Hi Dr Hall, I’ve had a partial filing on my teeth #31 and #32. Today, after 2 months of constant pain (I was taking Ibuprofen) I went to the dentist. After a x-ray, he said we should extract those teeth because I have an abscess and an infection. I want to know if that’s the only solution and what could be the consequences? What do you think I should do? Thanks.
– Mel in Maryland

Mel,

Yes, there are other options available, unless, say, you are on a government funded health care plan. When the government funds it, such as with Medicaid programs, they tell you what option you have to choose, and it’s almost always the cheapest one. In that case you would probably not have a choice and have to have these teeth extracted.

But otherwise, the dentist is under ethical and also legal obligation to inform you of all your options. If this dentist didn’t give you any other choice, I’d get a second opinion. Plus I’m suspicious that the fillings may not have been done right which led to the teeth being infected. That may be why he just wants to take the teeth out without giving you any other choices, if he feels that he screwed up somehow.

Tooth #31 is your lower second molar. #32 is your lower wisdom tooth. When a tooth is infected, generally the best option is to have a root canal treatment. And if the tooth has abscessed, the tissue inside the tooth is dead, so there is no feeling in the tooth, which makes a root canal treatment much more comfortable than, say, an extraction. However, with a wisdom tooth, the root anatomy is often very complex and the access to the tooth is very difficult, so I personally would not recommend that tooth for a root canal treatment. But a second molar, yes. I have two root canal treatments on my own lower second molars.

If the lower second molar is extracted, the upper second molar will probably drift down into that space until it hits the lower gums. If that happens, you will eventually lose that tooth also. So that is a consequence. Since there are no teeth behind that tooth, you won’t have the usual extra complication of teeth drifting forward and tipping into that space, which completely disrupts your bite on that side.

I hope this is helpful.

Dr. Hall