When is a tooth not worth saving?

Hearing that a tooth may need to come out can be unsettling. Your dental provider wants to save your tooth when possible, but some damage may be too serious to repair. Knowing what dental providers look for can help you feel prepared if extraction comes up during your appointment. 

What you will learn in this article: 

• Severe bone loss from gum disease can leave a tooth without enough support. 

• Some cracked teeth can be repaired, but a crack below the gumline or a split tooth may require extraction. 

• An infected tooth can often be treated with a root canal or endodontic surgery. 

• If a tooth must be removed, your dental provider can discuss options such as an implant or bridge. 

If you have a tooth that worries you, schedule an appointment with an Aspen Dental provider. A dental provider can take X-rays and tell you exactly where things stand. 

What makes a tooth hard to save? 

A tooth works as a system. The root anchors it in the jaw. Bone holds the root steady. The crown is the part you see and chew with. When damage reaches deep enough into that system, there may be nothing left to build on. 

Does gum disease make a tooth unsavable? 

It can. The American Academy of Periodontology (AAP) explains that gum disease can break down the tissue and bone holding your teeth in place. If a tooth loses too much support, it may need to be removed. In some cases, regenerative treatment can rebuild part of the damaged bone or gum tissue.¹ 

Bone loss does not always mean a tooth is beyond saving. Your dental provider or periodontist will look at how much support remains and whether treatment could help keep the tooth stable. 

What about a cracked or broken tooth? 

Some cracked teeth can be repaired. A crack that reaches the soft tissue inside the tooth may be treated with a root canal and crown. 

The American Association of Endodontists explains that a crack extending below the gumline is harder to treat and, in some cases, means the tooth must be removed. Newer treatment approaches have improved outcomes for some of these teeth, so it's worth asking an endodontist whether yours is a candidate before assuming extraction is the only option.² If the tooth has separated into distinct pieces, the whole tooth cannot be kept, although part of it may sometimes be saved.³ 

Your dental provider will check where the crack begins, how far it extends and whether the tooth has started to separate. 

Can an infection make a tooth unsavable? 

An abscess is an infection in or around the root of a tooth. It may cause pain while chewing, aching in the jaw or swollen gums, but some abscesses cause little or no pain. 

According to the AAE, an abscessed tooth is usually treated with a root canal or endodontic surgery. These treatments remove bacteria and clean and seal the space inside the tooth. If treatment succeeds, a dental provider can place a crown or another restoration to protect the tooth.⁴

Your dental provider will consider the infection and the condition of the rest of the tooth before deciding whether it can be saved. 

What happens after a tooth is removed? 

If a tooth must be removed, your dental provider can explain how to replace it. The AAP notes that a dental implant takes the place of both the missing tooth and its root. Because the implant connects with the jawbone, it can help keep the bone healthy. It also does not require the nearby teeth to be ground down as a traditional bridge does.⁵

An implant is not the only choice. Depending on your mouth and needs, your dental provider may also discuss a bridge or removable partial denture. Talking through these options early can help you plan your next step. 

If you’ve been told a tooth may need to be removed, talk with your dental provider about what your exam and X-rays show. They can explain whether saving the tooth is realistic and walk you through your treatment options. 

When is a tooth not worth saving? FAQs 

Still have questions? Here are a few that come up often. 

Does a loose tooth always need to come out? 

Not always. Your dental provider first needs to find out why the tooth is loose. Severe loss of the bone around a tooth can make extraction necessary, but gum disease may have other treatment options when enough support remains. 

Is extraction painful? 

Your dental provider numbs the area before starting. You should not feel sharp pain during the procedure. Some soreness afterward is normal. Your care team will explain what to expect and how to manage discomfort. 

What if I put off getting it checked? 

Dental problems can become harder to treat when they are ignored. The American Association of Endodontists notes that treating a cracked tooth sooner can improve the chance of saving it.³ The best way to understand your options is to have the tooth examined as soon as you can. 

Sources 

¹ American Academy of Periodontology: "Surgical Procedures." https://www.perio.org/for-patients/periodontal-treatments-and-procedures/surgical-procedures/ 
² American Association of Endodontists, Communiqué: "Cracked Teeth: To Treat or Not to Treat?" https://www.aae.org/specialty/cracked-teeth-to-treat-or-not-to-treat/ 

³ American Association of Endodontists: "Cracked Teeth." https://www.aae.org/patients/dental-symptoms/cracked-teeth/ 

⁴ American Association of Endodontists: "Abscessed Teeth." https://www.aae.org/patients/dental-symptoms/abscessed-teeth/ 

⁵ American Academy of Periodontology: "Single Tooth Dental Implants." https://www.perio.org/for-patients/periodontal-treatments-and-procedures/dental-implant-procedures/single-tooth-dental-implants/