I have toothache - should I get it pulled or saved?


Dr Sanjeev Bhanderi is a dentist offering specialist endodontic treatment. Here, he tells us all about root canal therapy and why we should always save a tooth.

Should I get my tooth pulled or saved?
This is a simple question but with a complex answer!

There are many causes of toothache, ranging from a premature (high) bite on a tooth, overload on a tooth due to a grinding/clenching habit, periodontal (gum) disease, deep decay, a crack in a tooth, or an endodontic (root canal) infection/abscess.

Sensitivity to temperature (hot and cold) or sweet foods can indicate that the nerve inside the tooth is irritated possibly due to decay or a root canal, or even recession of the gums.

The first approach would be to see your dentist to assess the problem so they can confirm the diagnosis.

Once a diagnosis has been established, the problem can be addressed and hopefully resolved quickly.

If the tooth is damaged in any way e.g. due to decay, fracture, or is already heavily filled) your dentist will make a decision and advise you on whether the tooth can be saved or not.

If your dentist feels that the problematic tooth can be saved, then the final decision on whether to save it or not is really yours and usually based on your expectations of how long the tooth should last, given any options to replace it, and the cost of trying to save it.

I can always get artificial teeth, right?
Artificial teeth can be either removable denture, or a fixed bridge (attached to existing teeth adjacent to a gap), or a dental implant (a titanium artificial root screwed into the jaw with a crown on top).

However, there are drawbacks with each:
Denture A denture is a removable plate so you'll have to get used to such a device in your mouth. It is also difficult to keep clean and, therefore, there may be an increased risk of periodontal (gum) disease or decay in surrounding teeth.
Fixed bridge The teeth have to be used as supports either side of the gap, which means they have be cut down. Cutting down any relatively healthy teeth is destructive and leaves the risk of future problems.
Dental implant The initial cost is high and also involves a surgical procedure. A number of appointments are usually required and close maintenance and care thereafter is also important to prevent failure.

Keeping your own tooth is important so that you can enjoy the wide variety of foods necessary to maintain the proper balanced diet.

Does it hurt?
A root canal actually relieves toothache when infection reaches the root of a tooth. With the use of cutting-edge dental technology, along with predictable and painless anaesthetic techniques, having a root canal nowadays feels similar to having a normal filling and with little or no after-effects.

How quick is recovery?
Recovery after having root canal treatment is quite quick depending on the extent of infection prior to the treatment. Normally, you might feel some mild discomfort for a few days after treatment that will disappear soon after. Dentists usually advise taking a painkiller just before the treatment and for a few days after just in case or as required. If there are ongoing problems, then your dentist is always there to call for further advice but this is rare.

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