Why Do Some Teeth Need To Be Extracted Instead of Filled?

All about tooth extraction

There are some cases where a tooth extraction is the only way to restore your oral health.

When you see us here at River Walk Dental, sometimes we recommend a filling, sometimes a crown, sometimes a root canal and crown, and sometimes a tooth extraction. Why exactly is this? At what point will your dentist decide the tooth can no longer be saved? Let’s talk about the stages of tooth decay and the other reasons a tooth may need to be pulled.

Severe Decay

Our teeth are made up of four parts. The enamel is the hard outer coating of the tooth. Damage to the enamel is the beginning of tooth decay. 

The dentin is the tissue located beneath the enamel, the cementum is the hard connective tissue that holds the tooth in place, and the pulp is the soft, sensitive tissue at the center of the tooth that contains the nerves and blood vessels. All of these parts serve a unique purpose in maintaining the strength and health of the tooth. Tooth decay generally starts with the outermost part (damage to the enamel) and works its way inward. 

How Tooth Decay is Treated in the Beginning 

The hard enamel that our teeth are encased in is meant to protect them. When the enamel starts to lose some of its strengthening minerals, we call this demineralization. White or brown spots will start to appear on your teeth as the enamel wears away. 

When the enamel is further broken down, irreversible damage occurs. As you know, these holes in the teeth are called cavities (or caries). At this point, your dentist will recommend a filling to stop the damage from progressing. 

By the time tooth decay reaches the dentin, it may be very visible; however, you may not be able to see the extent to which the tooth is damaged, so that’s why diagnostic imaging is so important.

Dentin damage may call for tooth extraction.

Once the damage is found, dentin decay can sometimes be repaired with a filling, similar to the process for enamel decay. Further damage may call for a crown. However at this point, the decay may have caused the tooth to become brittle, weak, extremely discolored, or at a high risk of becoming infected, and those are all reasons why tooth extraction would be the best course of action. 

A bad toothache may mean the damage has reached the nerves. 

Inside your root canal lies the body of your tooth—the soft tissue that keeps your tooth alive. We call this the “pulp.” The nerves and blood vessels are stored here. If you are experiencing a toothache, it may be due to the fact that the decay has reached the nerves. You could be experiencing pain, swelling, and signs of infection. When it’s progressed this much, the only option for treatment is to remove the natural pulp and replace it with synthetic material—a process you’re familiar with as a root canal.

Severely abscessed may also be a reason for tooth extraction. 

A tooth abscess is simply an infected tooth and a pocket of inflammation around the tooth. This needs urgent dental treatment. Without treatment, the infection can spread to the bones in the jaw, neck, and head, and cause difficulty swallowing and breathing. Like with every other stage of tooth decay, you may not feel any pain and that’s why routine oral exams are so important. A tooth abscess, though, can and often will cause extreme discomfort, swelling, a foul-smelling pus, and discharge.

There are other reasons that may call for a tooth extraction besides tooth decay. Sometimes it’s the gum that gets infected and causes problems. Let’s discuss gum disease. 


Tartar and plaque buildup around the gumline cause infection. During the first stage, we call this gingivitis. If your teeth bleed when you floss them, there’s infection there. Thankfully, at this stage, gingivitis is reversible with good oral care and dental hygiene appointments.

Advanced Periodontitis 

When gingivitis isn’t treated, it causes irreversible damage to the bone and surrounding fibers. We call this periodontitis. Without treatment, periodontitis will progress to advanced periodontitis—when there is so much bone loss that your teeth shift and change position. If the condition is past treatment, the teeth may need to be extracted.

Traumatic Injury 

Trauma is a reason for tooth extraction. The most common types of trauma are chipped teeth and missing teeth. You should see your dentist immediately following a traumatic injury as sometimes the tooth can be saved; however, sometimes it cannot. Dental imaging is extremely important in this instance as it allows your dentist to assess exactly how much damage has taken place. 

Crowding and Impaction

When a tooth cannot erupt properly, we say it is impacted. Impaction is common in children who have crowded baby teeth or in adults with wisdom teeth. Impacted teeth are often angled incorrectly. The misalignment makes it easy for food debris to get trapped in the cracks and crevices, and heightens the chances of tooth decay and gum disease. In this case, your dentist may pull the impacted teeth to prevent future oral complications.

We’re here to help.

River Walk Dental offers the best dental services in Flower Mound, Texas. We provide high quality, skilled care to make sure your teeth get the best treatment that is out there. If you suspect you have gingivitis or want to discuss the health of your teeth, contact us for an appointment. We look forward to helping your smile be your brightest and healthiest.  

River Walk Dental

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