Should You Extract a Cavity-Infested Tooth? Expert Insights

Should cavities be extracted?

Recently, I sought medical attention due to pain in my left second molar.
At the first clinic, the doctor assessed my condition without taking an X-ray and suggested starting with root canal treatment, followed by gum reduction and a dental crown to protect the remaining teeth.
However, I personally preferred to have the tooth filled after treatment.
Subsequently, I went to a larger hospital for further examination, where an X-ray was taken.
After evaluation, the doctor advised me to extract the tooth.
I asked the doctor if it was possible to keep the remaining tooth for a dental crown after treatment.
The doctor informed me that due to the deep decay, extraction was necessary, and attempting to place a crown might lead to instability due to saliva secretion or could cause autoimmune reactions resulting in infection.
Therefore, the doctor did not recommend a dental crown.
If extraction is performed and I need a replacement, dental implants could be an option.
After hearing this, I am unsure how to decide and am concerned that if I extract the tooth, the adjacent teeth might shift or misalign due to the absence of the tooth, which could have significant future implications.
I would like to know if I should proceed with the extraction.
Thank you.

Nìmíng, 20~29 year old female. Ask Date: 2017/05/18

Dr. Huang Tingfang reply Dentistry

Dear Anonymous Miss,
Hello! If the cavity is too deep and causing pain, root canal treatment is necessary.
After that, a crown will need to be placed, which may extend further down.
Each dentist may have a different perspective on this.
You might consider crown lengthening before placing a prosthesis.
Alternatively, you could proceed with root canal treatment and then fill the tooth, monitoring it until it can no longer be used.
Please communicate openly with your dentist! Thank you! Wishing you peace!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2017/05/18

More Info

When faced with the decision of whether to extract a cavity-infested tooth, particularly in the case of your left second molar, it is essential to weigh the potential risks and benefits of both extraction and preservation. The recommendations from dental professionals often depend on the extent of decay, the tooth's structural integrity, and the overall health of the surrounding gum tissue.

In your situation, the first dentist suggested root canal treatment followed by a crown, which is a common approach for teeth that have significant decay but still have enough structure to support a restoration. However, the second opinion from the hospital, which involved an X-ray, indicated that the decay was too deep, necessitating extraction. This is a critical point, as deep cavities can lead to infections that may not only affect the tooth itself but can also spread to surrounding tissues, potentially leading to more severe health issues.

Reasons for Extraction:
1. Extent of Decay: If the decay has reached the pulp of the tooth, it can cause severe pain and infection. In such cases, extraction may be the only viable option to prevent further complications.

2. Risk of Infection: A tooth with deep decay is at a higher risk of developing an abscess, which can lead to systemic infections if not treated promptly.

3. Structural Integrity: If the tooth is too compromised to support a crown or filling, attempting to save it may lead to further complications down the line.

Concerns About Extraction:
1. Adjacent Teeth: You expressed concern about the neighboring teeth shifting into the space left by the extracted tooth. This is a valid concern, as the absence of a tooth can lead to misalignment and bite issues over time.

2. Future Restoration Options: If you choose to extract the tooth, dental implants are a reliable option for replacing missing teeth. They can help maintain the integrity of the jawbone and prevent adjacent teeth from shifting.

3. Self-Immune Reactions: The dentist's mention of potential autoimmune reactions to materials used in crowns is a consideration, albeit rare. Most dental materials are biocompatible, but individual reactions can vary.

Recommendations:
1. Seek a Third Opinion: If you are uncertain, it may be beneficial to consult another dental professional for a third opinion. This can provide additional perspectives on your situation.

2. Consider Your Symptoms: If the pain is severe and persistent, it may indicate that the tooth is beyond saving. Conversely, if the pain is manageable, you might explore options for treatment.

3. Discuss Restoration Options: If extraction is necessary, discuss with your dentist the best options for replacing the tooth, such as implants or bridges, to maintain your dental structure and function.

Conclusion:
Ultimately, the decision to extract a tooth should be based on a thorough evaluation of the tooth's condition, the risks of infection, and your long-term dental health goals. While preserving a tooth is often preferable, the health risks associated with a severely decayed tooth may outweigh the benefits of keeping it. Engaging in a detailed discussion with your dental care provider about your concerns and treatment options will help you make an informed decision that aligns with your health needs and personal preferences.

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