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To keep or not to keep: root canal therapy or tooth extraction?


Deciding between root canal therapy or tooth extraction is something we help our patients navigate through almost on a daily basis. In this blog we’ll look at the indications, pros and cons for keeping or pulling a tooth.

What dental problems lead to root canal or tooth extraction?

When you get a toothache – especially a constant throbbing one that doesn’t settle easily, it’s a pretty clear warning sign the nerve in your tooth is irritated, inflamed, dying or infected. The tooth nerve or ‘pulp’ sits in the middle of the tooth, surrounded by hard enamel and dentine. Pulp gets affected by trauma or exposure to the mouth which most commonly happens from deep dental decay reaching the centre of the tooth. 

A severely inflamed pulp is called ‘irreversible pulpitis’ an infected one is called ‘pulp necrosis’. Either of these two scenarios mean the nerve will not heal. Instead, it needs to be completely removed to resolve the toothache properly. Placing a filling in the top of the tooth to seal it up simply just won’t work. 

So you can either keep the tooth after completing RCT or take the whole tooth out. Let’s look at each of the options:

Why choose root canal therapy?

RCT means cleaning out the nerve in the centre of the tooth, filling up the canal spaces, and restoring the tooth properly for appearance and long-term daily use. Technically the tooth is dead, in the same way your hair, fingernails and toenails are not alive either. A well restored, root-filled tooth can last indefinitely in your mouth, well over 10 years, which tends to be the length of the longest review studies.

Keeping the original tooth is usually considered the best option by dentists whenever possible, because any substitute will be a compromise and have a limited life expectancy of around 10-20 years at most. This is a routine procedure for all dentists to perform, although sometimes in complex cases, a referral to an endodontist – a dental specialist in RCT is recommended to complete.

Some things to be mindful of with RCT:

  • If there’s not enough sound tooth structure left to adequately seal the canals and support a restoration, RCT cannot be done and tooth extraction (EXO) is indicated instead
  • RCT is an intensive, technique-sensitive procedure that can take multiple visits to complete, the cost of the treatment reflects this complexity
  • The best prognosis for a root-filled tooth is when the RCT is completed quickly, not drawn out over months and months, and a solid filling – often an onlay or crown is placed 
  • The risks of RCT are generally small – occasionally procedural complications may arise from doing the treatment, but these are uncommon

Why choose to extract a tooth?

Extracting a tooth (EXO) means to completely remove a tooth – and its nerve – from the jaw bone. This is a permanent, irreversible procedure. This leaves a space where the tooth used to be. The jaw bone and gum heals over the site, the bone remodels and often reduces in size, surrounding teeth can drift into the open space, changing the bite and appearance.

EXO is a routine procedure for all dentists, however it can range in complexity from fairly straightforward and quick, through to quite complex and demanding, often involving surgery ie cutting of the gum and jaw bone, needing stitches to heal. In some situations, referral to an oral surgeon  – a dentist who specialises in removing teeth surgically is recommended.

Some things to be mindful of with tooth extraction:

  • Often the gap left by extracting a tooth requires replacement with another restorative option such as a denture, bridge or even implant. Often these treatments are more expensive in the long run than RCT, filling the tooth and keeping it
  • There are more risks with taking out a tooth including: prolonged bleeding, retained root fragments, delayed healing, sinus exposure requiring repair, or nerve damage causing temporary or permanent, partial or full sensation loss
  • Every tooth extraction is different, so that’s why a dentist won’t quote you over the phone without seeing the tooth and knowing more about your medical history

Ultimately the decision to keep or pull a tooth comes down to you, but is guided by dentist-informed factors like: remaining tooth structure, prognosis, complexity, cost, time involved, risks, appearance, function, along with your personal priorities

Best wishes in making the right decision for you!

















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