Root canal or extraction?

Kate Kestrel said:

can I ask if anyone on here has had the experience of having to make this choice

I have had this choice on 4 occasions - and chose to do root canal and crown each time.

My experience is that the issues around the choice are mostly price and secondly the discomfort,

Price wise I had one lot of root canal work done in the uk (because it was infected) and it cost about £900 for one tooth and it was just filled at the end. Time wise it took about 45 mins.

Pain wise the work didn't hurt in the way you expect drilling to - the injections killed the pain receptors and they could get in there and drill the roots of the molar out. Note that molars can have more than one root and you can pay per root - best to check the price up front so you know what to expect.

The "pain" related issue was having your mouth open for a long time while they work. 45 mins of this got quite uncomfortable, There can be a strange sensation with the upper teeth when they are fishing the nerves out the roots with tiny files as these are going right up in your skull - it doesn't hurt (if it does tell them and they will add anaesthetic) but feels strange.

Where I elected to go for a crown on top it took twice as long and several visits due to the need for shaping the base of the tooth to fit the crown over then the fitting process of the crown. Expect more than one visit but since the nerves of the tooth are gone there is no need for further injections.

I was advised that leaving a void where the tooth was (ie extraction) will lead to the teeth potentially starting to shift towards the space over time and can leave bigger gaps, and more risk of food remaining and causing cavities if you are not strict with brushing / flossing after eating. Maybe that was a sales pitch.

Luckily where I live in Brazil the dental care is a lot better than the UK and prices are a lot lower. I just replaced a big amalgam filling that I've had for over 30 years, had 3 roots canals treated and a crown fitted for abut £600. It took 4 sessions as there was an infection to clear (after the root canal work they pack the roots with antibiotic material for a week then have to re-open the tooth to remove it before closing it up permanently) then they shaped the tooth, test fitted the crown and finally fitted the adjusted crown.

Honestly there was no pain, just the discomfort of someones hands in your mouth and the drilling. You can ask if you can use headphones but the dentist will then need to manually open your mouth wider / move it to the side etc if you can't hear the instructons. That can be a trade off. I tend to put myself into a sort of dissociated state so the discomfort fades away and I can hyperfocus on something I like.

One last word of warning - extractions do come with additional risks - my mother has really deep roots in her teeth and one extraction she had broke some of the structure of her sinuses. That never quite healed properly even after being rushed to hospital for corrective surgery.

Please make sure they have x-rays and talk over the risks with you.

One thing I should add which I was warned about is that if you have an infected abcess form around the root of the tooth (this will be the source of the pain) then untreated it is likely to lead to the infection eating away at the bone and can lead to multiple teeth literally falling out or in the worst case (the lower jaw) can lead to your jaw breaking on the weakened part where it requires extensive surgery to strengthen and rebuild.

This could be partly scare tactics to encourage you to get it treated but I recall researching it at the time and it seemed true, plus I  could not endure the pain for that long.

It was during this that I first encountered the advice about how to use over the counter painkillers in combination to manage the pain as I was stuck on an island in Indonesia for 10 days when it the toothache began and their local dentist did not look safe.

That’s sounds alarming. Mine was left for longer than was ideal because the dentist couldn’t identify the tooth that was the cause of the pain, and prescribed antibiotics, it improved a little and then got worse, and then on the second appointment with a different dentist she couldn’t identify the tooth either and recommended Sensitivity Toothpaste - and then a few days later it was absolute agony. She then ‘

- after loads of tapping on my teeth and trying to work out which it was - took out the filling from the tooth and put a dressing in and prescribed stronger antibiotics. Tbh I’m not very impressed with them. Now the pain has gone and the swelling has largely gone - but I just hope that we’ve identified the right tooth. It’s weird because looking online it says you can see a tooth infection on x ray. I’m so fed up with it. 

You obviously travel a lot Iain :) 

That’s sounds alarming. Mine was left for longer than was ideal because the dentist couldn’t identify the tooth that was the cause of the pain, and prescribed antibiotics, it improved a little and then got worse, and then on the second appointment with a different dentist she couldn’t identify the tooth either and recommended Sensitivity Toothpaste - and then a few days later it was absolute agony. She then ‘

- after loads of tapping on my teeth and trying to work out which it was - took out the filling from the tooth and put a dressing in and prescribed stronger antibiotics. Tbh I’m not very impressed with them. Now the pain has gone and the swelling has largely gone - but I just hope that we’ve identified the right tooth. It’s weird because looking online it says you can see a tooth infection on x ray. I’m so fed up with it. 

You obviously travel a lot Iain :) 

Wow Iain - you have achieved so much!  Sometimes I forget that some autistic people can really function incredibly well in this society despite the challenges of being neurodivergent. My eldest (also autistic)  did so well academically (he went to Oxford Uni) but he found the workplace much more challenging and decided to return to academia - he is currently doing a PHD. His PHD is going well but he is still daunted by certain kinds of work culture and the social demands of working in certain sectors. It’s encouraging to hear of people like you on here that find a path of employment where they can do so well. I must add though that having said that it’s no judgement on those that struggle to do that - I’d include myself and my youngest in that camp and I think it’s important to also be forgiving of ourselves for struggling in a paid work environment. Thankfully my husband as a ‘regular’ job - so we do ok as a team together. 
Thank you again for your help on here - you’re always such a good source of information and advice on here and it’s really appreciated :) 

Kate Kestrel said:

It’s weird because looking online it says you can see a tooth infection on x ray. I’m so fed up with it. 

It can be difficult as the infection can be inside the root of the tooth rather than in the bone so it won't show up clearly in a simple contract x-ray and a more involved scan is cost prohibitive, so they have to do a "best-guess" approach in these situations.

There is a good explanation of the treatment of infected teeth here:

https://www.ballantyneendo.com/dental-emergencies/can-a-tooth-infection-be-cured-with-antibiotics/

I note the part about draining infections is another good reason for having the dental dam - you probably don't want all that puss going into your mouth.

The tablet antibiotocs are more to deal with secondary infections while the packing of the tooth with specific antibiotics will deal with the core issue.

Kate Kestrel said:

Now the pain has gone and the swelling has largely gone

That is a really good sign that they got it right. It can take a week or two to return to more normal levels and longer to be no longer noticable but it seems they have nipped it in the bud.

Kate Kestrel said:

You obviously travel a lot Iain :) 

A combination of being responsible for the IT on different continents for some big companies and having to recruit local support staff to replace me when I left, helping my wife with her fashion business and running trade booths around the world and taking the few remaining days off to explore the world (my wife is the one who wanted to see exotic places all the time).

I also ran an IT import/export business as a sideline for a while so was often travelling to pick up certain high value items by hand, but that was less fun.

I probably have a carbon footprint the size of London by this point in time