Dentists around the world routinely remove diseased or damaged teeth every day. While some extractions require surgery, many don't: Your family dentist can perform these simple extractions, usually with little complication.

The term simple doesn't necessarily mean easy—as we'll note in a moment, it takes a deft and experienced hand to perform this type of extraction. The term in this case refers more to the type and condition of the tooth: The tooth roots are relatively straight and reside in the bone at an accessible angle. There are otherwise no meaningful impediments to removing it straight out.

The idea of “pulling a tooth” out of the jaw isn't the most accurate way to describe the procedure. A tooth is actually held in place within its bony socket by the periodontal ligament, a tough, elastic tissue between the tooth root and the bone that attaches to both through tiny fibrous extensions. The best method is to first loosen the tooth from the ligament's tiny attachments, for which experienced dentists can develop a certain feel. Once released from the ligament, the tooth will usually come free easily from its socket.

Not all teeth, though, can be removed in this manner. Teeth with multiple roots like back molars, and without a straight trajectory out of the socket, can have a complicated removal. Other dental conditions could also prove problematic for simple extraction, such as brittle roots that might fragment during removal.

For these and other complications, your general dentist may refer you to an oral surgeon for the tooth extraction. But even with the surgical component, these more complicated extractions are relatively minor and routine—millions of wisdom teeth, for example, are removed every year in this manner.

If you have a tooth that needs to be removed due to disease or injury, your dentist will first determine the best way to remove it and will refer you, if necessary, for surgical extraction. And whatever kind of extraction you undergo, the dentist performing it will make sure you remain pain-free during the procedure.

While tooth preservation is usually the best course for long-term dental health, it's sometimes best to remove a tooth. If that should happen, your dentist will make sure it's done with as little discomfort to you as possible.

If you would like more information on dental extraction methods, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Simple Tooth Extraction?”

A traditional root canal procedure can be a “life-saver” for a decayed or injured tooth. But while it’s usually the best course for a damaged adult tooth, variations of the procedure are advisable for a new permanent tooth in a child or young adolescent.

This is because the inner pulp, the focus of the treatment, plays an important role in a young tooth’s development. When it first erupts a tooth’s dentin layer, the living tissue that makes up most of the body and roots of the tooth, hasn’t fully formed. The pulp increases the dentin layer over time in conjunction with jaw development.

Because a full root canal treatment removes all of the pulp tissue, it could interrupt any remaining dentin development in a young tooth. This could lead to poorly-formed roots and a less healthy tooth. For an immature permanent tooth, then, we would use variations of a root canal treatment depending on the nature and extent of the injury, the patient’s overall health and medications they may be taking.

Our main objective is to expose or remove as little of the pulp tissue as possible when treating the tooth. If the pulp hasn’t been exposed by the decay or injury, we may only need to remove the softened decayed or injured dentin while leaving harder dentin nearer the pulp intact. If, however, the pulp has become partially exposed by disease or injury, we would then perform a pulpotomy in which we remove only the exposed tissue and then place calcium hydroxide or mineral trioxide aggregate (MTA) to stimulate dentin growth that will eventually patch the exposure site.

In cases where decay or injury has rendered an immature tooth’s pulp tissue unsalvageable, we may use a procedure known as apexification that seals off the open, cylindrical root end of the tooth. This will allow bone-like tissue to grow around the root to serve as added support for the tooth. Although it can save a tooth in the short run, the tooth’s long-term survival chances may be lower.

By using these and other techniques we may be able to save your child’s immature tooth. At the very least, such a technique could postpone replacing the tooth until a more opportune time in adulthood.

If you would like more information on treating damaged teeth in children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Saving New Permanent Teeth after Injury.”

We most often associate plastic surgery with cosmetic enhancements to our outer appearance. While this is their primary purpose, some forms of reconstructive surgery restore lost function and health as well as improve appearance. A classic example is cosmetic periodontal (gum) surgery that restores receded gum tissues that have exposed more of the tooth than is visually appealing.

