Why Have Dentists Become So Reluctant To Just Pull Teeth Out

[JackD]

First off, I am not seeking any advice in any way, i promise. I have had problems in the past when I have ventured out of the psychology boards, when simply curious about something in another field. Some have thought I was seeking free advice. Never my intention.

Anyway, I have heard several times, over the last few years, that dentists today are very reluctant to remove teeth (besides wisdom teeth) and will only do so as a last resort. However, this seems odd, since that seems like all dentists used to do. You see older people with dentures all the time, so it seems like pulling teeth was once a very common practice. In fact, to someone like me, who knows nothing about dentistry, just pulling out a damaged tooth seems logical and easy. Root canals and crowns and all of the ways in which a tooth is saved seem like a huge hassle. Why is it so important to save a damaged tooth, instead of just yanking it out and being done with it?

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[InMyCrossHairs]

Well there Billy Bob, ya see. Up here in these parts, where city slickers roam, we here see tha value of them there pearly whites. Heck, sometimes we even use em to chew our supper. And when we get all gussied up, and take the purdy ladies out, we even there crack a smile, and allow em to sparkle.

Now I can see the value in forgoing the hassle and just gettin em yanked, and on the weekend put in our Sunday Teeth and be done with it...but I think I will just continue to edumacate my patients on the value and need for investment.

 

[tkim]

When I did my OMFS rotation, we pulled teeth all day long. For people who can't afford the restorative procedures, or simply are not going to employ good dental hygiene and therefore be back all the time, pull them is an acceptable option.

For people who can afford restorative procedures, and want to keep their teeth, pulling teeth is a later option.

I think it's cheaper to pull teeth. And vice versa.

 

[JackD]

For people who can afford restorative procedures, and want to keep their teeth, pulling teeth is a later option.

So it is more of a personal preference of the patient not to have a gap in their teeth (which I am sure we all like) than preventing some kind of horrible conditions, like years of infection in the area where the tooth was pulled or possible deformity over many decades?

It is just interesting to see all of the lengths that a dentist is willing to go and the procedures that have been invented, to save a badly damaged tooth when just pulling it out would probably make your lives way easier. And of course I meant teeth that were badly damaged, for whatever reason, not ones that have small cavities or other minor problems. Anyway, from what I have read, performing a root canal and putting in crowns and all of this, can take quite a long time and a lot of work, when in contrast, just removing a damaged tooth would probably take less than 30 minutes.

Lovely. Thank you.

 

[tkim]

Uh, I wouldn't take my word on it. I'm not a dentist. It's what my clinic offered and lots of people accepted. Stark difference when I see my dentist. If I wanted a tooth pulled he'd probably offer alternatives before doing it.

 

[Huggies]

We don't pull teeth as a first option b/c we see what happens to patients who've done it one too many times. Having dentures is no picnic and we see it first hand. I have not met a single patient who loves their dentures and would not give anything to have their natural teeth back.

That's why when possible we do root canals and place crowns. Nothing beats what you were born with. Why don't you cut your hand off and see how you do with out it, or w/ a prosthetic one? We need every part of the body we were born w/.

 

[NyCzPeter]

Next time you get a broken finger, why go through all that trouble of wearing a cast for months when it'll only take about 5 seconds to chop it off?

I understand what you're trying to say, but that logic has a huge hole as illustrated above. Granted, you can argue that teeth are not as important as fingers, but the idea is still the same.

Of course it's much easier and cheaper to perform an extraction, but that is equivalent to just getting rid of the problem rather than actually treating it, and thus should only be undertaken as a last resort.

 

[NyCzPeter]

Well there Billy Bob, ya see. Up here in these parts, where city slickers roam, we here see tha value of them there pearly whites. Heck, sometimes we even use em to chew our supper. And when we get all gussied up, and take the purdy ladies out, we even there crack a smile, and allow em to sparkle.

Now I can see the value in forgoing the hassle and just gettin em yanked, and on the weekend put in our Sunday Teeth and be done with it...but I think I will just continue to edumacate my patients on the value and need for investment.

and ROFL

 

[goodeye]

i think the OP realizes this argument that you don't want your natural gear lopped off or yanked out when possible, but he thinks having root canals and crowns done on a tooth is really too much effort for the potential benefit yielded, instead of just having it pulled. assigning the importance of a finger to the importance of ONE tooth is not a good comparison for obvious reasons. so why have dentists devised so many methods and bend over backwards just to save one tooth?

simply because there is a demand for it. to many people, it is well worth the hassle and cost of a root canal and/or crown to prevent the future heartache of having fewer and fewer teeth. i'm not sure if you are missing any teeth, but the inconvenience and esthetic cost of allowing teeth to degrade and finally get extracted increases as more teeth are pulled. sure, people can live their lives without teeth, but the quality of their life will surely be degraded as well. dentists know this from seeing their patients with few or no teeth, and it is something that people with a healthy compliment of teeth don't think about too often. that's why we take every opportunity to save natural teeth. there are patients, like yourself, who might not see the point, especially if esthetics is not an issue and perhaps you have enough healthy teeth to eat meat and corn on the cob or bite into an apple or whatever...then getting rid of the tooth is definitely an option. we just want to make sure the patient is aware of the future problems they might encounter with fewer and fewer teeth.

and to reiterate, dentures are a pain in the ass for the wearer. your jaw bones tend to resorb without teeth so the fit of the denture becomes poorer with time. there comes a point where the denture will be loose no matter how well made.

