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Should I Extract My Last Two Upper Teeth?

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I only have two teeth left on my upper arch. They are my two front teeth. I’ve been using partial dentures for the remainder of my teeth, but it is super uncomfortable and I rarely wear them. I can eat most things without the partials with just those two front teeth. I only put them in if I’m eating something that requires grinding, like steak. I’ve been to four dentists and they’ve all said different things, but it boils down to they keep saying it is up to me. I’ve found that their advice seems to revolve around what procedure THEY offer. So, I picked a dentist in a totally different part of the country from me so I’d get impartial advice because I can’t come to your office (sorry). Here’s my question. Would I be better off extracting my last two upper teeth and getting a full denture or is this the best I can do?

Caden

Dear Caden,

Before I answer, bear in mind that I have not examined you or seen any x-rays. Because of that, specifics would be dangerous. However, I can give you some generalities that will be helpful.

Zirconia dental implants

Dental Implants

If you are looking for the absolute best solution, it would be to get dental implants and anchor the partial dentures to them. You will have secure teeth that feel like having healthy, natural teeth in your mouth. I suspect that you will need bone grafting done before this is possible. When your teeth are extracted, your body immediately begins to resorb the minerals in the jawbone in order to use them elsewhere in your body where they will be more useful. That bone structure is necessary in order to retain the dental implants. However, if you can afford it, getting dental implants to replace those teeth would be the ideal.

If you cannot afford to get those than my recommendation would be to go ahead and extract the two remaining teeth in order to get complete removable dentures on your upper arch. These are held in by suction, so the bone is not as essential as it is for your lower teeth. While your two front teeth are healthy right now, the stress that is being placed on them both, from being your main source of eating, as well as from the partials, makes me think you won’t have them long anyway.

You lower teeth would be a completely different story. As the minerals in that jawbone are lost, your jawbone shrinks. Eventually, you will not have enough bone left in your jawbone to even retain your dentures, making you a dental cripple. This is known as facial collapse in dental circles. The only thing to prevent that would be implant supported dentures.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

 

Dentist or Oral Surgeon for Dentures

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I am 68 years old and always had a terrible fear of the dentist because of a traumatic experience in my teen years. Because of that, my teeth are an absolute mess and need to come out. I’m not sure I know how to approach this. If you need dentures, do you go to a dentist or an oral surgeon to remove the remaining teeth?

Fred

Dear Fred,

Hilton Head Affordable Dentures

I would look for a dentist who can do both the surgical removal of your teeth as well as the dentures. This will give you the best outcome. I’m going to also suggest, though it is completely up to you, that you look into snap-on dentures. This gives you two dental implants that can anchor your dentures a little bit to your jaw. This way you won’t have to worry about them slipping around. Obviously, the more dental implants the better and more secure they are, but two is enough to keep them in.

Because of the dental anxiety you mentioned, I think when you look for the dentist to do this, you find one who offers oral conscious sedation. This is will give you a pain-free and anxiety-free procedure. It is administered by a pill but is quite strong. In fact, some people have dubbed it sleep dentistry because you can sleep through the entire procedure. I honestly wish someone had told you about sedation dentistry earlier because it could have helped you with your fear of the dentist and saved your teeth. Either way, at least you can go to the dentist this time knowing it will not be the horrible traumatic experience you had in the past.

One last thing to check before committing. You are still young and I want you to have a smile you are proud of. Ask to see some of their “after” pictures of dentures they’ve done. You want a dentist who can create a beautiful smile for you. These days, dentures can look natural and beautiful so don’t settle for someone who is going to make you fake looking teeth.

This blog is brought to you by Hilton Head Cosmetic Dr. Bonnie Rothwell.

From Dental Crown to Extraction

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I’m a little frustrated. I had a dental crown and root canal treatment. I was horseback riding and had an accident which broke the dental crown. I had an emergency dental appointment and they fitted me for a new crown. It kept feeling really weird. I let it go for a while, but then the crown fell off after a second accident. When I went in to see the dentist again he said the tooth was eaten up by decay and needed to be extracted and replaced. How can that happen? Did the dentist do something wrong when he replaced it the first time? How would I not feel pain with that much decay? What kind of tooth replacement are best in these circumstances?

Katy

Dear Katy,

image of dental implant in three stages

I don’t think your dentist would have done anything to cause decay. A lot has gone on with that poor tooth, especially given you’ve had two riding accidents that have knocked off your crowns. Teeth that have had a root canal treatment become very brittle and vulnerable. That is why we almost always place a crown on the tooth.

There are many ways bacteria could have gotten in there. There is a very sound reason why you didn’t feel any pain. The root canal treatment cleared out all the pulp in your tooth. There wouldn’t have been anything really to feel. That tooth is dead.

So where do you go from here?

Tooth Replacement Options

After you have your teeth extracted, it will be important to replace it. Without that, the adjacent teeth will shift and tip into the open space. The best replacement option is a dental implant. These mimic your natural teeth by placing a prosthetic root inside the jawbone, then places a dental crown on the implant to serve as the visible part of your tooth.

