Retain or extract: the decision process.

It is difficult to give up attempts to save a tooth and decide to extract. Sometimes the decision is easy because experience allows the dentist to evaluate the patient and the situation and make an educated prognosis for the tooth. The thought process is extremely involved and many variables must be taken into consideration, some of which the dentist has very little control over. The process was much less involved when there were fewer options available to the patient and the dentist. Teeth in themselves are very rarely hopeless; it is the desires of the patient, the expertise of the dentist, and the conditions of the oral environment that lead to a hopeless prognosis. A tooth can be moved to another place in the mouth or even into another patient's mouth, and the treatment decision changes, making it not as hopeless. The wish of the patient is usually the final, determining factor for how treatment is carried out. Patients make the decision whether to spend their time and money to save the tooth with extraordinary effort or whether to cut their losses and give up on the tooth.