Root canal, extraction and tooth-pain questions

A root canal aims to retain a tooth that can be predictably restored; extraction removes it and creates a separate decision about the space. The deciding questions are restorability, fracture, periodontal support, long-term prognosis and the complete replacement pathway.

Antibiotics may be appropriate when infection is spreading or systemic involvement is present, but they may not remove the source inside a tooth or abscess. Definitive treatment can involve drainage, root canal treatment, periodontal care or extraction.

Symptoms can fluctuate even when the source remains. Infection may worsen, spread or reduce the chance of retaining the tooth. Facial or neck swelling, fever, severe illness, or trouble breathing or swallowing requires urgent assessment.

Not always. Tooth location, chewing, bite, neighboring teeth, appearance, future movement and patient preference matter. The options can include an implant, bridge, partial denture, orthodontic space closure or monitored nonreplacement.

Often yes. Endodontic retreatment removes the existing filling material, re-cleans the canal system and seals it again, and it is the usual first option where a treated tooth retains disease. Surgery at the root tip is an alternative where retreatment is not feasible. What matters most is why the first treatment did not resolve, because untreated canal anatomy and leakage are addressable while a vertical root fracture generally is not. Ask what the suspected cause is.

The pattern is more informative than the intensity. Sensitivity that is brief and stops as soon as the stimulus is removed is common and often relates to exposed dentine. Pain that lingers after the stimulus has gone, arises spontaneously, or disturbs sleep is the pattern clinicians associate with pulp inflammation needing treatment. Neither pattern is a diagnosis on its own, but the second is a clear reason to be examined, not to try a desensitizing toothpaste.

Most often it means there is not enough sound tooth structure left above the gum for a crown to grip. The technical term is inadequate ferrule. Without that band of solid tooth, a restoration tends to come off repeatedly or the root fractures. Other reasons include a root fracture or inadequate periodontal support. Ask which applies, and whether crown lengthening or orthodontic extrusion could change the answer. Both exist for exactly this situation.