Faced with the dilemma of a root canal or extraction and unsure of what to do?

There can come a time in a tooth’s life where it gets into a real spot of bother. Perhaps it’s been filled a few times and now consists of more filling than tooth. Maybe it’s had a hard knock or it’s been rotting for a long time and now has a huge cavity.

If one of these problems leads to the death of the tooth, it’s something known as irreversible pulpitis. If any other part of your body gets to this point, the outcome is normally terminal. However, with your teeth, you’ve normally got one more chance. The tooth’s ninth life.

This final roll of the dice is root canal treatment, a procedure which aims to save the tooth. But is it worth it? Will it work? Perhaps it’s better to just have the tooth out and be done with it?

So what do you do – root canal or extraction? This article will compare the procedures and assess the benefits and drawbacks of both to help make your decision.

root canal or extraction speech bubble

What actually is a root canal or extraction?

Root canal treatment is also known as a root filling and the aim is to keep your tooth in your mouth.

Simply, it’s an extension of a filling from the crown of your tooth to the root. Your tooth has a tube running from top to bottom. This needs to be cleaned, widened and then filled. Root fillings fill the tube from the part of the tooth you can see to the end of your root underneath your gum.

Extraction is the complete removal of a tooth from your mouth.

This means loss of the tooth, but also the source of the infection which is causing any pain. Once the tooth is removed, the infection goes with it and the pain is sorted. But there’s no going back.

What’s the procedure in root canal or extraction?

Root canal fillings

image showing root filling procedure steps

There are two important stages of root canal treatment which will determine the success of the procedure.

The first stage is the disinfection of the root canal, the tube which the nerve and blood vessels sit in. If you need root canal treatment this tube will be harbouring bacteria or infection. We need to remove the bacteria to ensure there’s no infection left. This is done through widening the canal and washing it with disinfectant.

The second stage of the procedure is the root filling. Once the tube is clean and widened we can then place the root canal filling. This filling stops any further infection from getting into the tube.

Extraction

Extractions are generally done under local anaesthetic, although sedation or a general anaesthetic is possible.

Once the tooth is numb, it’s gently lifted from the gum. You won’t feel any pain during this procedure, but you will feel slight pressure and pushing.

Time taken to complete a root canal or extraction

picture of a clock

Root canal fillings take a lot longer than extractions.  The procedure is intricate and the steps need to be completed in a set order for success. The minimum amount of time is 30 minutes for a simple root filling on a front tooth, however, a tricky molar tooth may take hours.

Extractions are a lot faster than root canal treatment and can take less than a minute.

If you’re a nervous patient and don’t want to sit in the dental chair for long then extractions are your best option.

 Success of root canal or extraction

Although the aim of root canal treatment is to keep your tooth, there is absolutely no guarantee that the procedure will work.

The further back your tooth is the less the chance of success. Not only are there more canals to fill, but access and ability to see are greatly hindered.

So, it may be you sit through 1-2 hours of root canal treatment and it fails.

One way to improve the chance of success would be to see a ‘specialist endodontist’. This is a dentist who has studied several more years at university and only does root fillings. Using a microscope, they generally have the equipment and skill to do a better job than a general dentist.

Extractions are usually more predictable. Although there’s the risk any tooth could break, generally, they can be removed in a single appointment and problems thereafter are non-existent.

Potential drawbacks with the procedures

Root canal fillings

The main issue here is failure. If the root canal filling doesn’t work there’ll be a lingering infection in the tooth. This can lead to pain, swelling and abscesses.

And if it is unsuccessful, now what?

Well, you could have another go at the root canal treatment, but the second time around it’s even harder.

Or you’ll have no other option but to extract the tooth. Some teeth cannot be saved.

Extractions

There’s always the risk that a tooth can break during extraction and this can complicate the procedure. Your tooth may need drilling to help remove it, similar to when you have a filling. Sometimes we make a cut on your gum to allow us to see it better.

After tooth extraction, there’s a risk of a dry socket, which can cause further pain. Good aftercare is essential to prevent this.

But the obvious and biggest drawback is your tooth has gone and there’s no changing your mind.

Isn’t it easier just to remove the tooth and fill the space?

If you did this you’d still have a tooth but wouldn’t have to bother with root canal treatment.

Well, it’s not really the right way to look at it.

In your mind, if you’re thinking I don’t want a space in my teeth, then always try to save your own tooth first. We have some great alternatives for teeth these days, but nothing will ever be as good as your natural one. If the root canal treatment fails and you need an extraction, this is the time to replace it and not before.

Alternatively, you don’t have to have anything to fill the gap at all. If the space after an extraction doesn’t bother you aesthetically or functionally just leave it there.

What can you replace the tooth with after an extraction?

If after extraction you find the space does bother you, then you have three main options for replacement.  This consists of something fixed (that you can’t remove) or a removable tooth replacement.

The removable option is a denture (or false teeth). These are plastic or metal replacements that fill the gap but can be taken out.

The fixed options are either dental bridges or implants.

Cost of a root canal or extraction

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Root canal treatment on the NHS comes under band 2 and costs £59.10 (Feb ’19). A specialist root filling can cost £300-£1000 depending on the complexity of the roots but remember you get what you pay for and your chances of success are higher.

An extra cost to bear in mind after root canal treatment is the possibility you may need a crown. A crown will cost £250-£1000 on top of the root canal treatment.

Extractions on the NHS come under band 2 and cost £59.10. Privately, they may be from £50-250 depending on the difficulty of the extraction.

Finally

Whether you opt for a root canal or extraction is down to you, but whatever you do it’s in your best interest to choose one or the other as soon as possible. If you bury your head in the sand and ignore the problem, it’s guaranteed to come back with a vengeance.

Remember, root canal treatment is a last-ditch attempt to save a tooth which would otherwise need to be removed. It really is last chance saloon and your dentist cannot work miracles if your tooth gets to this stage.

For this reason, if your heart’s set on keeping your teeth then seeing a specialist will give you the best possible outcome.


AUTHOR

Dr Gareth Edwards Dentist AuthorDr Gareth Edwards BDS (Hons) MFDS RCPS (Glasg) qualified as a dentist with honours. He has a keen interest in orthodontics and aesthetic dentistry and is a certified Invisalign and Six Month Smiles provider. Dr Edwards now works in the Bournemouth & Poole area of Dorset, UK.

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