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The choice between a root canal and an extraction is dependent on many circumstances, including affordability, dental recommendations, visibility of the affected tooth, success rate, discomfort level, and success rate. Both of these procedures also have to be considered in light of what else is required. Root canals typically are followed by placement of porcelain or metal crowns, especially in adults. After an extraction, patients may either opt to do nothing or get a dental implant, which involves several surgeries.
Perhaps the biggest factor in choosing between a root canal and an extraction is the patient’s financial situation. Even with insurance, patients can expect to pay significantly more out of pocket for a root canal and crown than a simple extraction. Dental implant surgery is even more costly. Some dentists, oral surgeons, and endodontists may make it possible for patients to pay over time, but many want the total payment upfront. Thus, the choice between a root canal and an extraction may be severely limited by a person’s financial and insurance status in some regions.
When a patient can afford the more costly procedure, it certainly helps to get the advice of a dentist. Most dentists prefer saving the existing tooth, and the root canal/crown method achieves this goal. In other instances, the tooth that is broken, painful and/or damaged may already have had the roots scaled and filled or may be dying. It isn’t always possible to save a tooth via a root canal, and an extraction could be preferred to reduce patient pain or because it is the best option.
Some people weigh finances and also weigh the visibility of the tooth when making a decision. If the tooth is in the front of the mouth where it will be noticed as missing, they decide they’d prefer a root canal and crown. Clearly, extraction without replacement will mean there is a visible gap in the mouth. On the other hand, if the choice between a root canal and an extraction concerns a tooth at the back of the mouth, patients might just opt for the extraction alone, since people aren’t likely to notice the missing tooth.
There are others who base their opinion on the success rate of root canal/crown versus an extraction/implantation. The root canal and crown route has a slightly higher success rate. Extractions alone are successful too, but dental implantations may not last a lifetime and may require replacement.
Alternately, the choice between root canal and an extraction could center on discomfort associated with both procedures. A skilled dentist should be able to make patients comfortable for either procedure, and some dentists even offer sleeping dentistry so patients don’t have to feel what is occurring. Recovery time and length of procedures for dental implantation is much more significant than that associated with root canals and crowns.
I've heard so many stories about root canal pain that I would probably choose an extraction, assuming I even had a choice. I had one tooth pulled while under general anesthetic, and the process wasn't that bad overall. There's a gap, but nobody can see it. My dental insurance would have covered most of the expense of a root canal procedure, but I didn't feel like it was necessary because of the tooth's location.
Speaking from personal experience, the decision between a root canal and extraction shouldn't be made under duress. Sometimes a tooth can hurt so bad that your only thought is to have it extracted immediately, regardless of any other considerations. When one of my teeth got abscessed, I wasn't thinking about appearances or crowns or the cost of the procedure. I just wanted instantaneous pain relief. I opted for an extraction by an oral surgeon.
While I'm happy that the infected tooth is completely gone, I still miss being able to chew my food normally. I had to get used to pushing food away from that gap. If I hadn't been in so much pain when I saw my dentist, I might opted for a root canal and a crown to replace the tooth.
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