So you have a dead tooth and you’re wondering what you should do with it.
As a general and restorative dentist, our preference is for you to keep the tooth and not have it pulled. Although there are certain situations where we may have no choice but to remove it. Nonetheless, we wish to reiterate that the preference is to NOT pull it.
Let us explain when you would be able to keep it with a root canal vs when you would have to remove it with an extraction.
When to get a root canal for it
Despite your tooth being dead, if its condition meets these criteria, you may not need it pulled. In fact you can save it and keep it in your mouth by getting a root canal done on it instead.
- Good Structural integrity. Tooth retains a lot of its natural tooth structure, meaning there hasn’t been a lot of previous dental work on it.
- Not mobile. Tooth feels rock solid with no mobility.
- Patent canals. The canals where the nerve comes in is wide open and easily accessible for a root canal.
- Minimal tooth decay. Little to no cavities on the tooth.
The overall criteria which we are looking for is a good prognosis that allows us to do the root canal treatment. Anything that results in a poor restorative prognosis afterwards would be better served with an extraction instead.
When to extract the dead tooth
It’s always better to keep your tooth whenever possible but there are situations which leave you with no choice but to extract it.
- Large cavity. The tooth has a large amount of decay which will compromise the overall structural integrity.
- Not stable. Tooth feels loose or wobbly.
- Obliterated canals. The canals inside of the tooth are barely visible or no longer accessible. If this is the case, it makes it impossible to do a root canal.
- Large infection. The abscess is so large that the prognosis after treatment would be incredibly poor.
The series of x-rays above is to give you an idea of patent vs obliterated canals. The obliterated ones have a near non-existent canal which makes the root canal impossible. If your dentist can’t do it, the only other option would be to have the tooth removed.
Essentially the factors which make us lean towards an extraction is if the prognosis is poor.
Pros and Cons – Root canal vs Extraction
There are certain situations which may force us to choose one procedure over the other but here are some advantages and disadvantages to getting them.
Benefits of a root canal over an extraction
- Keep your natural tooth. You don’t have to pull the tooth so you can retain your own tooth. You do need a crown over it afterwards to protect it and mask the discoloration.
- Completing the treatment is faster. A root canal and a crown would take about four appointments spread out over a month or so. If you opt for an extraction and implant, that process can take 8-12 months to complete.
Benefits of an extraction over a root canal
- Initial cost is less expensive. An extraction costs significantly less than a root canal and crown. However you do have to keep in mind that if you do want to replace the missing tooth later on, the implant makes it equally as expensive.
- Tooth removal only requires one visit. You’ll be done with just a single appointment. Of course this does not include the implant which you do need to decide for later on.
Why we prefer to not pull it
If you’re able to afford the root canal and crown, that would be the best option. You get to keep your own tooth and if anything happens to it, you can always do the extraction and implant later on.
You can think of it as giving your tooth as many chances as possible. If the root canal fails, you always have the option to extract it. However if you jump right into tooth removal with an implant, if the implant fails, you don’t have very many options left afterwards!
Aside from that, another reason is that keeping the tooth requires a lot less surgery. The root canal and crown are both fairly conservative when compared to taking out the entire tooth and then placing a titanium screw into your jaw.
If you’ve a dead tooth it is better if you don’t pull it. That is at least what we would recommend whenever possible. However if your situation does not permit you to keep it, then pulling it may be the only option left.
Please discuss with your dentist what the best course of action should be for your particular situation.