The impact of tooth extraction – Mark Allen Coltene

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  Posted by: Dental Design      23rd January 2020

A patient who has kept a good standard of oral health for years may still face the prospect of losing a tooth. A failed or failing restoration, a tooth that has been damaged as the result of a trauma or infection – it isn’t just decay and poor dental hygiene that can lead to extraction.

To be told that extraction is necessary, or is an option following assessment, can be a significant psychological blow. People have an emotional attachment to their teeth, yet perhaps they didn’t realise how strong this attachment was until they faced the prospect of losing one.  

A qualitative study from Guy’s, King’s and St Thomas’ Dental Institute in London that looked at the emotional effects of tooth loss, concluded that “the impact that tooth loss can have on people and their lives should not be underestimated”.[i] The study found that, for the 45 per cent of participants who had difficulty accepting the loss of a tooth following extraction, they were “more likely to feel less confident about themselves; more likely to feel inhibited in carrying out everyday activities; and less able to accept the inevitable change in facial shape which occurs following the loss of teeth”.[ii]

Another piece of research concurred with these findings. When asked how they felt when undergoing a tooth extraction, adult patients reported feelings of “sadness” and “depression”, as well as the “feeling of losing a body part” and of “ageing”.[iii] The authors also believed their study indicated that “the effect of tooth loss on self-esteem and self-image is not short lived, as it has been assumed”.

More than vanity

Teeth give support and balance to the face as well as carrying out essential roles. They are central to someone’s physical identity. The impact of losing a tooth can be social, aesthetic and functional. Feeling too inhibited to open your mouth to smile or talk, will affect social engagement and all kinds of relationships. The media may bombard us with images of beautiful smiles, but this isn’t solely about vanity. Anything that changes the way someone looks can affect their self-confidence. Happiness and level of self-worth can also be impacted which, again, may lead to social withdrawal and an unwillingness to participate in all kinds of activities, including work situations.

If someone has lost a tooth, or faces the prospect of extraction, they may become less willing to smile. Smiling is a simple, yet powerful action – both giving (and receiving) a smile establishes a positive bond between individuals. Smiling is contagious; when someone smiles at you, you often reciprocate without even thinking about it, leading to a feeling of wellbeing. A spontaneous, genuine Duchenne smile, where the corners of the mouth raise, makes everyone look more attractive. The rush of endorphins you experience when you smile is a natural stress-buster, too and, it has been claimed, can elevate a pain threshold.[iv]

More dentulous adults

In the past, losing a tooth was to be expected, as part of the normal ageing process. But as per the last published Adult Dental Health Survey, more than half of people over 85 have retained some of their natural teeth, compared to 37 per cent of the population 50 years ago.[v] If a younger patient facing extraction thinks that they won’t be able to chew food properly, or eat the food they want, this can also be a source of considerable distress.

So why, when the offered alternative to extraction is root canal therapy, do some patients still hesitate? If an infection has led to a recommendation for an endodontic procedure, because it is threatening the life of a tooth, this should always be the preferred option. Modern endodontic therapy is quick, ethical and stable. Success rates are extremely high and, even better, a patient will be able to save their tooth rather than needing to replace the extracted one with an implant or prosthesis.[vi] Thanks to modern techniques, a patient will also get their healthy-looking smile restored efficiently – with some tools and materials, the entire treatment can be wrapped in one appointment. Along with technique, material selection is fundamental for successful endodontics; COLTENE’s HyFlex™ file system means that even narrow files can be prepared efficiently. Clinicians may find they can complete the entire preparation sequence with just one or two files and the new HyFlex™EDM Glidepath file 15/.03 was recently introduced to help dentists successfully face the challenge of complex cases.



The psychological impact of extraction is significant and possibly underestimated. For dentists, the aim is to help patients stay dentulous for as long as possible and, should the situation arise, recommend that they choose to save and retain the natural tooth. Having a tooth extracted can affect many areas of a patient’s life, including their mental wellbeing and ability to engage with others. When the reason for a tooth failing is an infection, the best course of action for long term success is always root canal therapy.


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[i] Davis DM, Fiske J, Scott B, Radford DR. Prosthetics: the emotional effects of tooth loss: a preliminary quantitative study. British Dental Journal. 2000 May;188 (9): 503.

[ii] Davis DM, Fiske J, Scott B, Radford DR.

[iii] Okoje VN, Dosumu OO, Alonge TO, Onyeaso C. Tooth loss: are the patients prepared? Nigerian Journal of Clinical Practice. 2012;15 (2): 172-5.

[iv] Dunbar, Robin IM, et al. “Social laughter is correlated with an elevated pain threshold.” Proceedings of the Royal Society of London B: Biological Sciences (2011): rspb20111373.

[v] Adult Dental Health Survey Executive Summary. The Health and Social Care Information Centre, 2011. Link: (accessed September 2019).


[vi] Pulp fact – looking inside endodontic claims. DDU Journal. Link:—looking-inside-endodontic-claims (accessed September 2019).



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