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Sunday, February 5, 2012

Is it time to have all my teeth out?

How many times has a patient come in and said, "Dr. I want all my teeth out!"
So many times I have said, YES you are right it is time to have them out and so many times I have said, NO it is not time.

How does a dentist decide whether  this patient needs or should have all their teeth out?
There are a number of issues we must look at before arriving at the decision.  Remember, once you take them out, you can't put them back.  Afterwards the patient may have to deal with other issues such as retention of a denture, gaginess and general discomfort.  And of course, even though a patient wants all his teeth out that doesn't mean that we have to do it.

The simpler cases are when the patients teeth are hopeless.  When, the teeth are so rotten or the teeth are moving so much that there is really no choice but to extract all of the patients teeth and make them dentures.  It starts to get complicated when those rotten teeth can be fixed and those receded gums can also be stabilized.  Then what?
A partial denture is better than a full denture because it is more stable in the mouth since it can use solid teeth as aids for stabilization.  Of course, no denture is the best, if we can just fix your teeth or create a fixed bridge.  Nothing to take out and of course the feel is the most natural.

So here we move into the grey area.  A patient comes into the practise and he has a fair number of teeth that are decayed and moving.  He has not brushed his teeth in a number of years.  When I ask him if we can fix his teeth will he start brushing them?  He answers NO.  Then the teeth are going to be lost no matter what and there is no point in wasting time trying to save these teeth because no matter what they will develop new problems again after we have done all the work to fix them.

A patient comes in with decay in his teeth, we fix all the teeth and then 6 months later the patient returns with large amounts of decay just as he had entered on the first day.  He now tells us that he has 5-6 Tim Horton's triple triples every day.  (That is triple sugar with the coffee)  He says he refuses to stop this as it is his one vice.  In this case we would also take the teeth out since the battle is lost before we even fired the first shot.

Sometimes a patient will come in who hasen't seen the dentist in 15 years, she may have 1-2 cavities and a lot of cleaning to do, but she is adamant that she needs all her teeth out.  Well of course we won't take her teeth out because she doesn't need it.  We will try to make the patient understand that their situation doesn't need such drastic measures and that they would be a lot happier with their own teeth.

All of these situations have happened to me and were dealt with as I have described.  Every case is different and requires a different response.  On the whole, keeping your teeth is better than extracting them, even keeping a few teeth is better than extracting them all but in some situations extracting all the teeth is the treatment of choice.   The black and white cases are easy to decide.  But through years of experience, through discussions with our patients of their needs and wants, we learn to make the proper and informed choices in the gray zone.

All the best

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