 

[NyCzPeter]

i think the OP realizes this argument that you don't want your natural gear lopped off or yanked out when possible, but he thinks having root canals and crowns done on a tooth is really too much effort for the potential benefit yielded, instead of just having it pulled. assigning the importance of a finger to the importance of ONE tooth is not a good comparison for obvious reasons. so why have dentists devised so many methods and bend over backwards just to save one tooth?

simply because there is a demand for it. to many people, it is well worth the hassle and cost of a root canal and/or crown to prevent the future heartache of having fewer and fewer teeth. i'm not sure if you are missing any teeth, but the inconvenience and esthetic cost of allowing teeth to degrade and finally get extracted increases as more teeth are pulled. sure, people can live their lives without teeth, but the quality of their life will surely be degraded as well. dentists know this from seeing their patients with few or no teeth, and it is something that people with a healthy compliment of teeth don't think about too often. that's why we take every opportunity to save natural teeth. there are patients, like yourself, who might not see the point, especially if esthetics is not an issue and perhaps you have enough healthy teeth to eat meat and corn on the cob or bite into an apple or whatever...then getting rid of the tooth is definitely an option. we just want to make sure the patient is aware of the future problems they might encounter with fewer and fewer teeth.

and to reiterate, dentures are a pain in the ass for the wearer. your jaw bones tend to resorb without teeth so the fit of the denture becomes poorer with time. there comes a point where the denture will be loose no matter how well made.

Right, but its plain and simple, people don't want to lose their natural teeth the same way that they don't want to lose their natural hair. And if thats what the people want, well gosh darn it thats what the people gon get.

 

[bigmgreen68]

I don't know if anyone else is running into this but I have patients denying a root canal buildup and crown and requesting an extraction and implant instead. While this isn't always the best option especially in the young and medically compromised why not for the right patients( bone, space, contraindications, $$$, etc$

 

[aphistis]

I don't know if anyone else is running into this but I have patients denying a root canal buildup and crown and requesting an extraction and implant instead. While this isn't always the best option especially in the young and medically compromised why not for the right patients( bone, space, contraindications, $$$, etc$

Under certain circumstances, the ext+implant idea is definitely a viable option for managing a severely compromised tooth. There's an old thread here in the dental forums about that exact topic, if you want to do a search for it.

 

[LeoDDS]

I still agree with the finger analogy. Your teeth are a part of you, it's tissue that can never be replaced. If one of your fingers was to get an ulceration, wouldn't you want the doctor to find ANY possible way to save it before cutting it off?

Having missing teeth also says a lot about your social status. Other signs of disease are easier to mask as long as you're not too old and frail. But a universal way to assess social status is just by looking at a person's mouth when they are talking. That's why people would rather spend any extra $$ they have on having a tooth saved (rather than pulled) instead of putting that $$ towards new clothes/etc. You might only wear the outfit a few times (or drive that new car for a few years) but 24-7 for the rest of your life you're stuck with the mouth you have.

 

[puncho]

I don't know why no one has mentioned proprioreception, occlusal strength in natural teeth, loss of taste with dentures, etc.

 

[Stillmaticbeat]

well ask any dentist and he could tell you a variety of different answers but this is what i've garnered from asking questions over the year i've shadowed dentists:

1st, it's always best to keep your original tooth - usually

2nd, our jaws need mechanical force/pressure for it to retain calcium. if you keep pulling out the teeth that force is absent and the jaw will degenerate. that's why you see old people /w no teeth + no jaw.

once again i'm not a dentist yet. but these seem like 2 good/logical reasons to me why you should try to keep your teeth or put an implant in.

Also, every oral surgeon i know would have no problem taking out your teeth + putting implants in

 

[TenaciousGirl]

Root canals and crowns and all of the ways in which a tooth is saved seem like a huge hassle. Why is it so important to save a damaged tooth, instead of just yanking it out and being done with it?

Nice to see another psych person venturing out...

First thing that came to my mind when I read your post.... We only get one set of teeth. I mean after the baby teeth and 12 y/o molars and all of that jazz. You get your one set and that's it. And yes they have implants now and as technology improves, so does medicine and dentistry but I have this feeling that there isn't anything quite like the real thing? I dunno... just my opinion.

 

[CanuckDDS]

well ask any dentist and he could tell you a variety of different answers but this is what i've garnered from asking questions over the year i've shadowed dentists:

1st, it's always best to keep your original tooth - usually

2nd, our jaws need mechanical force/pressure for it to retain calcium. if you keep pulling out the teeth that force is absent and the jaw will degenerate. that's why you see old people /w no teeth + no jaw.

once again i'm not a dentist yet. but these seem like 2 good/logical reasons to me why you should try to keep your teeth or put an implant in.

Also, every oral surgeon i know would have no problem taking out your teeth + putting implants in

Ah, yes. The old always usually argument. Compelling.

Oral and Maxillofacial surgeons pull teeth based on proper treatment planning with the patient's best interest in mind. Not simply to place implants. Operating by any other principle is shady, stupid, and will likely get you sued at some point.

 

[oldboy]

When I did my OMFS rotation, we pulled teeth all day long. For people who can't afford the restorative procedures, or simply are not going to employ good dental hygiene and therefore be back all the time, pull them is an acceptable option.

For people who can afford restorative procedures, and want to keep their teeth, pulling teeth is a later option.

I think it's cheaper to pull teeth. And vice versa.

SO, you actually extracted teeth in your rotation? I didn't think they let anyone but dental students do that?