If the nerve has been affected inside, to the point at which it can no-longer recover (irreversible pulpitis), or has already died, then there are only three choices:
- Do nothing
- Extract the tooth
- Have a root canal treatment.
Let's look at our alternatives in more detail:
If the tooth isn’t currently giving you problems (which means an area around a root on a tooth with a deep filling was most likely discovered by accident on an X-ray
, you may decided to leave it. This is your right and if it has been silent for many years, then I can understand your point of view.
However, it is worth commenting that leaving any infection in your body is probably not a good idea and if the balance for some reason is tipped in favour of the bacteria, pain and an acute abscess will result.
Unfortunately there is no saying when this might occur, so it may be better to be proactive, but this is of course your decision. If you are already experiencing some pain and decide to leave the tooth and do nothing, it is likely that the pain will get more frequent and severe, until eventually you have to resort to one of the options below.
Sometimes as the nerve is dying it can be very painful, then suddenly… Relief! In these circumstances, the tooth is likely to have been experiencing irreversible pulpitis, which is painful until the point at which, the swelling inside the nerve is sufficient to cut off its own blood supply to the tooth and the nerve dies and the pain disappears. This may stay silent for a while, but then follow a similar course to that discussed above.
There are some circumstances where it is advisable to remove a tooth, or it is not possible to perform a root canal- these are discussed in more detail below. Removing a tooth can have a number of negative consequences
, these include:
1. Aesthetic problems
- obviously this is personal and up to you, but having a space where your front tooth is will have significantly more impact than a space right at the back of your mouth.
2. Problems chewing
3. Speech problems
4. Worsening of periodontal disease
- because the remaining teeth are now taking more pressure or tooth movement has created areas that are more difficult to clean.
5. Sensitivity of the roots-
relating to the teeth next to the space- as the bone in the extraction site shrinks down
6. Tooth movement
(i) Teeth next to the space may tilt inwards, similar to when you remove a book from a shelf of books- the ends tilt in.
(ii) Teeth opposing the space may over erupt. Teeth maintain the ability to erupt, so when a tooth is removed and they are no-longer balanced, it can erupt further, providing a cosmetic problem- areas that trap more plaque and sensitivity from the exposed root, which are now above the gum.
Changes in your bite can result in problems of the jaw joint, See
-TMDS, though this is relatively rare.
Whilst all these consequences happen in varying amounts, most patients in my experience who opt to remove the tooth and not to fill the gap learn to adapt to their new mouth without too much trouble. Are you best to fill the gap? Of course! It is the best way to avoid the problems, but I am conscious that some dentists may over emphasize these issues and push patients towards expensive replacements. See- Missing teeth,
for more information.
Tooth movement commonly occurs following an extraction and if you leave this over a long period, it may be much harder to put something in the space without moving the teeth first.
Extraction is the cheapest, fastest and simplest option to get you out of pain, but not if you wish to consider filling the space it leaves. The price of a getting a denture would be similar- which begs the question why extract it in the first place- you get to keep your tooth as before and don’t have to take the denture in and out. If you already wear a denture then adding a tooth to it is a cheaper option.
A bridge, or implant to replace the tooth will nearly always exceed the cost of the root canal, so where your intention is to seek a replacement, it is better where the prognosis for the tooth is good, to have a root canal treatment and keep the tooth.