To root canal or not to root canal?

January 6, 2006 3:52 PM

To root canal or not to root canal? I never thought it would happen to me but here I am one emergency pulpectomy later, wondering if I should go ahead with the root canal procedure or just have the tooth extracted. Easy choice you might say, but wait...there's more. Well not really that much more.

I guess my main dilema at this point is the cost of the whole thing. I go to a dental school for the work and while they have been great so far (knock on wood) it's still damn expensive!

It would end up costing close to $1000 USD to get the root canal done (drilling, scraping, bleaching, crown and all) while it would cost only $87 USD to get the tooth extracted.

The tooth mentioned is the second molar on the top right side of my beautiful beautiful mouth. I've already got my top wisdom teeth (third molars) extracted from before so what's another one right? But one tooth here and one tooth there and before you know it I have no teeth.

What do I do? Do I get myself a $1000 tooth? or an $87 memory?
Anyone have experience with this?

posted by eatcake to health & fitness (25 comments total)

I think it's wise to save your tooth if at all possible. One tooth here and one tooth there and you'll soon have no teeth. The other issue, as explained by my dentist, is that a missing tooth can lead to problems for the teeth next to the gap, and to a weakening of your jaw. I will agree with you, though, that $1000 to save a tooth really, really sucks.
posted by MegoSteve at 3:59 PM on January 6, 2006

I'm not a dentist, but from what I have read, MegoSteve is right on the money. From all the scary stuff I have read about the effects of losing a tooth, $1000 to save the tooth seems like a bargain. Has your dentist advised you on the drawbacks of extracting a tooth?
posted by jayder at 4:13 PM on January 6, 2006

I've done both and I have to say, pull it if the dentists says it'll be ok.
posted by yodelingisfun at 4:22 PM on January 6, 2006

If you do pull the tooth, you'll still need either a bridge or an implant eventually, and and implant will probably be roughly equivalent to the root canal etc. I believe the bridge will be less up front, but you'll have to replace it periodically and it can have an adverse effect on the neighbouring teeth.
posted by mikel at 4:28 PM on January 6, 2006

Have the root canal.

That $1000 may save the tooth, and in doing so, keep other teeth from "drifting" out of place and wreaking havok in your mouth. It will cost you much more to correct that in the long run than to have the root canal.
posted by Verdant at 4:28 PM on January 6, 2006

Do you need a crown? I had a root canal a few years ago, but I don't have a crown over the tooth. After the root canal, my dentist determined I didn't need a crown (I guess it has something to do with how much of the surface of the tooth is ground down?) and just filled the hole with amalgalm.

She did say I might need a crown later, because the teeth become brittle after a root canal and are more easily broken.

Wouldn't removing the second molar leave a visible gap? I don't know how much this matters to you, but I'm vain enough that I'd opt for a crown.
posted by luneray at 4:35 PM on January 6, 2006

Save the tooth! In today's economy, even with dental insurance, $1000 is a bargain for a rootcanal, buildup, and a crown. An implant can be placed down the road if you do get it extracted, but what will happen over time is the lower opposing molar will start to rise from its socket, possibly necessitating its removal.

Oh and replacing a tooth with an implant a few years from now, if you decide that later, will be at least $3000 per toothspace.

I work for a dentist, a prosthodontic specialist. We see people everyday who'd love to pay $1000 to have been able to keep a tooth.
posted by Jazz Hands at 4:43 PM on January 6, 2006

Well, my mom's father believed in the "save money, pull it" idea. She now has to eat like a rabbit, because of the havoc wreaked in her mouth by the loss of teeth.

My dentist has told me: he will not pull a tooth unless you have no other option, and you understand the he hates doing it, and he never recommends it. My dentist is great.

I'd try to scrounge up the grand for the root canal. They let me get a loan at the dentist to pay for mine -- it was a high interest loan, but since they got the money up front, they were willing to pay the interest (they have some arrangement). So I just had the fee (which was 2 grand, if I remember), split over 18 months.

Maybe your dentist does something similar? That really helped me out.
posted by teece at 4:45 PM on January 6, 2006

I too have a dentist that won't pull teeth unless there is absolutely no other option, and for that, I'm grateful.

As previously mentioned, pulling a tooth will cause it's neighbours to drift into the space, which will cause you more problems down the road. Bite issues, among others.

