How to decide between root canal or extraction

One of the hardest decisions to make is whether to save a tooth with root canal treatment or to remove it (extraction). If you find yourself in this situation, the best thing to do is familiarise yourself with the two procedures. Then, weigh up the short and long term benefits and limitations to make an informed decision.  Make sure you factor in the time and costs associated with each treatment option and if you’re still unsure, ask your dentist, ask your questions!

What is root canal?

Root canal treatment is an option when the nerve inside a tooth is infected through decay or damaged through trauma. For example, you may constantly get food caught between two teeth which results in a cavity. This cavity eventually reaches the nerve and only then does the tooth start to hurt. Another common problem I see is a cracked tooth whereby let’s say you are stressed at work and you start grinding your teeth at night. In a short time, you can wear down and crack your teeth without even knowing it. Eventually, the crack reaches the nerve and you will feel quite a bit of pain. This pain can arise after eating or drinking something hot or cold, the tooth may be tender to pressure or chewing or you may have a swollen face or a swelling in the gum.

You’re more likely to choose root canal when…

These are just basic guidelines, so you’ll need to see your dentist for a more thorough discussion about your teeth. I happen to be a dentist, so if you need to have a chat about this, call my awesome team on 8678 3538. Root canal is a good option when:

  • You can see the tooth when you smile.
  • There is really good bone and gum support around the tooth.
  • The treatment is within your budget or you can organise a payment arrangement with your dentist.
  • You are committed to looking after your teeth through brushing, flossing and regular dental visits.
  • There is strong chance your other teeth will move into unfavourable positions if you have a tooth pulled out.
  • You have already lost many teeth and are finding it hard to chew so you want to salvage what you have left. Also removing more teeth will place extra pressure on the remaining teeth making them more likely to chip and crack.
  • You have a medical condition which may contraindicate an extraction at this stage, for example if you are taking strong blood thinners or injections for your bones.


You might choose extraction when…

  • Your dentist explains that the tooth is not salvageable and presents you with the options of doing nothing or extraction.
  • Access is difficult for root canal treatment, for example, a wisdom tooth can be difficult to clean properly.
  • A cavity is too large and there is not enough tooth structure to support a final filling or crown.
    • My Tip: in order for us to get the best quality outcome, enough tooth must be available for us to bond to it.
  • There is a large fracture extending into the nerve or possibly even splitting the tooth or root in half. A tooth like this will always be prone to having bacteria penetrate through this crack.
    • My Tip: if the crack extends below the gumline, then we cannot see how far down the root it extends and therefore removal is a better option than root canal treatment.
  • You can afford replacing a missing tooth with an implant, bridge or denture
  • You cannot or do not want to come in for multiple visits.
  • There is no opposing tooth now and in the future and so this tooth is not functional (not being used for chewing).


Now that you have made your decision, what should you expect?


What to expect during root canal

Root canal treatment has come a long way. Gone are the days where it was painful and drawn out. Nowadays, us dentists have an array of tools to make it faster and more comfortable…I find having Netflix and earphones available helps too! The process begins just like a filling – with a local anaesthetic. I place a special sheet over your tooth to help keep it isolated and also to protect you from medicines and instruments that we use. Then I gain access into the tooth and clean the diseased nerve tissue. X-rays will be used to confirm the shape and size of the nerve area. Depending on the size of the nerve area and the amount of infection, the number of multiple visits may vary. You may need over-the-counter pain relief in between visits for very mild discomfort. The final visit involves filling the nerve spaces and placing a filling over the top of the whole tooth.

What to expect during and after an extraction

We have come far in how we as dentists approach extractions. Firstly, as Pink Floyd would say, you will be comfortably numb. There will be pressure but you should not feel any pain. If you do, you must let your dentist know. I personally do multiple checks to ensure you will be comfortable. Afterwards, I check to make sure there is minimal bleeding and ask that you bite on a piece of gauze for 30 minutes. There may be some soreness and swelling afterwards so I recommend using a wrapped ice pack after the appointment. It is important to rest afterwards and favour eating on the other side. I recommend only soft and cool foods for the rest of that day.

I have enjoyed sharing my knowledge with you and I hope this has in some way helped you in deciding what treatment option is best for you.

Please take this as a guideline as every patient and every tooth is different and nothing replaces a face to face consultation and examination. If you are interested in this, you can call my team on 8678 3538.

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