Root Canal Treatment vs. Tooth Extraction: What to Do with an Infected Tooth?

Root canal treatment

I recently developed an abscess on my lower left molar, and sometimes it hurts when I bite down, while other times it doesn't.
I visited a periodontal specialist at a large hospital, and she recommended extracting the tooth.
However, an endodontist suggested that we could try to save it by first removing the existing crown and then evaluating the tooth's condition with a post before considering any microsurgical treatment.
Unfortunately, due to the long wait times at the hospital, it will take at least three months to get an appointment for the extraction.
I'm concerned that my tooth condition may worsen during this waiting period.
This tooth was treated about seven or eight years ago, and I'm worried that this situation might affect my other healthy teeth.
Should I go ahead and extract the tooth? I previously consulted another clinic where the doctor took a CT scan and mentioned that the bone underneath has already been compromised and that I would need bone grafting and a membrane.
I'm completely unsure of what to do now.

Ni Ni, 20~29 year old female. Ask Date: 2019/04/03

Dr. Huang Tingfang reply Dentistry

Dear Miss Nini,
Hello! Based on what you described, the situation seems quite serious.
The worst-case scenario is a cracked tooth root, which would require extraction.
I recommend seeking a second opinion at another dental clinic.
If the assessment is the same, then extraction would be necessary.
Please communicate thoroughly with your dentist.
Thank you! Wishing you safety!
Sincerely,
Dr.
Huang Ting-Fang, Dentistry

Reply Date: 2019/04/03

More Info

When faced with the dilemma of whether to undergo root canal treatment or to extract an infected tooth, it's essential to consider several factors, including the current state of the tooth, the extent of the infection, and the potential for future complications. In your case, the presence of a pus-filled bump and intermittent pain suggests that there is an ongoing infection, which can complicate the decision-making process.

Root canal treatment (RCT) is designed to save a tooth that has become infected or inflamed. It involves removing the infected pulp from inside the tooth, cleaning and disinfecting the root canals, and then filling them to prevent future infections. If the tooth has previously undergone RCT and is now showing signs of infection again, it may indicate that the initial treatment was not entirely successful, or that a new infection has developed. In such cases, a retreatment may be necessary, which can be more complex than the initial procedure.

On the other hand, tooth extraction is often recommended when the tooth is severely compromised, particularly if there is significant bone loss around the tooth or if the infection has spread extensively. The recommendation from the periodontist to extract the tooth may be based on the assessment that the tooth cannot be saved and that leaving it in place could lead to further complications, including the risk of the infection spreading to adjacent teeth or the jawbone.

Given that you have been advised by different specialists, it is crucial to weigh their opinions carefully. The dentist who suggested attempting to save the tooth through further evaluation and possible microscopic treatment may believe that there is still a chance to preserve the tooth, especially if the surrounding bone can be treated effectively. However, the concern about the waiting period of three months is valid; during this time, the infection could worsen, potentially leading to more severe complications.

If the bone loss is significant, as indicated by the previous imaging, this could complicate both the RCT and the extraction process. In cases of extraction, bone grafting may be necessary to maintain the integrity of the jawbone for future restorative options, such as dental implants.
In terms of immediate action, if you are experiencing pain and the infection appears to be worsening, it may be prudent to seek a second opinion from another dental professional who specializes in endodontics (root canal specialists) or oral surgery. They can provide a more comprehensive evaluation of your tooth's condition and the surrounding bone structure.
Additionally, while waiting for treatment, it is essential to maintain good oral hygiene to minimize the risk of further infection. This includes gentle brushing and rinsing with an antibacterial mouthwash, if recommended by your dentist.
Ultimately, the decision between RCT and extraction should be made based on a thorough assessment of the tooth's condition, the extent of the infection, and your overall dental health. If there is a significant chance of saving the tooth with RCT, it may be worth pursuing that option, especially if you are concerned about the implications of extraction and the need for future restorative work. However, if the tooth is deemed non-restorable, extraction may be the best course of action to prevent further complications.

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