Maybe a crown isn't necessary yet? I've had a couple root canals, but because I'm getting braces in ther near future (yes, braces, and i'm 27 and looking forward to it!) my dentist (and ortho) don't want me to get the crowns until my bite is fixed. Instead, the teeth are built up with a strong composite material, and frankly, I kinda like it. It's not permanent by any means, but it might give you a couple years.
posted by cgg at 4:58 PM on January 6, 2006

Shop around a bit, I've seen better prices than that.
posted by StickyCarpet at 5:01 PM on January 6, 2006

Consensus here is clearly in favor of saving the tooth. Along the lines of teece's suggestion, talk to the dentist (or office manager) and suggest payment over time. A high-interest loan may not be necessary, and you can't be their first patient who's been blindsided by an unexpected expense.
posted by rob511 at 5:17 PM on January 6, 2006

As far as I know, I will need a crown. The whole works. And of course 2 of the roots are curved so it's going to be a little more complicated procedure.

They didn't advise regarding the consequences of the extraction (drifting teeth etc..) There wasn't that much to talk really because I basically rushed in there ahead of other people. They did recommend saving it but my thought is that if it's going to be a really complicated procedure, what if after all that it's determined that it would've just been better to extract the tooth.

luneray I had my third molars on top (wisdom teeth) removed many years ago so it won't be like I'll have this gap in between 2 teeth. Besides it's in the back and aesthetically speaking, I don't think I could smile wide enough for my molars to be visible.

My only other option is getting the root canal in the next 2 weeks and then waiting until summer to have the crown done overseas for much much cheaper. (not worried about quality of work done and a friend got 4 cavities filled and root canal for less than $500 US).

I can see the point in more damage done in the long run and the thought of going through the pain I was in for the past few months (thought it was a sinus problem for a while) might convince me to save it.

What if I discussed this with them some more and see if we can figure out if my jaw bone structure or whatever can handle another extraction?
posted by eatcake at 5:45 PM on January 6, 2006

When I had to have my emergency root canal, the cost of the root canal used up my entire dental coverage for the year. In my case, the root canal was $1250. Getting a permanent crown put ran at another $850. This was in November of 2004- my dentist was willing to put in a temporary crown, send me off with instructions to chew carefully and a tube of fixodent in case it came out, and come back the following January when my insurance would be replenished and would cover it.

The permanent crown definitely feels much more natural in my mouth than the temporary one did, but if you can stretch it out until you have more money (or go overseas to have it done) that might certainly be an option.

$1000 for the whole works sounds like a bargain. I'd just do it and be done with it, if I were you.
posted by ambrosia at 6:02 PM on January 6, 2006

Last check at the office I go to (not too long ago)...root canal plus crown was about $1600. Bridge was $2500 (it's counted 'per tooth': little over $800 for the tooth to go in the gap, plus tooth-caps over the two neighbor teeth). Implant was about $3000.

If it really is a root canal including permanent crown for $1000, that sounds like a bargain to me too. I'd go for it.

The problem with those live bits of root is that infection can migrate down the 'canals' to the base of the root and establish itself underneath the tooth. Happened to me--you cannot imagine the throbbing, horrific pain when you have an infection in what's basically a closed pocket inside bone. Get 'em cleaned out a.s.a.p.

(Keep the receipt in a safe place, in case it comes in handy at tax time, too.)
posted by gimonca at 8:27 PM on January 6, 2006

Travelling any time soon? There are plenty of countries where the technology and dentistry are right up with the USA, but either (or both) a favourable exchange rate, and a lower local cost of living, makes the local price (in $US) low enough that the difference would pay a fair whack of the travel costs.

While $1000 isn't enough, unless you're going somewhere nearby, on more expensive proceedures you can soon get to the point where you could say "I get the proceedure done for the same price as here, but with a free flight to New Zealand thrown in"

:-)
posted by -harlequin- at 9:05 PM on January 6, 2006

I just had root canal done on a molar with a legit dentist in California for $1000, it seems a dentist school should be cheaper. Are there free clinics in your area? Whatever you choose, get to it before infection sets in.
posted by semmi at 10:21 PM on January 6, 2006

I missed the point that you get a crown too, sorry. It seems a reasonable deal.
posted by semmi at 10:23 PM on January 6, 2006

Okay so everyone is agreed. The price is quite good. My main problem with root canal is the level of pain. I know that movies, TV etc etc always pokes fun of this but I am very serious here, I now have a scale for my pain from hmm removing a band-aid (at say 1) to root canal (at 10) but in my head this is a sharply increasing exponential scale. Admittedly at the time the dentist I went may not have been the best in the world (but he wasn't at dental school either!).

