Should It Stay or Should It Go: Root Canals versus Tooth Extraction

For the thousands of patients faced with the agonizing pain of a dental abscess each year, many are also faced with a common dilemma: should they go through the trouble of having a root canal- or should they cut their losses and skip ahead to a tooth extraction? There are serious pros and cons to each procedure- but they can often be difficult to decide upon when you are in pain and seeking immediate relief. With Root Canal Awareness Week right around the corner (from March 27 to April 2), we spoke to Dr. Gary Lederman of Bellmore, New York about which option is best and how to make a choice for yourself if you’re ever faced with an abscess.

There are two different types of tooth abscesses: a periapical abscess, and a periodontal abscess. A periapical abscess is an infection that occurs in the pulp of the tooth. Periapical abscesses can be caused by many things, including cavities, periodontitis, broken teeth, and even previous failed root canal treatments to the same tooth. Periodontal abscesses, on the other hand, are usually localized in the gums and can spread to the teeth. They generally occur in patients with severe, advanced periodontal disease. Thankfully most patients undergo treatment for periodontal disease before a periodontal abscess has a chance to form, making them a lot less common. Still, despite the differences in these two types of abscesses, treatments are often very similar- as are the decisions each patient must make when faced with these types of infections.

According to Lederman, there are really only two options for treating a dental abscess: root canal or extraction. For patients suffering from a periodontal abscess, they will first need to have the abscess in their gums drained. This will provide some relief from the pain and pressure of the abscess, and allow the dentist to see how much damage the abscess may have caused. The drainage is followed up with a round of antibiotics, to kill any remaining infection. For a periapical abscess, you may need an antibiotic depending on the severity of the infection, but generally draining the tooth will clear out any infection present.

Once the drainage of the affected tooth and gums is complete, the patient may be faced with the decision to either have the tooth removed or to attempt a root canal. So, what exactly is a root canal?

"A root canal is a procedure which consists of drilling a hole in the infected tooth and draining out the infected pulp. Once the pulp is cleaned out, your dentist will then replace the pulp with synthetic pulp and reseal the tooth," Lederman said. "It’s gotten a bad reputation in popular culture as being a scary, painful procedure, but it’s really no more uncomfortable than getting a cavity filled."

So, given the relative ease of root canals, and the fact that you get to keep your natural tooth, why would anyone choose an extraction over a root canal? For some patients, a root canal simply may not be worth the risk.

"As with any procedure, there’s always a risk involved," Lederman said. "With a root canal, there’s a chance it may not work, and the infection can either return or the tooth may simply not survive with the synthetic pulp. In that case, it would need to be extracted."

On the other hand, patients undergoing an extraction needn’t worry about the infection recurring in the tooth- or having to face a root canal and a possibly inevitable extraction, and would be free to explore other options like a bridge, partial, or dental implant.

"If this is your first abscess and your teeth are otherwise healthy and the infection isn’t that bad, it’s worth the risk to try and save the tooth," Lederman said. "However, for patients with significant infection, or who have had problems with the same tooth or with other teeth before, it may be easier to go straight for an extraction- but it completely depends on the individual case. There is no ‘one size fits all’ treatments in dentistry."

According to Lederman, whether you opt for a root canal or an extraction, the most important thing to remember is that immediate treatment is of the utmost importance.

"Allowing an abscess to go untreated can worsen the damage to your teeth and gums," he said. "What may start out as an abscess that is easily treatable with a root canal can turn into a necessary extraction- or worse."

Lederman says the bacterial infection in your abscess can easily spread to other organs in your body, causing organ failure and even death. In fact, ER visits for patients with abscesses are on the incline, due partly to many patients lacking insurance, but also because many patients mistakenly believe that an abscess will heal itself.

"It won’t," Lederman said. "The only way to get rid of an abscess is by draining it and cleaning it out- and the longer you put that off, the worse the damage will be."

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