Gum recession occurs primarily because of excessive brushing (too hard or for too long) or because of periodontal (gum) disease, a bacterial infection that ultimately causes gum tissue to detach and pull away from the teeth. Gum recession not only affects the appearance of the teeth, it can expose the tooth’s root surface to further infection and decay. Without treatment, the disease could progress causing further damage with the potential for the tooth to be eventually lost.

In conjunction with plaque removal to stop gum disease and possibly other treatments like orthodontics to correct misaligned teeth, cosmetic gum surgery is used to rejuvenate lost gum tissues around teeth through tissue grafting. In these procedures, a combination of surgical approaches and/or grafting materials are attached to the area of recession to stimulate the remaining tissue to grow upon the graft and eventually replace it.

Donor grafts can originate from three sources: from the patient (an autograft); another person (an allograft); or another animal species, usually a cow (a xenograft). Tissues from outside the patient are thoroughly treated to remove all cellular material and bacteria to eliminate any possibility of host rejection or disease transmission.

Depending on the nature of the gum recession and tooth condition, the procedure can take different forms. It could involve completely detaching the graft tissue from the host site and re-attaching it to the recipient site. But if more of the tooth root is exposed, the surgeon may cover the graft with tissue adjacent to the host site to supply blood to the graft, and affix the loosened pedicle to the graft site. While any technique requires advanced training and experience, the latter procedure involves microsurgical techniques that require the highest levels of technical skill and art.

Cosmetic gum surgery can result in healthier gum tissues and teeth that are less susceptible to infection and loss. No less important, though, these procedures can return a more natural look to your teeth and gums — and a more pleasing smile.

If you would like more information on gum tissue reconstruction, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Periodontal Plastic Surgery.”

Sometimes it seems that appearances count for everything—especially in Hollywood. But just recently, Lonnie Chaviz, the 10-year-old actor who plays young Randall on the hit TV show This Is Us, delivered a powerful message about accepting differences in body image. And the whole issue was triggered by negative social media comments about his smile.

Lonnie has a noticeable diastema—that is, a gap between his two front teeth; this condition is commonly seen in children, but is less common in adults. There are plenty of celebrities who aren’t bothered by the excess space between their front teeth, such as Michael Strahan, Lauren Hutton and Vanessa Paradis. However, there are also many people who choose to close the gap for cosmetic or functional reasons.

Unfortunately, Lonnie had been on the receiving end of unkind comments about the appearance of his smile. But instead of getting angry, the young actor posted a thoughtful reply via Instagram video, in which he said: “I could get my gap fixed. Braces can fix this, but like, can you fix your heart, though?”

Lonnie is raising an important point: Making fun of how someone looks shows a terrible lack of compassion. Besides, each person’s smile is uniquely their own, and getting it “fixed” is a matter of personal choice. It’s true that in most circumstances, if the gap between the front teeth doesn’t shrink as you age and you decide you want to close it, orthodontic appliances like braces can do the job. Sometimes, a too-big gap can make it more difficult to eat and to pronounce some words. In other situations, it’s simply a question of aesthetics—some like it; others would prefer to live without it.

There’s a flip side to this issue as well. When teeth need to be replaced, many people opt to have their smile restored just the way it was, rather than in some “ideal” manner. That could mean that their dentures are specially fabricated with a space between the front teeth, or the crowns of their dental implants are spaced farther apart than they normally would be. For these folks, the “imperfection” is so much a part of their unique identity that changing it just seems wrong.

So if you’re satisfied with the way your smile looks, all you need to do is keep up with daily brushing and flossing, and come in for regular checkups and cleanings to keep it healthy and bright. If you’re unsatisfied, ask us how we could help make it better. And if you need tooth replacement, be sure to talk to us about all of your options—teeth that are regular and “Hollywood white;” teeth that are natural-looking, with minor variations in color and spacing; and teeth that look just like the smile you’ve always had.

Because when it comes to your smile, we couldn’t agree more with what Lonnie Chaviz said at the end of his video: “Be who you want to be. Do what you want to do. Do you. Be you. Believe in yourself.”

If you have questions about cosmetic dentistry, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Beautiful Smiles by Design” and “The Magic of Orthodontics.”