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Oral Surgery/To pull or not to pull


My dentist has recommended a pretty extensive (for me) set of procedures. I have followed up on part of her plan (crowns being placed on three teeth) but after doing some online research, I am questioning the final part of the treatment plan. I have a molar (I think it's the second) only left upper jaw that I was originally told needed a crown. Then she changed the prognosis to "guarded" saying there is a small amount of decay going into the bone line (3mm?). She shows me films and points out a very faint (is it there or not to my untrained eye) shadow going into the bone. Now, two weeks later and using the same X-ray, she is saying the tooth needs to come out and I should get an implant. Researching implants, I am now not so sure I trust her opinion (because it keeps changing and I keep wondering about if all these procedures are NEEDED or just a way for her to get money).  The reason I am soooo skeptical is that I am having NO problems with the tooth in question. No pain, no hot/cold sensitivity, no redness of gums,.... Nothing.  I am having trouble with one of the crowns she just put in not feeling like its in right (in fact I had her put it in with temporary cement to see if I just need to get used to it). But it too was on a tooth that was causing no prior problems. Really makes me leary about pulling another tooth that isn't being a problem.

Ok, enough background. My question is: if the only option is to pull it, is there a problem with just caring for it and watching it closely until it actually DOES start having problems then pull and implant? The old addage :"if it ain't broke, don't fix it."
Thank You.

The old adage if it aint broke, don't fix it only works when it is actually not broke.  Dentists are generally in the business of both treating problems and preventing future problems.  So, if (and it is a big if) your tooth actually has decay, watching it will only allow it to get worse.  You may end up with pain and/or swelling on the beginning of a 3 day holiday weekend in which case you are going to have a very uncomfortable weekend.  What I can not tell for you is if this is the case for your particular situation.  This service is really designed to help patients understand oral surgery but not to answer your specific clinical question.  

As always, if you are unsure I would recommend obtaining another clinical opinion.  

Good luck,

Dr. Jeff Bressman

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Jeff Bressman, DDS, Diplomate ABOMS


I am a board certified oral and maxillofacial surgeon with over 24 years of experience. The majority of my practice involves dental implants, removal of wisdom teeth, treatment of areas of oral pathology. Please note that this site is designed for general information and I can not give you medical advice specific for you.


I have over 24 years of private practice experience

American Association of Oral and Maxillofacial Surgery, Fellow American Board of Oral and Maxillofacial Surgery, Diplomate National Dental Board of Anesthesia, Fellow American Dental Society for Anesthesia

BS, University of Illinois with honors DDS, University of Illinois, with high honors Board Certified, American Board of Oral and Maxillofacial Surgery

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