Preserve Early & Save Your Pearly!
Dental problems usually start as small ones and lead to big ones later. Many experienced patients would also agree to the fact that a slight negligence or delay in treating them, certainly proceed to a string of future complications of some sort. In today’s dentistry the philosophy adopted in dental procedures is devoted to preserving the diseased tooth at any cost using whatever means of conservative methods. No matter how badly decayed or damaged the tooth considerable efforts are made to salvage it. Reason – the natural tooth is any day better than any form of artificial replacement available today in terms of function; and preserving it would be definitely a better choice in the long run than a non-judicial removal.
The mindset of a few when it comes to a problematic tooth is – to remove it and put an end to the problem once and for all. But in majority of the cases it does not necessarily work that way. A permanent tooth, unlike its deciduous counterparts, does not have a natural replacement i.e., once lost is lost. The loss of an anterior (front) tooth is regarded more serious by patients for obvious reasons because it affects their appearance, speech etc. and some tend to seek out replacements immediately. The same is not practiced for the lost posterior teeth (bicuspid and molar teeth), as it is assumed that they can put off replacement procedures or not to replace them at all, since it does not affect their esthetics. The opinion also follows that there are sufficient number of other teeth to perform satisfactorily. Another misconception is – the particular tooth in question was eliminated because it created so much of havoc, then why to bother taking greater pains to replace it? These are very wrong notions and are in no ways justified.
Removal of a tooth and not replacing it leads to a cascade of other related complications. The problems are just beginning. First and foremost after tooth loss a total loss of function in that site is immediate. Which means the chewing in that site is impaired. Another important aspect to be kept in mind is that, with no opposing tooth to interact during mastication the tooth opposing the one lost also becomes relatively functionless. If it is front teeth then their absence is very obvious and an immediate compromise in esthetics and speech is felt. The long-term damages are slow and occur over a period of time. The teeth in the oral cavity are in a constant state of dynamic equilibrium. Even if one is affected or lost, the entire equilibrium changes. All teeth have a precise positional relationship with one another, which has to be preserved so that a harmony is maintained. A tooth physiologically tends to move forwards (mesial migration) and towards its opposing counterpart (supra eruption). These movements are normally restricted by the presence of the adjacent and opposing teeth, and the integrity of their contact points is preserved. Hence when a tooth is removed, the empty space – triggers the natural response of the existing adjacent and opposing teeth to migrate toward the space. This leads to shift in the contact points between the teeth and leads to all sorts of complications starting with food accumulation between the teeth which then initiate a chain reaction of events such as gingivitis leading to periodontitis, inter-proximal decay, tooth sensitivity and finally pain. Hence maintenance of this positional relationship between the teeth is absolutely vital.
If a tooth is lost then replacement is a must. Many would disagree but long-term consequences as highlighted, though gradual, are very real. Moreover it is only logical to procure a feasible replacement for something lost. Understandably, the cost of these artificial replacements is the inhibiting factor for the wide majority in making a choice. In the long run it is worthwhile considering the cost factor involved for the subsequent other complications, which may arise. Today with advancements in procedures excellent replacements are available in the form of fixed ceramic bridges, implant assisted crowns etc., which mimic the natural tooth in terms of both function and esthetics. Hence an ideal replacement based the situation can be carefully planned and fabricated.
In the final analysis, all conservative methods suggested by your dentist in preserving a problematic tooth should be religiously followed; but if in a particular situation where a removable is inevitable then, a timely replacement is mandatory. If a permanent replacement should for some reason needs to be post-phoned then an interim replacement should be opted for maintaining the positional integrity of the existing teeth.
Adhering to De Vaan’s views – “Preservation of what remains is more important than the meticulous replacement of what is lost.” Conversely, to preserve what remains it is indeed important to meticulously replace.
Dr. Murali Srinivasan, MDS.
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