encourage you to discuss these considerations with your dentist and possibly seek a second opinion to ensure you make the most informed decision for your dental health. Thank you for reaching out, and I wish you the best in your treatment journey.

Best regards,
Doctor Q&A Teams

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