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Overview

Keeping your natural teeth

When a tooth is in trouble, taking it out is rarely the only option: gum disease, including periodontitis (gum disease that has reached the bone), can often be controlled, an infected tooth treated with a root canal, and a cracked tooth sometimes crowned. This section explains those treatments, and how a dentist decides when keeping a tooth is, and isn't, the right call.

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In short

Can a tooth with gum disease or an infection be kept?

Often, yes. Gum disease is treated in steps: deep cleaning (scaling and root planing) first, then surgery or other treatment where deep pockets remain, then maintenance. An infected tooth can usually be kept with a root canal, which endodontists call the preferred option whenever possible. Some teeth can't be kept, such as when too much bone is lost or a crack runs below the gum line.

From the office of Dr. Angela Berkovich, DMD, Deerfield Beach · (954) 427-3000

Last updated

How common
Nearly half (42%) of US adults aged 30 and older have periodontitis1
First step for gum disease
Deep cleaning: scaling and root planing7
If pockets stay deep
Pocket reduction surgery, regenerative treatment or laser treatment2,4,6
Afterwards
Maintenance visits every few months for more advanced disease, every six months for mild disease, set by your risk2,5
Infected tooth
A root canal saves the tooth instead of removing it10

In this section

Start with the question that matches where you are.

Signs worth getting checked

None of these means a tooth is lost. Each is a reason to have your gums and teeth measured.

  • Gums that bleed when you brush or floss
  • Gums pulling back from the teeth, or teeth that look longer
  • A tooth that feels loose or has moved
  • A tooth you have been told should come out, and you want a second look
  • A cracked tooth, or a tooth that hurts when you bite

How gum disease is treated, step by step

This is the stepwise approach in the European clinical guideline for periodontitis. Each step is re-checked before the next.

  1. Measure

    Gum pockets are measured with a probe and X-rays show the bone around each tooth.2

  2. Clean and control

    Home care, risk factors such as smoking, and a deep cleaning below the gumline (scaling and root planing).2,3

  3. Re-evaluate

    Pockets are measured again. Many patients need no further active treatment at this point.3

  4. Treat what remains

    Where deep pockets remain, pocket reduction surgery, regenerative procedures or laser treatment such as LANAP may be considered.2,4,6

  5. Maintain

    Supportive care visits at an interval set by your risk.2,5

When keeping a tooth is not the right call

Keeping a tooth is the goal only when it can stay healthy. An honest exam sometimes says otherwise.

  • When too much bone has been lost around a tooth, it eventually needs to be taken out.4
  • When a crack runs below the gum line, the tooth can't be saved; a split tooth can't be kept whole.9
  • When a tooth is removed, the gap is replaced with an implant, a bridge or a denture, each with its own trade-offs.12,13,14

Questions patients ask

Can gum disease be reversed?

Early gum disease (gingivitis) can often be reversed with daily brushing, flossing and a cleaning. Periodontitis, where bone has been lost, is controlled rather than reversed, though regenerative procedures can rebuild some lost bone and tissue.3,4

Is a root canal better than pulling the tooth?

The American Association of Endodontists says saving your natural tooth with a root canal is the preferred option whenever possible: it is typically less invasive and needs fewer appointments than extraction and an implant.8

Is LANAP the only option?

No. LANAP is one of several options for pockets that stay deep after cleaning, alongside pocket reduction surgery and regenerative procedures, and independent reviewers say the evidence for lasers is still limited.2,4,11

I was told my tooth has to come out. Should I get a second opinion?

It is reasonable to ask. Some teeth can be kept with gum treatment or a root canal; others, such as a tooth cracked below the gum line, can't. An exam with X-rays and pocket measurements shows which applies to you.8,9

Who you'll see

Dr. Angela Berkovich, DMD

Dr. Angela Berkovich, DMD

Dentist, trained at Oregon Health & Science University School of Dentistry

Dr. Berkovich measures your gums, explains which teeth can reasonably stay and offers LANAP with the PerioLase laser at the office, alongside deep cleaning and root canal treatment.

Medical content reviewed by Dr. Angela Berkovich, DMD on .

Office: 1348 E Hillsboro Blvd Suite A, Deerfield Beach, FL 33441. (954) 427-3000

About Dr. Berkovich

Sources

  1. Centers for Disease Control and Prevention: Gum disease facts
  2. PubMed: Sanz et al. 2020, treatment of stage I–III periodontitis: EFP S3 clinical practice guideline
  3. American Academy of Periodontology: Non-surgical treatments
  4. American Academy of Periodontology: Surgical procedures
  5. American Academy of Periodontology: Frequently asked questions
  6. Cleveland Clinic: Gum Disease Treatment
  7. Cleveland Clinic: Dental Deep Cleaning: What It Is & What To Expect
  8. American Association of Endodontists: Root Canal vs. Dental Implant: Which Is Right for You?
  9. American Association of Endodontists: Cracked Teeth
  10. American Dental Association (MouthHealthy): Root Canals
  11. PubMed: Mills et al. 2018, AAP best evidence consensus on lasers in periodontal therapy
  12. Cleveland Clinic: Dental implants
  13. Cleveland Clinic: Dental Bridges: Types & Who Needs Them
  14. American Dental Association (MouthHealthy): Dentures

General information, not a diagnosis or a promise of results. Individual results vary, and whether a treatment suits you depends on your exam.

Talk it through at a consultation

Bring your questions and any X-rays you already have. We'll look at your teeth, explain which options are reasonable for you, and what each one involves.

Request a call back Call (954) 427-3000
Call (954) 427-3000Request a call back