How many times have you gone to the dentist to get a bothersome tooth pulled out only to have him counsel you into ‘keeping it' and getting a Root Canal Treatment done. Or gone to get a decayed tooth filled but been asked to have it extracted instead?

A dilemma many of us often face when we go to the Dentists’ is to choose between Root Canal Treatment and Extraction. How do you decide whether you should keep the tooth or remove it? To help you make the right choice lets start by understanding what these procedures mean, how and why we do them. 

Root Canal: The Saviour 

Before and After Root Canal Treatment

•  Root Canal Treatment (RCT) is basically done to clean and disinfect the root canal and pulp chamber of the tooth and then fill it to avoid re-infection. 

•  The root canal and the pulp chamber of the tooth house the blood vessels and nerves of the tooth and give life to the tooth. 

•  A root canal is generally required when the nerves and the blood vessels are infected, dying or dead because of deep cavities, trauma, fractures of the tooth, gum problems or other reasons.

•  During an RCT, the dentist will first remove all the infected or dead tissue from the tooth and then clean and shape them with various instruments to clean and make sure all the bacteria have been removed. This is followed by filling and sealing of the canals, usually with a biocompatible material known as Gutta Percha. This can be done in one or multiple appointments.

•  The procedure is usually started after numbing the tooth, once all the infected material is removed, you will probably have no pain at subsequent appointments.

• Starting the RCT will usually relieve the pain you came in with, although a few patients do have mild pain between appointments and at times after completion of the root canal. But this is usually transient.

• RCT treated tooth will usually require a cap to protect the weakened remaining tooth structure from extra forces and increase its life. 

Extraction: The Endgame 

Post Extraction Healing

•  Extraction, or removal of the tooth, is removal of the tooth and its root from the socket.

•  It is usually done when the tooth cannot be saved if it's infected or for orthodontic purposes.

•  It is done under Local Anaesthesia. Your dentist will anesthetize the tooth and the surrounding area and after ensuring the area is numb, will remove the tooth with the help of pliers like instruments called forceps.

•  There is usually mild bleeding which is easily controlled. Some cases may require suturing.

•  The wound takes about a week to close and about 2-3 weeks to heal.

•  The procedure itself is usually painless because of the anesthesia, but you may feel slight pressure. You can ask your dentist to repeat the injection if you are still feeling pain.

•  There may be mild pain and swelling after the extraction depending on the degree of trauma to the surrounding tissues while removal.  

The Choice

Nothing is as strong as your natural teeth. That’s why as Dentists, we recommend holding on to them if you can. If the tooth has enough remaining structure to restore its function post RCT, then it's better to save it instead of getting it removed. The RCT will let you keep your natural tooth in place and if done properly it can last for years.

Removing a tooth is usually a one appointment, cheaper procedure, but the cost of getting a replacement is much higher than a routine Root Canal Treatment. And getting a replacement is very important to not disrupt the integrity of rest of your teeth.

That being said, at times the tooth too far compromised and there is no option left but to extract it. It usually happens in cases of tooth fractures that extend deep into the tooth, very mobile teeth, infected wisdom teeth with poor accessibility and teeth with very little tooth portion left, making them unrestorable. In such cases it's advisable to get a replacement as soon as possible.