Root canal or extraction: how we actually decide
Saving a tooth is almost always the better outcome — but not always. The four things we look at before recommending either.
You are in pain, someone has said "root canal", and someone else has said "just take it out". Both can be right. Here is how the decision is actually made.
1. How much tooth is left above the gum
A root canal removes the infected nerve, but the tooth still has to survive chewing afterwards. If enough solid tooth structure remains to hold a crown, saving it is straightforward. If the tooth has fractured below the gum line, there is nothing to build on.
2. Whether the root itself is cracked
A vertical root fracture cannot be repaired. We look for it on radiographs and, where necessary, under magnification. Treating a cracked root wastes your money and your time.
3. The state of the bone around it
Advanced periodontal bone loss means the tooth is loose in its socket. Perfect endodontics on a tooth with no support underneath still leaves you with a loose tooth.
4. What comes next
Extraction is never the end of the plan — it is the start of one. A gap left alone lets the neighbouring teeth drift and the opposing tooth over-erupt. If we extract, we tell you what replaces it and when.
The honest default
Your own tooth, kept, is better than anything we can make. Modern rotary endodontics with an apex locator makes single-sitting treatment routine and comfortable. We recommend extraction when saving the tooth would not last — not because it is quicker.
