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Best Extraction Decision

Treat It versus Pull It

At one time or other we are all faced with a situation where deciding to extract a tooth may be better than treating it. The two most popular determinants are cost and convenience.


Wisdom teeth, for most of us, are eventually extracted. They are at the ends of the arches and if they are pulled as "opposing pairs" there isn't much threat of super eruption, where the opposing tooth starts moving in the direction of the opposing jaw (movements can become quite severe).

For some patients there can be a disturbance of the bite, leading to temporary occlusal issues that might cause the tmj joints to dysfunction mildly, which is treated easily, if early enough.

Anterior and Non Molar Positions

Altered Occlusion Destroys More Teeth
Extraction dentistry can wreak the most havoc in the other areas of the jaw. It can be the most sensible perfect treatment for a fractured or cracked tooth or for treating a previously root canaled tooth that continues to be problematic.

Re-Treating an Extraction

This is an area of dentistry that should be kept in focus, at all times, if possible.

Untreated extractions cause an immediate loss of bone mass between two adjacent teeth which can, for many patients, cause not only teeth to shift, but also adjacent bone loss due to resorption.

Altered Occlusion Destroys More Teeth
Socket grafts are popular for filling in an extraction site while a treatment is developed for replacing the tooth.

As can be seen in the adjacent pictures, tooth extractions create an immediate change in bite. Depending upon which tooth (teeth) get extracted, lateral forces can begin to operate causing teeth to literally break off or become loose... which leads to yet another extraction.

In Pediatric Dentistry, the pedodontist will frequently use spacers to maintain a child's bite while developmental events continue. With the adult population, the Flipper device is usually recommended as a place holder while underlying hard and soft tissues heal... for eventual tooth (teeth) replacement options.

Planned Delay vs No Plan

Cost, convenience, work schedules, school schedules, overriding family financial needs, inadequate or no insurance and just plain bad timing can interfere with getting dental treatment when it is needed the most.

Resorbed Upper Jawbone
Most dentists can develop an immediate means for keeping things safe and healthy while resources are being pulled together to get needed treatment. This is called a plan... and it usually addresses a time table of some kind.

It is the No Plan kind of planning that causes the most potential for damage and heartache. Our last photo demonstrates the severity of impact caused by a series of untreated extractions.

This last photo amply demonstrates how teeth play a key role in keeping our jawbones healthy.

Treatment Planning Multiple Extractions

To review additional diagnostic detail and treatment planning possibilities on the three extraction examples shown here, review our Bad Teeth Photo Gallery.

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