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Dentistry/small carie under gum line on third molar

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Question
Greetings.  Upon routine inspection, my dentist probed a small carie on my left third molar on the outside of the tooth.  He said he won't fill it, to remove that tooth and the healthy molar above it, and disappeared before I could question him.  I strongly suspect that there is no reason to remove two teeth for a single shallow carie slightly below gumline on an asymptomatic rearmost tooth, but I'm guessing that many dentists would not bother to address this, as it is easier and more lucrative to just pull teeth.  Is it necessary to treat or is watchful waiting ok?  How do I find a dentist (either generalist or surgeon) who would evaluate me for sealing, filling, or whatever else is necessary, if necessary?  Your thoughts on potential procedures?  Thanks much in advance.

Answer
Tom - The decision to fill an area of decay on a third molar mostly depends on the location of the decay and the ability of the dentist to remove the decay, completely visualize the area to insure that only decay is removed and damage to the nerve is not done.  Often, due to the lack of flexibilty of the cheek tissue in the region and the level of bone around the third molar, it is very difficult for the dentist to remove the decay and not further damage the tooth.  In that situation removing the tooth is less damaging to the patient.  As far as removing the upper tooth, throughout life all teeth erupt and move towards the front of the mouth and only stopped when they touch the teeth on the opposite jaw or the tooth in front. When the tooth in the opposite jaw is removed, the tooth touching it will continue to erupt and eventually, that time is variable, but can be only a short time, it will bite on the opposite jaw and cause major pain and other problems.

Again, I cannot say if this is correct without examining you, but it is often the correct approach.

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Joel S. Teig, DMD, Diplomate ABOMS, retired

Expertise

I am a board certified oral and maxillofacial surgeon and I am available to answer questions related to tooth extractions, implant insertion, facial recontruction, facial and oral tumor removal, TMJ dysfunction and various successful treatments, including surgery if all else fails, and occlusal discrepancy requiring orthognathic or jaw surgery.

Experience

Board Certified Oral and Maxillofacial Surgeon practicine for over 20 years. Assistant Clincal Professor and State University School of Dentistry.

Organizations
American Dental Association, American Association of Oral and Maxillofacial Surgeons, American Board of Oral and Maxillofacial Surgeons

Education/Credentials
BA -University of Connecticut DMD - University of Pennsylvania School of Dental Medicine

Awards and Honors
National Honor Society (OKU), Philadelphia County Dental Society, Mosby Book Award, Oral Surgery Honors, Summa Cum Laude

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