Expert: Mark Bornfeld DDS - 10/11/2006

Question
I am 52 years old. The outer side of my second molar, bottom left, broke off. There is a gold crown next to it (no wisdom tooth in this area). Even with insurance, a crown alone (without root canal) will cost me $500. Is this molar really necessary? What happens with the opposing tooth? I am not concerned about shifting. I would like to have the molar extracted if it doesn't present major problems in the future.  C. Apuan  

Answer
Dear Mr. Apuan,

Strictly speaking, any given tooth can be thought of as unnecessary. However, there are often adverse consequences that follow the loss of a tooth. Not only does one lose the functionality of the tooth, but there are changes in the bite that negatively impact on the way the remaining teeth function.

Although you say you are not concerned with tooth shifting, perhaps you are not aware of the implications of that phenomenon. The opposing tooth will tend to drop down into the space left by the lower tooth extraction, and the tooth immediately in front of the dropped upper molar will tend to move backward. This will open contact points and make the teeth deviate from their normal vertical axis. The functional and cosmetic consequences of this can be dramatic: changed chewing patterns that cause discomfort; TMJ dysfunction; open contacts leading to food impaction, tooth decay, and periodontal disease; and posterior bite collapse, which can reduce facial height and cause a "denture" appearance to the facial profile.

Of course, the full effects of tooth loss vary from case to case, and I can't reliably predict the effect the extraction of this tooth will have on you. I would suggest that you discuss this issue with your dentist before you decide to follow through with that extraction.

Hope this helps...

Mark Bornfeld DDS
www.dentaltwins.com
Brooklyn, NY