“They Told Her the Tooth Had to Go.
I Disagreed.”
A second opinion saved Barbara’s tooth—and changed her understanding of dental care.
About ten years ago, a woman in her mid-60s named Barbara walked into my Washington, DC prosthodontic office with a simple request: remove the tooth her dentist had already written off.
She had been referred to me specifically for an extraction. Not for a consultation. Not for an evaluation. Just the procedure.
Now, in the world of dental referrals, that distinction matters. Sometimes, a colleague will send a patient over for a second opinion and trust my training in prosthodontics and periodontics to guide the next step. Other times, the referral comes with a specific request—“just do the extraction”—and any deviation from that plan can be seen as stepping on toes.
That puts a specialist like me in a difficult position. If I follow through with a treatment I don’t believe in, I violate my own ethics. But if I recommend something different, I risk losing the trust—or the referrals—of a colleague.
Barbara’s case was one of those moments.
A Tooth Labeled for Extraction
Her dentist had already told her the tooth couldn’t be saved and should be replaced with a dental implant. But when I examined her myself, I saw something different: a tooth that was not only salvageable, but one that could continue functioning for many years—with the right care.
I explained the situation. She was surprised. Even suspicious. After all, she had already accepted the idea of an extraction. Plus, the cost of a dental implant was outside her budget. She told me her dentist had offered to place a bridge afterward—more affordable, but one that required shaving off from adjacent teeth.
At that point, the referring dentist was insistent: remove the tooth so he could proceed with a 3-unit bridge. I explained my findings, but he wasn’t interested in revisiting the plan. A few weeks passed, and Barbara scheduled her extraction with me.
That’s when the story shifted.
A Second Chance
Before her appointment, Barbara called to say her dentist had passed away. The loss was tragic—but it gave me the space to speak more freely with her.
I told her again: I believed I could save the tooth predictably.
She was skeptical—understandably so. But I made her an offer: I would charge the same fee she had already budgeted for the extraction and instead perform a minor periodontal procedure to stabilize and preserve the tooth (it is called Crown Lengthening and it cost more than extraction).
That’s when she understood this wasn’t about profit. It was about giving her the best outcome possible. She agreed.
A Tooth That Still Stands
Today, over a decade later, Barbara still has that tooth. It’s healthy. It’s functional. And it serves as a quiet reminder that the right decision isn’t always the most common one.
Far too often, teeth are extracted not because they’re beyond saving, but because the treating dentist isn’t equipped—or incentivized—to save them. And with increasing pressure from dental insurance companies and corporate dental chains, more and more treatment plans are guided by efficiency and profit rather than what’s best for the patient.
Patients like Barbara are often left in the dark, unsure who to trust.
But in my office, patients don’t just get procedures—they get options. I believe every person deserves honesty, thoughtful care, and the opportunity to make informed choices about their oral health.
The Bottom Line
Saving a tooth is sometimes harder, sometimes slower—but when it’s possible, it’s worth it. Barbara’s case proves that the right hands, the right tools, and the right philosophy can make all the difference.
At my practice, the patient’s best interest is always the goal.
