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Is Second Molar Replacement Absolutely Necessary?

Updated: Feb 6

We often get asked, "Do I need to replace my second molar?" so today we're going to help you decide whether or not it is worth it. There are pros and cons to replacing it after a tooth extraction which we'll explain.


Second molars on a skull model

Table of contents:


Pros & Cons

There are advantages and disadvantages to replacing a second molar which we will list below.


Pros:

  • Maintaining full set of dentition.

  • Prevents supraeruption of the opposing molar.

  • No decrease in chewing power.

  • More difficult to replace later on.


Cons:

  • Implants are costly.

  • Second to last tooth in the mouth so no one sees it.

  • Doesn't severely affect chewing.

  • Difficult to restore.


We will go through each of these points in greater detail in the following sections.


Benefits of replacement

Despite the cost, there are many benefits to replacing your second molar if you've had it extracted.


Full set of teeth

The most obvious advantage to restoring a lost second molar is that you get to maintain a full set of dentition. Tooth loss should only occur if a catastrophic event happens to them such as severe tooth decay or infection.


Most people would prefer to not lose any body parts if they don't have to. By replacing that molar, you can restore your body back to its original condition.


Prevents supraeruption

Most patients don't realize it but if you do not replace the extracted second molar, the opposing tooth will supraerupt. This is a condition where the opposing tooth will start growing into the space of the missing tooth.


model of supraerupted tooth

An example of this happening is if you extract tooth 15 and you don't replace it. The consequence is that tooth 18 will supraerupt out of the arch and into the space of where 15 use to be.


Ultimately, you may end up losing tooth 18 in addition to 15. Therefore, if you do not replace that second molar, you will end up losing another second molar.


Maximize chewing efficiency

Missing a molar will affect your chewing effectiveness and efficiency. On average, if you do not replace the second molar, you may lose about 10-15% of your chewing power.


It may not seem like a lot and while a lot of people do get use to it, it does account for something. Do you already have trouble chewing certain foods? Well, not replacing it will only make it worse.


Difficult to replace in future

If you extract the second molar and you do not replace it, it will become more difficult and costly to do so if you change your mind in the future. Having a tooth present helps to preserve the jaw bone but if you lose it, the bone of where the molar use to be will start to erode. Your body will slowly resorb the bone in the area and use it elsewhere.


What that means for you is that if you wanted to place an implant there later on but if you don't have enough bone, you may not be able to do it.


Consequences of no replacement

There are consequences if you choose not to replace your second molar after having it pulled.


Lose opposing tooth

An unreplaced second molar will induce the opposing molar to supraerupt and attempt to grow into the missing tooth space. The supraeruption makes the molar more prone to tooth decay and periodontal disease. Most people end up losing this supraerupted molar.


More costly to replace in future

Bone loss will occur in tooth sockets with no replacement. While it's still possible to replace the missing tooth in the future, it will be most costly because you may need extensive bone graft to be able to place an implant there.


You could've avoided all of this additional cost if you simply replaced the missing second molar within the first year of having it taken out.


Sets a precedent

If you decide to not replace the extracted second molar, it may set a precedent for you to think it is ok to not replace the next tooth that is taken out. This idea may fester in your mind and take you down a deep dark rabbit hole.


Since it was okay to not replace this missing tooth, you may think it's okay to not replace the next one and the next one. If this pervasive thought remains, you may eventually end up with no teeth left.


After all, those in dentures aren't in that situation because of a single decision. It is actually due to a string of many bad decisions that led them to losing all of their teeth.


Common hesitations in replacing second molars

The two most common pain points or roadblocks which make people hesitate in replacing their missing molar are that it's expensive and sometimes it's difficult to restore.


Implants are expensive

The most ideal way to replace a missing second molar is with an implant and that can be costly. The average cost for an implant including the crown is $4900 without any insurance.


implant crown and screw fixture


Implant Part

Average Cost

Implant screw fixture

$2200

Implant abutment

$1000

Implant crown

$1700


Difficult to restore

Let's be honest, the second molar is really far back and sometimes there isn't enough space to restore the tooth. The surgeon may have a difficult time placing the implant or your dentist may have a difficult time getting a crown on it.


Ultimately, if an implant is unable to be placed in that location, you will not be able to get a replacement!


The Verdict

In our opinion, if you have the means to replace your missing second molar and there aren't any restoration difficulties, you should do it.


The easiest and least costly time to do it is shortly after having the tooth pulled. If you change your mind in the future and want to do it then, there is a good chance you may need costly bone grafting.


Last but not least, we also believe that keeping a full set of teeth helps you maintain a positive mindset. If you think it's okay to lose one molar, what's there to stop you from losing the second, third, fourth, fifth tooth and etc?


Usually that negative downhill perspective is how people end up in dentures. People just let it go and then it begins to snowball until they lose all of their teeth. However, if you put your foot down with a hard no, perhaps you won't ever get to that point. At least that is what our dentists in Long Island City believe.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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