Why would I need an Extraction?

The primary reason for needing an extraction is that the tooth cannot be saved in any other way; whether physically impossible or financially impossible.

An extraction may be necessary as an alternative to a root canal in the following situations:

  • The nerve is dying (Irreversible pulpitis) or has died (Pulpal necrosis)This is the most common reason for an extraction to be performed. It is most likely to happen as a result of dental decay. Less commonly, it is due to trauma or cracked teeth. If the tooth has irreversible pulpitis, (due for example, to a very deep filling or deep decay), then the damage is such that the tooth is not able to recover and will die off over time. Signs and symptoms suggesting that this is the case are discussed in the section on pulpitis. Aside from wisdom teeth removal, the most common reason for having an extraction is decay.
  • An abscess/apical infection. If the tooth is very painful to touch and you can’t bite down or chew on it, it is likely you have a dental abscess. It is important that we identify the source of the abscess- is it an acute peri-apical abscess coming from an infected tooth, or a periodontal abscess? An abscess of gum origin is quite different and rarely requires root treatment.
  • Significant sensitivity. If sensitivity is affecting your life and you can’t eat and drink without pain something needs to be done. If all other treatments aimed at reducing your sensitive tooth have failed, then as a last resort, a root canal may need to be performed.

An extraction may also be needed in the following circumstances:

  • Wisdom teeth trouble. Wisdom teeth commonly need extracting when they give pain, cause infection or risk damage to the useful second molar in front. See- The signs and symptoms for needing your wisdom teeth out.To even consider a root canal you would need a fully erupted useful wisdom tooth and even then, because it is so far back, the access will be too difficult in most cases.
  • Un-restorable tooth. Grossly broken down teeth that have decay extending way under the gum are often hopeless and need to be removed. (Don’t leave it so long next time!)
  • Roots. Sometimes these can be useful and savable, sometimes not- it depends. The main option for restoring a tooth like this is a post and crown or it could simply be sealed and left if not infected, or extracted.
  • Un-opposed wisdom tooth. If the opposite wisdom tooth has been taken out, then the cleansing action of chewing food doesn’t happen and it tends to build up plaque more quickly and be harder to clean. If there is ‘low’ risk of complications this tooth may be better off removed.
  • Failed root canal treatment. Instead of trying to do a re-root canal treatment, a lot of people opt for an extraction since the prognosis is proportionally worse the second time round. Otherwise, referral to a specialist Endodontist may help to ensure the best possible outcome.
  • Orthodontic reasons. If there is not enough space for all your teeth or a tooth is too far out of position- an extraction may be advised as part of the overall plan by your orthodontist.
  • Baby teeth. If a baby tooth is hanging on really loosely and there is a risk of swallowing or inhaling it, it should be removed. If it hasn’t fallen out because its roots have not been resorbed properly due to the adult tooth not been directly underneath, it may need to be removed. Note, not all baby teeth have adult teeth ready to replace them so this should be confirmed on an X-ray.
  • Impacted teeth. If they are causing or likely to cause problems.
  • One tooth. If you only have a single tooth holding your partial denture in, it is likely to affect the suction and how much it moves. You may get better suction and grip by removing the tooth and moving to a full denture or having an implant to help stabilise the other side.
  • Cracked/fractured tooth. Where the crack or fracture is such that it makes the tooth impossible to restore, for example if it splits the roots in half or goes too far under the gum to save.
  • Fractured roots/ fractured post crown. Where everything has been done to try and save your tooth without success, extraction and looking at the options for the missing tooth may be the only way.
  • Before major surgery. If the teeth present a risk of infection, or are in the way of a surgical jaw procedure, they may need to be removed. It is also often advisable to extract questionable teeth in the field of radiation before beginning oral cancer treatment or prior to an organ transplant, since the risk of unpleasant consequences involving delayed healing and infection afterwards is high.
  • Associated disease. In some circumstances, the disease can only be removed by extracting the tooth for example where a cyst is associated with it.
  • Stable solution. When considering a prosthesis such as a bridge, or a partial denture, if the prognosis of a tooth is so questionable, it may make more sense to remove it as part of a more definite treatment plan.

What are the Signs and Symptoms you would need an Extraction?

I guess some of the discussion above is relevant here but in a nutshell, if your tooth has died, or is dying then you either need root canal treatment to save it, or an extraction.

Thus, the signs and symptoms you need a root canal are basically the same as for an extraction, so click the link to read about them. A common exception is for teeth that are seriously loose and painful from gum disease. In these circumstances, a root canal won’t achieve anything, and extraction is commonly the only option. Where teeth have broken off under the gum, you should also brace yourself for having the tooth removed.