YMMV but I thought it was important enough to sign up for an account to bring up the associated levels of pain (my root canals took ... 3 sittings so its not like its all over in one go).

I still go to a different dentist now but I am much more firm about what I will and wont have done. (Root canal falls into the second category).
posted by Gilgad at 5:56 AM on January 7, 2006

I'll disagree, but only for certain cases. I had a tooth removed and it was a very positive experience.

I had a wisdom tooth with little space and the tooth in front could either be extracted or get a root canal. My dentist and I decided it was better to remove the bad tooth and let the healthy wisdom tooth grow into the space. This worked extremely well.

So if you're under a certain age and might end up with wisdom teeth coming out soon AND it's a back tooth, there may be a good reason for the extraction!
posted by wackybrit at 8:13 AM on January 7, 2006

I had a root canal . . .a year ago? About that anyway. The worst part was the dental dam, because I felt vaguely like I was suffocating. If they don't have TVs there for you to watch, bring your iPod or whatever and have it set up where you don't have to mess with it too much. You should have plenty of novacaine for this procedure. If they aren't going to give you novacaine, take your business elsewhere. This sort of thing can be very painful if you are not properly taken care of -- laughing gas will *not* be adequate, IMHO, because they are poking around in the nerve area of your tooth.

They offered me percocet for the "pain" afterwards, but really, about four Advil and I was fine. I also used Peroxyl to rinse my mouth for a couple of weeks because it's better for you than Listerine (it's what you're supposed to use to rinse when you've gotten an oral piercing) and I felt very plaque-y for a while for some reason. Keeping in mind of course, that I have a very decent tolerance for pain, and don't like the disassociative state caused by most narcotic painkillers, and every time I take LorTab I get as sick as a dog. So. YMMV. And $1000.00 is very reasonable. It cost me $900.00 out of pocket AFTER my insurance paid up.
posted by Medieval Maven at 10:19 AM on January 7, 2006

Thank you everyone for all the advice!

I think I'm leaning towards saving it. I just want to talk with the dentist about the possibility of the procedure making things worst because of the curved roots.

Extraction is going to be cheaper and quicker but like it was said before, getting an implant down the line will cost more $$ and time.

But I gotta tell you, if an extraction won't have any adverse affects...hmm
posted by eatcake at 11:21 AM on January 7, 2006

I had a root canal years ago (no pain, outside of holding my jaw open that long), closed up with amalgam. The amalgam lasted about 3 years.

Dentist drilled out what didn't fall out, put an offwhite substance in as a temp filling until new insurance year. Have had that for 9 months or more now, no problem. He said it might last up to a year.

I'd rather have the tooth pulled, and be done with it, but 4 dentists have looked at me in horror and refused when I've asked them to just pull the little bugger.

YMMV, of course.
posted by QIbHom at 1:11 PM on January 7, 2006

I manage a dentists office. The patient's we feel for the most are people who got extractions and could have saved the tooth. The expense that they incur is just enormous. Implant technology, though quite good, does not always succede, and often requires a graft of bone to the jaw in order for the implant to hold. Failed implants are some of teh saddest cases, and even while the implant is healing, there are a lot of restrictions.

Save the tooth now rather than try to replace it later. Once bread is toast, it can't be bread again.
posted by bilabial at 1:11 PM on January 7, 2006

My root canal (the result of a broken tooth) was not at all painful.

Sidenote: The dentist performed the root canal without telling me until it was over. She explained, "I didn't want to scare you." Stupid kid that I was, I didn't realize what an egregious breach of professional ethics and informed consent the dentist committed by not telling me.
posted by jayder at 2:07 PM on January 7, 2006

Save the tooth, that's a good deal btw, with the crown. I thought my root canal would hurt terribly, but it was actually one of the least painful dental procedures I have ever had.
posted by Divine_Wino at 12:59 PM on January 9, 2006