April 14, 2021 - Wednesday

Replace or Keep a Tooth: How Do I Decide?

By Lee R. Cohen, D.D.S., M.S., M.S.
Replace or Keep a Tooth:The decision to keep or replace a tooth is a very emotional one for many patients. Beyond the concern over losing a tooth, many patients have difficulty with the idea of removing any part of their body. Typically, our patients request the most “conservative” option available. Although keeping a tooth (no matter how diseased it may be) seems conservative, it may in fact be the least conservative option that could end up in additional cost and more invasive procedures.
Collect The Data:
Just like in any important decision, it is critical to gather all the information you can regarding the prognosis of the tooth in question. It is obvious that we need to know about the presence of decay in a tooth and the extent of its invasion. Questions such as “will this tooth need a crown?”, “will this tooth need a root canal?” and “will this tooth need additional procedures to save it?” are all good to ask.
An equally important question is, “what is the periodontal health of my tooth?” Periodontal health is the health of the gum and bone tissue supporting the tooth (think of it as the ground around the tooth). Imagine you were building a new house on the beach which stands on a pillar. Clearly you would want to know the status of the pillar. It would be important to know if the ground around the pillar was solid. If it was determined that this ground was weak or much of it had washed away, you may think twice about investing time and money building something on that existing structure.
Similarly, if the gum and bone around a tooth is compromised, it may not be worth the investment to repair a tooth (such as placing a new crown). Although a new crown may help with the decay, it would be of no use if the entire tooth was lost due to the lack of bone support around it.
Alternatively, if the tooth truly does not have a good prognosis, removing it may help save the jaw bone. This will allow for other options to replace the tooth while bone still exists (for example a dental implant). Saving the bone in this situation is actually the conservative choice. Replacing a tooth is often a lot easier than replacing jaw bone.
Periodontal Evaluation:
A periodontal evaluation can help determine what the overall foundation around the tooth looks like prior to making your decision about the best treatment for you. This examination is painless and involves reviewing a current set of dental x-rays, measuring the “gum pockets” and “gum loss” around the teeth, checking for tooth mobility and determining the amount of healthy tooth root that remains in the bone. The above information can help predict the prognosis of the teeth.
Working with your dentist and periodontist as a team can help you decide what treatment options are available to you. Understanding the long term prognosis based on the health of the tooth and the periodontal foundation will help you make a more informed and conservative treatment decision.
Lee R. Cohen, D.D.S., M.S., M.S., is a Dual Board Certified Periodontal and Dental Implant Surgeon. He is a graduate of Emory University and New York University College of Dentistry.
Dr. Cohen completed his surgical training at the University of Florida / Shands Hospital in Gainesville, Florida. He served as Chief Resident and currently holds a staff appointment as a Clinical Associate Professor in the Department of Periodontics and Dental Implantology. Dr. Cohen lectures, teaches and performs clinical research on topics related to his surgical specialty.
The focus of his interests are conservative approaches to treating gum, bone and tooth loss. He utilizes advanced techniques including the use of the Periolase Dental Laser (LANAP procedure) to help save teeth, dental implants, regenerate supporting bone and treat periodontal disease without the use of traditional surgical procedures. Additionally, Dr. Cohen is certified in Pinhole Gum Rejuvenation, which is a scalpel and suture free procedure to treat gum recession with immediate results.
Dr. Cohen uses in-office, state of the art 3D CT imaging to develop the least invasive dental implant and bone regeneration treatment options. Dr. Cohen and his facility are state certified to perform both IV and Oral Sedation procedures. Botox® and Dermal Fillers are also utilized to enhance patients’ cosmetic outcomes.
Dr. Cohen formerly served on the Board of Trustees for the American Academy of Periodontology and the Florida Dental Association. He is past president of the Florida Association of Periodontists and the Atlantic Coast District Dental Association. Dr. Cohen is a member of the American College of Maxillofacial Implantology and the American Academy of Facial Esthetics. In addition, he has been awarded Fellowship in the American College of Dentists, International College of Dentists and the Pierre Fauchard Academy.
Palm Beach Center for Periodontics & Implant Dentistry

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