Tooth Removal - Really Required?

Teeth are one of the most precious parts of the human body.  By playing a significant functional and structural role in aesthetics, facial appearance, and food habits, digestion and chewing, all efforts at maintaining them should be undertaken. As we all know, we have two sets of teeth, primary or deciduous and the permanent set. Let us discuss tooth removal in these two sets separately.

Primary Teeth
In the primary teeth, the main indication would be dental decay.  If the tooth is severely damaged beyond repair with fillings, then removal could be an option, with two things considered. The primary successor will erupt within the next 6 months; if not, a space maintainer would be put in place.

Another reason would be if the tooth is beyond its lifecycle and is blocking the eruption of the successor, then it requires removal.

The permanent teeth, however, are a set that are meant to last for a lifetime and removal should be considered only as a last resort. With advances in dental treatment methods, gone are the days when removal would be an option for severe decay. 

Some of the absolute indications for removal would be:

1. Wisdom teeth: if it is erupting in abnormal position (flattened or crooked), then removing them to avoid infection and impingement on other teeth needs to be considered. Wisdom teeth infection is one of the most common causes requiring tooth removal. 
2. Recurrent infections: If a tooth has been root canal treated, but continues to have ongoing chronic infection, it could be a case for removal.
3. Malformed or supernumerary teeth: These may also block eruption of other teeth into the mouth. 
4. Orthodontic treatment: In cases where the jaw size is really not sufficient to realign the mal-positioned or crooked teeth, the first premolar is often sacrificed, and this space is used to align the other teeth. 
5. Injuries: In case of accidents or injuries with jaw fractures, teeth in the line of fracture may need to be removed. 
6. Preparation for dentures: In cases of severe periodontal disease, where the mobility of the teeth is high and complete dentures are being considered as an option, teeth removal may be planned.  Also, if there are teeth which are in the line of fixed partial dentures, again removal might be planned
7. Radiation therapy: For head and neck cancer patients, if there are teeth in the line of radiation, then removal might be planned.

Unlike in the earlier years, the absolute indications for removing tooth have changed.  A thorough examination, both oral and radiological, should be done before zeroing on extraction.