Another good option, when it comes to replacing a single tooth, is a dental bridge. This suspends a false tooth between two dental crowns. Getting a bridge makes more sense if one or both of the adjacent teeth already need a crown. Without that, you have to grind down healthy tooth structure, which isn’t a great option if it is avoidable.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

Dentist or Oral Surgeon for a Tooth Extraction

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I had a dental filling which fell out. I was foolish and didn’t go back to the dentist because my last appointment was a bad experience. I know I should have because eventually the tooth developed an infection and I was in tremendous pain. In fact, it was so unbearable I went to see another dentist. This dentist did a root canal treatment, but we never scheduled a follow-up appointment. Because of that it eventually developed more decay. Now, I’ve got a dentist telling me it needs to be extracted. He suggested the extraction would be complicated enough that I might consider an oral surgeon. I did some number crunching and the oral surgeon would be a lot more expensive. Am I putting myself in danger by going with the less expensive option?

Amanda

Dear Amanda,

Woman asleep in the dental chair from detntal sedation

I feel it was unfair of your dentist to phrase it this way. It makes you feel like going the affordable route is dangerous. It’s possible he feels this procedure is above his current skill level and that is why he’s recommending an oral surgeon. If that is the case, I definitely wouldn’t have your dentist do it. He could get into a situation during the procedure where he doesn’t know what to do.

Before making a decision, I’d ask some more questions. Has he done this type of extraction before? What is his comfort level in performing the procedure himself? Does he offer dental sedation?

If it turns out he’s experienced and comfortable with the extraction and he offers sedation options, you’re fine to go ahead having the extraction done at his office. Based on how he framed it, however, I don’t think that is going to end up being the case. You will either need to see an oral surgeon or use a different dentist who had more experience in this particular procedure.

How Using Dental Sedation Can Change Your Life

When you have dental anxiety, it often has a negative impact on your oral health. You’ve already experienced this so you understand, I’m just saying it for the benefit of others. However, knowing that doesn’t take away your anxiety. I do have something that actually could help, though.

Going to a dentist who offers sedation doesn’t have to be reserved for the most difficult of cases. It can be done for any procedure you’d like. Though, if you’re just getting a cleaning, I wouldn’t go for the “big guns”, like oral conscious sedation or I.V. Sedation. You’ll be fine with just nitrous for that.

If you’re having specific work done, such as dental fillings or a dental crown, you could then upgrade to something like oral conscious sedation. You’ll also find you can get more work done during each appointment, allowing you to catch up much more quickly on the work you’ve been needing. Before you know it, you’re all caught up and no longer even need sedation.

This blog is brought to you by Hilton Head Dentist Dr. Bonnie Rothwell.

How Long Will My Wife Need Dental Sedation?

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I’m not trying to be insensitive, but every time my wife needs anything at the dentist, even a simple filling she won’t go in without dental sedation. That requires me to take time off work AND we have to pay for it out of pocket because insurance won’t cover it. I know her childhood dentist was pretty rough, but now that she’s had positive experiences, shouldn’t she be ready to transition to regular dental care?

Ben

Dear Ben,

It sounds like your wife has been through a lot. I know it’s a hardship for you to take time off work too, so I’m not ignoring the sacrifices you’re giving. But there’s no definitive time in which trauma takes a backseat.

While some patients can ease into dental care without sedation in just a few appointments with good experiences, others may take a lifetime. It all depends on the severity of the trauma in their mind and what the triggers are.

For her, it may be the dental chair itself. Without the sedation, she may end up hyperventilating. Many dentists have had patients panic in the dental chair.

Sedation Dentistry is Probably Saving You Money

You mentioned your wife won’t go without dental sedation. That would mean a definite decline of her oral health. We’ve seen this before with patients who suffer from severe dental anxiety. The only thing which brings them in is a dental emergency. They tend to wait until the pain is so unbearable they have no choice.

By then, there is usually no way to save their tooth. Now instead of paying for dental sedation, they’re paying for a tooth extraction and the expense of surgery replacing the missing teeth with dental implants.

Regular, preventative care, is always more cost-effective than putting off care.

I realize it is an inconvenience for you to take off work every time. Is there a way a family member or friend can share the burden? I’m sure they’d be compassionate and understanding given her childhood history. Truthfully, most dental anxieties start in childhood.

I don’t know if you guys are parents yet, but that fact alone should tell you how important it is to choose a pediatric dentist carefully.

Give your wife some time. Let her tell you when she’s ready to try it without dental sedation. If, however, you find her anxiety starts bleeding into other aspects of her life, it might be time to get to the source of things with a therapist. But, believe me, that will cost a lot more than dental sedation.

This blog is brought to you by Cosmetic Dentist Dr. Bonnie Rothwell.

Can the hospital extract my teeth?

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I need to get several teeth extracted. I’m not comfortable at the dentist’s office under the best of circumstances, so the idea of endurring these teeth extractions is like a living nightmare. Can I just go to the hospital to have them extracted? I’d rather not be knocked out.

Shannon M. – California

Dear Shannon,

You are not alone in your dental anxiety, and NO ONE looks forward to a tooth extraction, so I want you to realize your fears are no uncommon. While there are some hospitals that will allow patients to have their dental work done by a dentist under general anesthesia, it is really pricey. I’m going to suggest an alternative and you can decide what you’d like done.

There are dentists who use sedation. Given your level of anxiety and the procedure you’re facing, I’d look for dentist who uses oral conscious sedation and/or I.V. sedation. In either of those procedures you’ll be in a sleepy state and unlikely to remember the procedure.

You’ll need someone to drive you to and from your appointments, because you’ll be too loopy to do it yourself. But, you’ll find you can get a lot more work done under sedation than you can without it. Plus, it will be completely pain free.

This blog is brought to you by Hilton Head Cosmetic Dentist Dr. Bonnie Rothwell.

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