The Removal of Teeth for the Future Health

The Removal of Teeth for the Future Health of Those Remaining

Nourishment to Teeth Interfered With

Teeth receive nourishment from the blood stream and surrounding tissues. If there is any impediment or irritation any place along that supply –how can the organ at the end of the line receive its proper amount of subsistence?

In the case of the lower teeth the underlying structure of the teeth often begins to absorb around the centrals before any other place. True, this may be because of traumatic occlusion but an occurrence more than incidental is the fact that some tooth or teeth posterior to the centrals is in an unhealthy state and the amount of nutrition getting to them is less than they and the surrounding tissues need. The removal of a malposed tooth has often cleared up pathological gum condition that were chronic for as much as six years, when if allowed to continue the patients stood a good chance of losing all the nearby teeth in a short time.

I watched with interest the return to normal of a nurse’s gums after the removal of impactions. Her condition had been diagnosed as Vincent’s infection and a smear sure enough showed some of the organisms present and with a history of cellulitis after the removal of a former third molar. I proceeded very cautiously. Incidentally her gum condition was not bad in the quadrant where the wisdom tooth had been removed, and I removed the remainder, in one week after the removal of each tooth the sensitiveness and bleeding ceased in that quadrant.

How many times have we made a mandibular injection for the removal of a lower tooth when acute or chronic pathology existed in it, and had the patient report that as soon as the tooth was removed the teeth anterior to it or the socket of the tooth itself became more numb? Was there not an impediment to the conduction of the effects of that anesthetic anterior to the pathology? Then why have not the teeth and tissues anterior to that diseased condition been undernourished during the entire presence of that pathology? Any leak along a water pipe will cause less pressure beyond the leak, if an infection is sapping nutritive cells from the blood stream won’t everything beyond that infection suffer?

Please do not misunderstand me, I do not mean that every decayed or malposed tooth should be removed, neither should every impaction be extracted. I do say that a study should be made with the future health of the rest of the teeth in mind. I think most of us were taught that the six year molar was the “keystone” of the arch and every trick known to modern dentistry including root canal therapy should be tried before its removal, but with present knowledge of nutrition how true are these teachings?

Consider the child of 14 who appears for operative work. The six year molars have cavities of the 2nd or 3rd degree, the twelve year molars have incipient caries. An x-ray is taken and an inpaction is notice, possibly one of mesial inclination at about a 45° angle. Wouldn’t a far greater service be performed from his if the 1st molars were removed allowing the space to partly or entirely occlude with the probably prognosis of the 3rd molar straightening enough to erupt a normal and healthy tooth without caries?

One case I have in mind is a boy of 16 with his mouth in a deplorable condition but with heavy deposits of secondary dentin under all caries. X-rays were taken. All 3rd molars were in fair position. All 1st molars were beyond repair. In all, 28 distinctly separate fillings were necessary and many of them with little tooth structure left for retention. The first molars were removed, and three years later only three more fillings were necessary to place his mouth in a good condition and these were probably present at the time of the other operative work but unnoticed among the myriads of caries. The third molars had erupted and were four of the nine teeth in his mouth without a cavity. The spaces where the 1st molars were removed was completely closed in two places and nearly so in the others.

If the individual has reached perhaps the age of 19 and the first molar has a filling in good condition and the 3rd is noticed impacted, then the removal of the latter would seem indicated. Patients practically always given an argument, asking, “why should a good tooth be removed,” or “can’t it be filled,” or worst still the old assertion, “it doesn’t bother me now so why have an extraction.” But, is it a good tooth, and how do they know it isn’t bothering them and all the rest of their teeth? The recent discoveries of infected foci around devitalized teeth have definitely proven that just because dentist try was apparently clever enough to fill root canals and keep teeth in their places, the procedure was not always the best in the end.

Dentists Should Cure as Well as Repair

Dentistry is largely repair work but why can it not be more curative rather than simply remedial in scope. I have noticed that discomfort in a normal upper lateral incisor which tooth as a class happens to be the least resistant to disease of the anterior teeth, can be relieved by the removal of a tooth posterior to it as a far removed as the third molar.

Any tooth, but more noticeably the posteriors, seem to have a far greater possibility of recovery from an exposed pulp if a pressure is relieved that is being exerted on them by some other tooth. A pulp can be in the active stages of hyperemia and if the conditions of circulation and nutrition are normal still recover without later developing apical pathology. If the incidence of decay has been materially lessened and oftentimes arrested entirely as I have seen in many cases, why is this not reason enough for the removal of a tooth nature has doomed by caries because a mouth simply cannot accommodate all of the teeth in a healthy state? Wouldn’t our actions as doctors of the dental organs and their related structures be much more honorable if we tried to guide the health rather than to simply repair damages? In several years of practice along these lines not one criticism has been received. Of course, I still have a few years to practice before my annuity runs out buy my models made from impressions taken in many cases before the extractions will be carbon copies of what did exist and models made at later dates will be the compensation for the results.

The health of our mouth and the rest of the body of 90% of us would be better off without the four least healthy teeth, one in each quadrant, because 28 in good or fair condition are far better that 32 with many in a poor or an irreparable state. Furthermore, caries are caused in other teeth by retaining in position a tooth that nature has doomed to loss by decay because there just simply isn’t enough nourishment for all of them.

Bridgeton, N. J.