Dentist Journal

Should I stay or should I go I can’t decide between root canal therapy or extraction

Ever had agonising pain in your tooth? Maybe as you tried to cope with the pain, you wondered whether you should just get the tooth extracted? After all, if the tooth isn’t there, the pain should just disappear!But before you picture yourself walking around with one less tooth, you might like to know that modern dentistry doesn’t advocate tooth extraction as the first option. Modern dentists will usually advise you to preserve and keep your natural tooth – tooth extraction is normally the last optionTooth extraction isn’t the first option of modern dental treatment because removing a tooth that’s painful can have negative consequences on your mouth and gum health.When you have a tooth extracted:

  • You’ll look different: Extracting a tooth near the front of your mouth will have more impact than a tooth at the back of your mouth.
  • Your teeth next to the space will move inwards and tilt.
  • Your bite will change, which can lead to jaw issues later down the track, and
  • The remaining space can be hard to clean, which can result in periodontal disease developing.

Tooth extraction is a fast, cheap and simple option to relieve your pain, but it’s not always the best long-term option for your dental health. And even though you may know many people with missing teeth and they say everything is fine, you need to make sure you clearly understand and accept the consequences. Because once your tooth is gone – it’s gone!So if your tooth isn’t going to be extracted, how will your pain be relieved?Root canal therapy is an alternative dental treatment to tooth extraction, where the soft tissue (pulp) inside the damaged tooth is treated. Your damaged or infected pulp is filled during a procedure known as endodontic treatment.Some patients wonder why they can’t just get their pain eased with medication, “Can’t you just give me some antibiotics to clear the infection Doc?” We’re used to doing this when we go to the doctor with an infection. And if the first course of pills hasn’t cleared up the infection, we go back for another course of treatment.But why is an infection in a small area of your jaw so intensely painful, complicated and costly to repair? To solve your tooth infection problem properly, it’s best to eliminate the cause of the infection – not just the signs and symptoms of the infection itself (which is partly what antibiotics do). Here are your choices if you’ve got advanced disease of the tooth:

  • Medication by itself will rarely solve tooth infections
  • Extracting the offending tooth will relieve the pain
  • Root canal therapy will save your tooth and solve the cause of the pain

When I explain to patients why the best option is to save the teeth, how many appointments are needed, and the cost involved, they’ll often reply, “Can’t I just have the tooth out doc? It all sounds so expensive, complicated, painful and time consuming!”Removing the tooth is certainly a good idea if you’ve left the tooth too long and nothing can be done to save it. There will be consequences after the tooth is removed, but you’ll be able to adjust to these.So should you save the tooth that’s causing you pain? You need to ask yourself how important keeping your own teeth is. How do you see yourself, as you get older? Have you got a picture of your grandparents in your mind and wonder if you’ll end up looking like them?Keeping the tooth does require several decisions that must be made with your dentist (or specialist). However, if the tooth can be saved, keeping it may work out better in the long run.This will depend on several factors that include:

  • How long you can expect the tooth to survive once treatment is complete,
  • How successfully the infection be treated, and
  • Whether the tooth can be strengthened for normal chewing – this is important if it’s one of your back teeth,

You also need to consider:

  • What the tooth will look like once treatment is complete? This is very important if the tooth is visible when you smile.
  • If you have the time and finances for the treatment?
  • Why has the tooth infection occurred in the first place and are your other teeth at risk?

Still got questions about whether you should have your tooth extracted or root canal therapy? Leave your questions in the comments below and I’ll answer them for you.