While we do everything, we can to try to save a tooth, sometimes it’s just not worth saving. Like the song goes, you have to know when to hold them and when to fold them. As children, baby teeth get pulled when they are infected or if they don’t fall out in time. We even have a special character made for such occasions – the tooth fairy. The tooth fairy collects teeth and is willing to pay you for that extracted tooth. All you have to do is place it under your pillow before you go to sleep and you will be rewarded with cold hard cash in the morning. This can range from a few dollars to even $100 a tooth according to some stories. Not bad, right?
Baby teeth get extracted when there is trauma, infection or fractures. Basically, we don’t want any infection or trauma to spread to the adult teeth so extraction is a way to minimize any potential risk. Depending on the tooth and the age when it is taken out, a space maintainer may need to be made to prevent the surrounding teeth from shifting and covering the space necessary for the adult tooth to come in properly. If a baby tooth falls out, never try to put it back in – that’s only for adult teeth. Also, never perform your own extractions at home even though it makes for a great social media video. You can damage the adult tooth underneath or leave a piece of the baby tooth behind if it breaks off. Extracting baby teeth is usually a simple procedure and most kids are back to normal the very next day.
Extraction of adult teeth is a little different. Like children, we take adult teeth out when there is infection or trauma. Another reason is impactions, when a tooth does not have enough room to develop or grow in properly, like wisdom teeth. However, before taking out an adult tooth we must consider how we are going to replace it. Why is this important? Think of your teeth as a row of books on a bookshelf – if you pull one book out, all the other books will start to collapse around the space. Neatly in a row, they keep each other lined up and stable. The same is true for your teeth. When a gap is left by a missing tooth, the surrounding teeth will shift to try and fill that gap. Over time, teeth may become crooked or new gaps may appear between teeth. Your bite will also shift and you will end up putting pressure on teeth that are not meant to handle more pressure. Super-eruption can also occur. This happens when a tooth grows out from its position because it no longer has an opposing tooth to resist it.
What are your options then for replacing a missing tooth? You can replace missing teeth with implants, bridges or partial dentures. You can also choose to do nothing but this should never be an option. Each option will have different risks and benefits but an implant is the closest thing to a natural tooth. Another important consideration when a tooth is extracted is grafting. When we remove an adult tooth, the gums and bone in that area will shrink because the body believes nothing is there so it doesn’t waste any energy maintaining it. The body is very efficient in this regard. Without a graft, it can be harder to place an implant in the future or to clean the area properly if doing a bridge. To play it safe, always graft the area with a bone substitute regardless of how you are replacing the tooth in the future. When in doubt, graft. It is always easier and less expensive to preserve bone than to rebuild it in the future.
What about third molars (wisdom teeth)? Everyone has heard dreaded stories of swelling up like a chipmunk, eating through a straw and funny YouTube videos of being sedated and saying all kinds of crazy things. Removing wisdom teeth, however, is a common occurrence and most people heal within 3-7 days.
Wisdom teeth can come in a variety of shapes, sizes and even numbers.Some people have no wisdom teeth and some people can have up to 7 of them. They are generally a remnant of evolution – we no longer need them based on changes in our diet and physiological changes (smaller jaws) mean there is hardly any room for them anymore. Impacted wisdom teeth can start pressing on the second molars, cause cavities, gum issues and infections. It is a good idea to start looking at removing them around 17 years old depending on their positioning and development – a panoramic x-ray will help us make this determination. Ideally you want to remove them before you turn 26 – beyond this, the procedure may be more difficult and the potential complications can increase. As well, the root development of lower wisdom teeth can get entangled with sections of the trigeminal nerve which could increase your chances of a nerve injury. It is preferable to remove a wisdom tooth earlier instead of waiting to see if the roots develop in that direction. Grafting after removal of wisdom teeth may be necessary if there is significant bone loss due to infection, cysts, gum disease or depending on proximity to the second molar.