Root canal or extraction

When a tooth's nerve has become infected, usually after deep decay, a crack or a knock, the infection doesn't go away on its own. Two options remain: the tooth is saved with root canal treatment, or it is removed by extraction.

The first keeps your own tooth, with its root. The second resolves the infection faster but leaves a gap that, most of the time, needs replacing.

Root canal treatment is done under local anaesthetic, with a microscope, in one or two visits. Afterwards the tooth needs a build-up and, for back teeth, usually a crown so it doesn't fracture.

An extraction is quicker, also under local anaesthetic. But the gap changes your bite over time: the neighbouring teeth can tilt, and the opposite tooth can drift. That's why, apart from wisdom teeth, a removed tooth is usually replaced with an implant, a bridge or a denture.

When the tooth can be saved, we usually recommend keeping it: nothing replaces a natural tooth perfectly, and a replacement takes time and procedures of its own.

Extraction becomes the better option when:

• the tooth has a vertical fracture down into the root;
• too little of it is left to rebuild;
• gum disease has destroyed much of the bone holding it;
• a repeat root canal no longer has good chances.

On the X-ray, and if needed a CBCT scan, we show you the state of the root and bone and tell you honestly what chance the tooth has.

Root canal treatment plus rebuilding the tooth usually means a few visits over a few weeks. Extraction plus an implant takes several months, because of healing into the bone; with a bridge, a few weeks.

Your written plan sets out both options, with the stages, timing and an estimate for each, so you can compare them calmly. More at Root canal treatment under the microscope and Extractions and wisdom teeth.

Does an extraction hurt less than a root canal? Both are done under local anaesthetic. After an extraction, discomfort usually lasts a few days; after a root canal, the tooth may also be tender to bite on for a few days.

If I choose extraction, do I need an implant straight away? Not straight away. The plan shows you the right moment; sometimes the implant goes in once the bone has healed.

How long does a root-treated tooth last? With a build-up or crown done in time and regular check-ups, it can last many years.

Can I put off the decision? A little, not long: the infection doesn't clear on its own and can reach the bone. We help you decide quickly and on an informed basis.