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Dentistry/Will 2nd molar extraction affect jawline or teeth in front of it?

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Question
I am a 47 year old female and have all my teeth except for the top left wisdom. I have had an apecoetomy (spelling) in the tooth two places to the right of the one affected. Currently I have a infection and abscess in my right lower molar next to my wisdom tooth (2nd molar). I did see a dentist am on Amoxicillin and pain relievers until the infection clears for treatment. The tooth originally broke off partially from a large silver filling. In Kenya, I had a composite filling done around it in March, and had planned to replace it with a crown late this year. I suppose either decay was left from the dentist inn Kenya or the composite cracked. In any case, my choice is a root canal or extraction The tooth is fairly weak, but the dentist said it could possibly be done--not knowing how long it will last. I do still have a healthy wisdom tooth in back of it.I am a bit hesitant to have it extracted for all the possible complications and especially for loss of jaw bone. I am afraid it will change my bone structure in my jaw (appearance), which is currently rather strong. Will this particular one tooth missing, affect my jawline in any way? I have to also consider the price difference but do not want to make a mistake in extracting this tooth, if it will change the appearance of my jawline or largely impact my mouth or other teeth in any way (if I even have a choice to keep it). What would be your opinion, from your experience? Thank you

Answer
Cherie - This is a difficult question to answer because it is based on the skill of the doctor and the possible changes to the bite that could occur with an extraction.

For a lower second molar apicoectomy, only a specialist should do this procedure because it is quite technical.  So if it is a board certified oral and maxillofacial surgeon who will be doing the procedure that is positive towards a successful outcome.  This is quite a difficult procedure even for a specialist, but if the doctor is qualified and the tooth is not too broken down the procedure should work.

As far as the extraction, the extraction itself should be straight forward and easy, the after effects are what need to be considered.  During life all of our teeth continually erupt and move towards the front of the mouth.  Unfortunately, that forward move is usually not straight forward, but often tips.  So the wisdom tooth might enter the space left from the extraction, but some type of alignment might be necessary to keep it straight.  If nothing is done and the tooth does not move, the upper second molar will begin to erupt downwards into the open space.  Not usually a good situation and can cause a bite irregularity.  

So what should you do.  If the apicectomy is a straight forward one done by a skilled surgeon that is the best choice.  If not, then the extraction and alignment of the erupting and drifting wisdom tooth needs to be controlled.

So the decision is one that must be made and either could work, but only with a skilled doctor overseeing it.  Any further questions, feel free to contact me again.

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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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