Dental Topics What is Cosmetic Dentistry? Veneers Tooth Whitening/Bleaching Dental Phobia Tooth Sensitivity Dental Implants Don’t Use Teeth as a Tool Bad Breath Senior Dental Health Dental Health New Year Resolution Minimal Tooth Removal Importance of Maintenance Appointments High Tech Dental Procedures Dental Information

When less is better. Tooth removal or restorations
The Wisdom Tooth by Wynn H. Okuda, D.M.D.

Before

After

In dentistry, when is less better? I’m sure some of you may be thinking that the less you need to see your dentist for appointments, the better it is! However, the point I want to make in this month’s article is less is better in dentistry when dentists can remove or cut away the least amount of natural tooth when preparing it for restorations. It means patients can now benefit from treatment that is as conservative as possible, until the situation merits more invasive procedures, which contributes positively to a person’s long term dental health.

Does it matter if a more extensive restoration compared with a less extensive restoration is placed? Definitely! For example, if you have a small cavity on one of your teeth, the first step definitely is not to pull it and place a bridge! If your dentist recommended that, I’m sure you would protest very strongly! Rather the more conservative approach would be to remove the decay, prepare the tooth and place the smallest restoration possible. If eventually that same tooth were exposed to more decay, only then would more natural tooth be removed to eliminate the decay. Only in extreme situations, such as a severe, irreparable fracture or extensive bone loss would a tooth perhaps need to be extracted. Therefore, the more conservative approach taken now, the more options there are in the future.

Years ago, the crown or "cap" was the only option when there was a large amount of decay on a tooth or if a larger filling needed to be replaced. The crown offered protection for the tooth, as well as the ability to withstand the powerful biting forces of your jaws. Unfortunately, to prepare a tooth to be fitted for a crown, the tooth must be drilled down on all five sides of the tooth, whether or not there was decay or destruction. In other words, the mere design of a crown required this extensive removal, even of healthy, unaffected natural tooth. At that time, with dental materials being what they were, the only way to have strength and durability required was the metal reinforced crown.

Dentistry has entered an exciting time for dental restorations. The goal in preparing a tooth for a restoration has evolved from whittling a tooth down to a "nub" for an extensive crown preparation to saving as much of a person’s natural tooth as possible. Through extensive research, materials were developed that offered everything: strength, durability, non-metal, and a smaller size. This allows restorations that are less invasive than the crown to be placed when the tooth decay and situation permit it. These tooth conserving restorations include the "inlay" and "onlay", which are laboratory fabricated and cover one or more tooth surfaces. Certainly, crowns are still prescribed when the tooth destruction is severe. Similar to other dental materials, the materials now used for crowns also do offer more strength and durability.

Why is it ideal to minimize natural tooth reduction? The natural tooth is the optimal substance as far as strength, durability, and compatibility with surrounding gum and bone structure. Nothing can exactly replace the benefits of your natural teeth. When the dental professionals talk about the mission of keeping your teeth for life, this is where it all begins.

The primary objective is to minimize tooth decay and gum disease, and maintain good oral health. Preventive dental activities, such as brushing, flossing and professional cleanings and exams, play an important role. That’s why dental health education is strongly emphasized at your office visits. However, human nature and genetics also play a role in how your dental health will fare. This is where tailored regimens are prescribed to optimize each patient’s dental problems.

The secondary objective is to minimize natural tooth loss, once decay does set in. This philosophy of keeping as much of your healthy, natural teeth as possible will further ensure keeping teeth for a lifetime. For example, some patients may think it’s an equal option to either extract a tooth or to have a root canal performed. However, by the simple existence of a natural tooth (even if it has a root canal) in the gums, this stimulates the bone and gum growth necessary to maintain its healthy level. Without a tooth there, the bone and gum level may drop, possibly affecting the bone and gum level of neighboring teeth. Also, the opposing tooth may drift and the adjacent teeth may tip into the empty position, which affects the way teeth come together when chewing. So what appears to some to be an equally satisfactory solution is in reality detrimental to a person’s dental health.

Thanks to advancements in dental technology, patients are now able to benefit from the range of restorations that minimize tooth removal according to each tooth’s specific needs. This in turn maximizes the amount of natural tooth, to give patients a fighting chance to keep their teeth for their lifetime. So less tooth removal from your mouth means more natural tooth in your mouth, which is better for all in the long run!