Dentistry for the 21st Century is about preserving as much natural tooth tissue as possible. You have been used to these structures since they erupted into your mouth, and teeth are important in maintaining the supporting bone contours, as well as providing surfaces to function with. By this I mean speech, biting and chewing. Teeth in one jaw also offer support to those in the opposing jaw, to maintain their position in the dental arch. Research has also indicated that the shape and position of your teeth also push food material over the gum tissue in a very special way, massaging and cleaning the tissue as you eat.

There are several occasions where tooth extraction is necessary, and these are decay, infection, fracture and severe crowding.


Tooth Decay
Dental decay is caused by the destruction of the outer enamel surface of the tooth structure, allowing bacteria to penetrate into the less dense dentine tooth body. As the process of decay progresses, the advancing wave of bacterial products begin to irritate, then kill the nerve tissue. Once the nerve tissue dies, depending on the bulk of the tooth remaining, it may be possible to save it by root canal treatment, or if the destruction is too great, accompanied with infection in the supporting bone tissue, removal or extraction becomes the reluctant treatment of choice.

There have been many theories why dental decay begins and progresses, but it is generally accepted that the following processes occur.

Decay occurs at sites where bacteria accumulate and convert sugars to acid by-products of living and reproduction. These acids dissolve the mineral components in enamel, and leave rough areas, which may be stained. These 'early lesions' can remineralise and 'heal' if recognised and you, the patient, become more motivated and efficient in your cleaning routines.

As further minerals are dissolved out of the decaying area, more bacteria collect in the rough area and the lesion penetrates through into the dentine. Dentine is a living tissue. If you can imagine a tooth structure as follows, then you will understand of the process of decay better.

The centre of the tooth is soft tissue, comprising nerve and blood supply tissue. The outer surface of the nerve tissue is similar, to you scholars, to a Medusa's head, with millions of fine 'hairs' that are minute nerve ends. Each 'hair' runs up inside a single small tube with in the dentine. So if you can imagine the dentine as an enormous bundle of straws centred around a ball ( the nerve tissue), these hairs would run up inside each straw. Covering the outer ends of the straw tubes is the enamel which is a very hard crystalline material. This outer surface is the surface that takes all the abuse of the food we eat, fluids we drink, and trauma when we bite and chew, or get hit in the mouth during sports, brawls and accidents. The reason that our teeth do not fracture all fall apart after each knock is their unique design. The dentine is 50% water, and the tubular construction when wet with nerve fluids keeps this material flexible, and able to absorb energy. So, you may well have many fracture lines that you can see in your own teeth, but the properties of the dentine bind the whole tooth together and keep it intact and functional. The analogy that I use to my Patients is a grass leaf. When wet, it can be folded, knotted and woven. These processes can be reversed, and the leaf returned to a single leaf, usually without breakage. But once the grass leaf dries to become hay, it is fragile and brittle. If you attempted to fold, knot or weave it is this dried state, it would probably break or fracture. Nature has many other examples of this.

Now once the acids and bacterial by-products gain entry into the dentine, the rate of penetration and destruction is increased by its unique 'straw-like' construction. Depending on where the decay area started in the tooth, and the shape of the advancing decay, structural failure of portions of the tooth, or the whole crown, can occur. Unless this stage is quickly stabilised, the nerve tissue will die, leading ultimately to infection within the supporting bone tissue.

Infection in the bone tissue is not a reason per se to remove the tooth, as many patients that we see have teeth where the nerve tissue has been removed and the tooth restored once the infection has been eliminated. This process is called root canal treatment (Click here for more details. )

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