Oral Surgery/Effects to jaw with extraction vs retreatment
QUESTION: Dear Dr. Teig,
I need help with making a decision on what to do with my teeth.
I have 7 problem teeth & was told it would be much "easier" to extract all 7. But I was wondering what would be the effects to the jaw and face if the following are pulled:
1, 15, 16, 17, 18, 30, & 32
#1, 16, 17, & 32 are my wisdom teeth
#15 has a large filling and the tooth has decay which is spreading to another tooth
#18 has a root canal and has been reinfected
#30 has a root canal and is no longer saveable because the tooth is broken to bits
I was told that it would be much "easier" to pull all 7 of my teeth... but I'm afraid of the effects to my face and jaw. I was thinking of having #18 retreated instead & somehow try to save #15... and then perhaps having an implant in place of #30.
I really don't want my facial structure to greatly be affected. I'm only 24 and the thought of losing 7 teeth is mind-blowing. Please help with an opinion.
Thank you in advance for your help.
ANSWER: Jessie - I fully appreciate your apprehension as to the effects of extracting the 7 teeth.
First of all, decay does not spread from one to the another. Just because #15 has decay, it does not mean that #14 or 16 will decay.
Of all the teeth you list, only #17 and 30 are truly important.
The overall effects to your face should not be dramatic, but saving the teeth is usually bet if the amount of trauma or decay is not excessive. Obviously it is best to save teeth, but if #17 and 30 are beyond repair or the extent of work necessary to save them is dramatic, then saving them might be wrong. An implant in tooth #30 position is not a bad idea, but if the tooth is infected, that replacement implant needs to wait for about 4 months after the extraction. If not infected it can be placed immediately after the extraction by an oral and maxillofacial surgeon. A regular dentist often traumatizes the surrounding bone in extraction and that could effect the success of the subsequent implant.
I wish I could be more helpful, but I would need xrays of the area. Your face should not greatly effected if all the teeth were extracted, but stability of the bite is important. If you have more questions or have the xrays for me to evaluate, feel free to get back to me.
---------- FOLLOW-UP ----------
QUESTION: Hi Dr. Teig,
I finally got an x-ray of my teeth. I know.. it looks pretty horrific (I haven't been to the dentist for 5 years). But I've gotten all my fillings done now.
So now I have an appointment to extract all 7 of those teeth (#1, 15, 16, 17, 18, 30, & 32). & I've scheduled to have a dental implant in place of #30. I'm afraid of my face sinking in like I've seen in pictures? Will that happen to my face? (I've attached a picture to illustrate my fear.) I'm also afraid of my teeth falling. The surgeon told me that "teeth do not fall backwards". Is that true? So if #15 & #18 are removed, will the bordering teeth fall?
Thanks for your help, Dr. Teig.
Jessie - the surgeon is correct that the teeth do not fall backwards. The only area that needs a tooth or treatment to prevent drifting of teeth is #30. You have two options there. The dental implant is one and a bridge is the second. The bridge is good, but requires that crowns be made on #31 and #29 and those crowns will allow a bridge to be made between. To prevent more teeth being cut to make the crown, an implant is a good idea. The most important thing is that an implant should not be placed in tooth #30 position immediately. Due to the evidence of inflammation or infection at the ends of the roots of #30, that area needs to heal first before implants are placed. That wait should be at least 4 months, but a skilled dentist will fabricate a simple appliance to keep the space open.
I wish you well and hope you are happy with the final results.
If you have additional questions, feel free to contact me again.