This is an interesting case in our surgery. In 2013, a nine year old child, let’s call her Anna, came in with her parents, she had a large cavity in her top left molar. This tooth was a six-year-old molar, a permanent tooth that was supposed to last her whole life. I could see the tooth had been filled before, there was new decay next to the existing filling. As could be seen in the first x-ray below, the decay was quite extensive and close to the nerve of the tooth, which meant the tooth was going to be either removed or it would need a root canal treatment. Anna’s parents wanted to do whatever was best for their child, and were willing to spend the money to save the tooth.
I sat down with the parents and discussed the procedures and likely outcomes with them. Root canal treatment was not guaranteed to be successful, of course that meant Anna would keep the tooth, but that tooth would need a crown later on, and if in the next couple of decades, the tooth should fail, Anna would be looking at a possible dental implant or a bridge as replacement. Alternatively, because of Anna’s age, extraction of the tooth now would mean the second permanent molar which normally would erupt around 12 years of age could come down and take up the space left by the first molar.
Anna’s parents were quite hesitant about the second option at first, as most people (rightly so) believed saving a tooth was better than removing it. I reassured them that if it were my daughter, this would be the treatment I would choose.
They decided to follow my suggestion.
Six years later, Anna’s upper second molar has completely taken up the room of the extracted tooth as shown in x-ray 2. This happened naturally without any orthodontic intervention or additional cost to the family. Anna and her parents are very happy with the outcome, it’s as if there had never been a permanent tooth removal. Anna herself does not even remember much about having a molar removed!