Do I extract or not?

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Dr. Bertrand Robert Stuart

Because a toothache patient is a scheduling problem for some dentists, a popular solution is to prescribe pain killers and an antibiotic to fight the suspected infection. However, this is not the correct approach for many reasons. The pain of an infected tooth is difficult to relieve even with a narcotic pain-killing drug. The antibiotic takes days to reach the infected tissue and will only delay proper treatment while allowing for a more serious infection that involves supporting bone.
Only a few minutes are required to anaesthetize, open, and drain an infected tooth. Once pulpal drainage has been established, pressure that creates extreme pain is immediately relieved, pain stops, and the infection drains and does not spread into supporting bone.
If root canal therapy with a post and crown cannot be afforded, the best approach would be an extraction. The pain of a typical tooth infection is the result of pressure build-up of the gaseous and liquid by-products of the infection. Those by-products when forced through the apex or small opening at the tip of the root, and into the supporting bone, cause an abscess.
Sometimes, Mother Nature intervenes and quite slowly furnishes drainage. This done by establishing a fistulous tract, generally referred to by patients as a “gum boil”. It forms in response to an infection at the base of a tooth’s root. An equally tiny drain develops at the tooth’s root and passes through supporting bone of the tooth and soft gum tissue. The process takes time, but that is how our immune system provides drainage of an infected tooth.
Once an infected tooth has been successfully treated by root canal, the fistulous tract will heal, closed by the body’s immune system. The infected tooth offers value, restoration by root canal, post, and crown provides permanence, function and cosmetics; taking everything into consideration this is the least costly solution. On the other hand, a lost tooth could result in far more expensive solutions.
Failure to replace any viable permanent tooth within two months after it has been extraction will lead to dental migration. That is, the adjacent ones will slowly move to close or expand the vacant space left by the lost tooth. In addition, there could be extrusion into the space by the antagonist (the opposite one). In both cases, proper replacement by any means becomes impossible. For children mainly, a special apparatus called a space maintainer is placed to prevent the unfortunate situation from occurring.
If adequate space to replace a lost tooth or perhaps various teeth is present there still would be problems. If the patient could afford an implant, he or she must have at least three hundred thousand Guyana dollars at hand. With proper osteo-integration (when the jaw bone unites closely with the metal root), etc., completion of an implant takes months. I do not believe in immediate loading implants because studies show they are deficient.
A fixed prosthesis in the form of a crown and bridge involves the irreversible destruction of the two adjacent crowns just to replace the artificial tooth. Incidentally, in my opinion a Maryland bridge is less cruel and reversible. Here again this is an expensive venture. However, a removable denture (commonly called a plate), which is much cheaper, can be unacceptable to many. Finally, loss of teeth may result in the patient requiring corrective treatment in the form of orthodontics (braces). Treatment is very protracted and can cost around a million Guyana dollars. So, the fear and anxiety of having one or more extractions done should be within the consideration of the potential mutilation as well as the implications of proper correction.