Extraction versus Root Canal Treatments. What are the Indications?

Why do you pull your tooth if you still can save it?

A Molar Extracted tooth with forceps

As with any pathology associated with a tooth, extraction is a fail-proof way to address the issue at hand. Obviously, though, this option comes at a steep price: loss of tooth. Losing a tooth may seem like an innocuous occurrence, but it can have long-lasting permanent side effects. When permanent teeth are extracted, the bone around them tends to slowly resorb over a period of time. The driving force behind this phenomenon is the same as that that causes atrophy of unused muscles. When a tooth is not present, the bone does not experience the compressive forces that occur when chewing occurs on the tooth. The body’s cellular processes interpret this to mean that the bone is no longer needed, and it is slowly destroyed.

The loss of bone can affect neighboring teeth, as well, causing them to loosen and drift out of their normal position. Furthermore, loss of bone in the maxilla (upper jaw) can present complications associated with the maxillary sinus, which is in close proximity to the roots of the maxillary teeth.                                                                                                                                                    

This is to say nothing, of course, of the reduced ability to chew and eat with maximum efficiency.

Obviously, even if extraction is chosen instead of root canal treatment, there are numerous options for replacing a missing tooth. Single teeth can be replaced with dental implants and dental bridges, for example. Dental implants, while a superb treatment option, are very expensive and time-consuming: one implant can cost upwards of several thousand dollars and may take 4-6 months before treatment is fully complete. Dental bridges can be done more quickly, but they require the irreversible alteration of otherwise healthy teeth and are somewhat challenging to keep clean.

Partial dentures are suitable when several teeth are missing, but these represent arguably the least desirable tooth replacement option. Dentures of all types can be unstable, uncomfortable, and come nowhere near the functionality of real teeth.

The bottom line is that there is no tooth replacement that can fully replicate the feel, appearance, and functionality of a natural tooth, not to mention the overwhelming physiological benefits of retaining natural teeth. That being said, root canal treatment is a far better option for an abscessed tooth than extraction.

There are instances in which the “restorability” of the tooth is questionable. What this means is that the tooth is so badly damaged that it is not certain whether the tooth can be restored to full functionality even after root canal treatment. In these cases, it is prudent to consider extraction as perhaps a more sensible treatment option. But assuming that the tooth is restorable and there are no other unfavorable circumstances, root canal treatment is by far better than a tooth extract.

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