Updated 14 July 2014

Why don’t we just pull it out?

Removing an infected, broken or painful tooth means that it will never bother you again, but for a number of good reasons saving the tooth is a better option.

It is a good question. Removing an infected, broken or painful tooth is one of the precious few guarantees we have in dentistry. If we take it out, it won’t bother you again.

It is seldom that simple though. Ignore for a moment the pain, fear and discomfort of oral surgical procedures. In a mouth where most other teeth are sound, properly restored and functional, the effect of a missing tooth is not really that big. Or is it?

Unbalanced bite
Leaving a gap, the neighboring and/or opposing teeth will “drift” into the space. This will lead to an unbalanced bite and ultimately to the breaking of the drifted teeth. Furthermore, the risk involved in the habit of just removing the offending tooth, is that function will gradually be lost. Patients tend to notice this after a few years and then the cost of replacing it is multiplied by the amount of missing teeth.

Dentures can be considered and whilst a well-designed denture is a good and economic option, most patients seem to be against the idea of wearing a removable oral device. Bridges and implants are also more expensive than saving a tooth.

Saving a tooth has become largely predictable. It is done by doing a proper endodontic treatment or a root canal. In essence a root canal entails that the small tunnels in the roots are accessed through the crown of the tooth. Small instruments are used to shape the tunnels in a specific way where-after it is properly disinfected and then filled to be airtight. Yes, the root canal treatment robs the tooth of life. Only the “shell” stays behind. The advantage is that it also gets rid of infective bacteria that will likely cause an abscess.  It is critical that all root treated teeth are crowned. Neglecting to crown will likely result in breakage and re-infection.

Bad reputation
Doing a microscopic procedure on a tooth is less painful, scary and uncomfortable than oral surgery. Unfortunately root canals have a bad reputation that is warranted in some cases. It is a technical, challenging and time consuming procedure in a world where time is money. There are a lot of botched treatments, usually rushed, or done with a lack of attention to detail. On the other hand, there were plenty of root canals done in the 1980’s that still functions exceptionally well and remains without infection. It is human nature to be vocal about failure but success stories are unsung.

It must be noted, however, that not all teeth can be saved. But there is enough evidence to indicate predictable preservation of favorable teeth and even if a root canal and crown does not last for decades it is still a safe and cost effective way of preserving teeth.


Dr Obus Venter BChD; DipOdont Endodontology  (Pret), Intercare Silver Lakes Medical and Dental Centre

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