When deciding whether to save a tooth or not, we will sometimes talk about a tooth as being “hopeless.” This is a semi-clinical term that is readily understood by dentists and periodontists, but may be unclear to you.
So, what do we mean by a hopeless tooth?
A Periodontally Hopeless Tooth
The term hopeless tooth was originally developed to describe teeth that had been so compromised by gum disease that they were unlikely to be saved. In order to be described as hopeless, a tooth had to meet at least two of the following criteria:
- Loss of more than 75% of supporting bone
- Pocket depths of 8 millimeters or more
- Class III furcation involvement
We can easily determine bone volume using a CBCT scan. Pocket depth is determined using a periodontal probe. Furcation involvement takes a little more explanation. Furcation means division, the way the tooth root divides into smaller parts, similar to the way tree roots branch out. When bone is lost around this division point, it significantly undermines the stability of a tooth. A class III furcation means that so much bone has been lost that a dental probe can pass entirely through the space.
Hypermobility just means that the tooth can move easily through a wide range of motion. Sometimes this is used to describe when a tooth has significant movement after periodontal treatment is completed.
If a tooth meets these criteria, we will describe it as “hopeless.”
Other Descriptions of Hopeless Teeth
Teeth are sometimes described as “hopeless” if they cannot be saved for other reasons. Most commonly this is because they have a root fracture or cavity. Although we can readily repair damage to the crown of the tooth–or replace the crown entirely–when the tooth root is damaged, the tooth is considered lost.
Are Hopeless Teeth Really Hopeless?
The criteria for hopeless teeth were defined decades ago, and since then we have improved our ability to treat some oral health conditions, allowing us to save many teeth that in the past have been described as “hopeless.”
Teeth with cracked or decayed roots are often still beyond our capability to save.
However, teeth that are described as “hopeless” for periodontal reasons can be saved in many cases. Often, they will last for decades once successfully treated. And, with gum grafts, they can be restored to an attractive appearance, no matter how much gum recession you’ve experienced.