Infected tooth, to keep (redo root canal) or extract?

August 22, 2024 7:43 PM

I have a 20 year old root canal in tooth #15 (left, top, back) that is now infected. How should I evaluate my options? What are peoples' experiences with this situation / type of surgery? If extracted, how did your teeth react to the tooth's absence?

The endodontist has offered two options (that seem to have two sub-scenarios):

(a) Redo the root canal.

They said that sometimes the root canal isn't done in a way that removes all of the nerves and this infection may recover if it is cleaned out properly.
i) The endodontist said that this often works and then we're done...for now at least
ii) But sometimes the redone root canal does not remedy the infection, or during the excavation they find a crack in the tooth and it can't be saved...

(b) Extraction of the tooth.

...Is required if the tooth can not be remedied by a root canal and the infection persists. The options are to get the removed tooth replaced with an implant or to leave it removed with no replacement.
i) For those that have done implants, how has it gone? Does it function like a tooth? Was it worth the cost?
ii) For those that have extracted and not replaced, how does your bite / chewing function? The endodontist mentioned that the bottom tooth (#18) can sometimes raise up to meet the whole. Has anyone experienced this?

...Also, I've gotten conflicting advice about the results of an extraction of tooth #15. The endodontist I went to said it's no big deal and that there's little chance of shifting because it's at the end. (Also that this location is hard to get good footing for an implant replacement). However, I also heard the opposite advice. Anecdotally, (dentist who is a friend of a friend) alternative advice is that because the last tooth serves as an 'anchor', that removing it can actually cause a large amount of shifting if it's not replaced with an implant.


This is confusing and there are a lot of options and this seems like a big decision and my mouth kinda hurts. Help. Thanks.

posted by Reasonably Everything Happens to Health & Fitness (14 answers total)

It’s hard to say what will happen if this is removed because mouths are so varied. I had several teeth extracted. Sometimes there’s been no shifting, sometimes it’s been noticeable.

Right now I have two back molars missing on my top jaw. My wisdom tooth came in and took the place of one, which was nice. The lower teeth have not raised up all. It hasn’t affected my bite much, I am a bit more cautious when chewing anything hard on that side though.

I do have one implant and it was absolutely worth the cost, I wish I could have afford to get more. It functions exactly like my other teeth. Once we got the fit right, took a few try’s, I never had to think about it again. That was 10ish years ago, it’s been great.
posted by lepus at 8:02 PM on August 22

Been there - #1 is antibiotics.

Then re-do the root canal as recommended by the endodontist. Extraction/implant is another conversation. The infection must be dealt with. The primary goal is to eradicate the infection and to clean out any infected residual tissue.
posted by citygirl at 8:08 PM on August 22 [1 favorite]

I’ve had 3 implants. They function like real teeth and feel fine. In fact, they’re in on one side of my mouth and that’s where I do most of my chewing, as there’s something going on with the other side. Total cost per tooth is $6000-6500 in my area,depending on size of tooth. This covers extraction, bone graft, implant, and crown. There are probably lower cost ways of getting implants, such as not getting sleep anesthesia, or going to a clinic that specializes in implants and dentures. My nephew’s wife, who is a native of Mexico, made a few trips back home and got implants for a fraction of what I paid.

My first implant was after a root canal; the root cracked the first year after the procedure. A friend who’s a hygienist told me that’s common, so the next time I needed a root canal I just opted for an implant. I’m getting old and I hate recovering from dental procedures.
posted by coldhotel at 8:10 PM on August 22

I had that exact same tooth extracted a few years ago after the endodontist said it couldn't be saved. I was also told that it's difficult to put an implant in that location and that it's common for people just to do without that tooth. I read some about implants and it sounded like it was not at all guaranteed to go smoothly and be a success. I ended up opting not to try it.

I chew more on my right side now, but it doesn't really bother me. I was worried about the opposing tooth rising up and maybe also needing to be removed, but so far that hasn't happened. I think that may be because I have a mouth guard I wear (somewhat inconsistently) at night to help with tooth grinding. If I go for a while without wearing the mouth guard, it feels like my teeth have shifted a bit and it's harder to put in and more uncomfortable for a night or two. But wearing it seems to shift them back into place. The guard extends over the spot where my missing tooth is, so when I'm wearing it the opposing tooth has something meeting it. I wonder if they ever prescribe mouth guards just to keep teeth from shifting around after an extraction? It seems like it could be a reasonable solution.
posted by Redstart at 8:23 PM on August 22

I had a bicuspid break a few years ago. It broke too low, so a crown wasn't an option, so I got an implant. I had it done with a couple other bigger things, so I can't remember the exact cost, but it was substantially lower than what Coldhotel paid. The whole thing took six months. The extraction, then waiting a bit before the bone graft, and then waiting for the bone graft to take hold, and then I think the implant went in, and then maybe there was another period of time until the tooth was installed. But the various procedures weren't lengthy, and there was only mild pain for a few days after the bone graft. It was definitely worth the cost. It looks, acts, and feels just like a regular tooth.
posted by jonathanhughes at 6:11 AM on August 23 [1 favorite]

They said that sometimes the root canal isn't done in a way that removes all of the nerves and this infection may recover if it is cleaned out properly.

Your root canal is 20 years old. It was about 18 years ago that they had just started using microscopes during root canals. I had a pre-microscope root canal become infected a few years ago. My dentist explained to me that it became infected because without a microscope, a thorough root canal was not done the first time. A microscope was used during the second root canal and I've been very happy with the result.
posted by SageTrail at 6:33 AM on August 23 [3 favorites]

I was in this exact situation a couple years ago with tooth #31. I ended up having it pulled and didn't get an implant, though I will in the future if my dentist recommends it. I haven't noticed any differences since the extraction, I still chew normally and everything. If I hadn't kept #31 on my dresser I would never think about it at all.
posted by birthday cake at 7:31 AM on August 23

I just recently had the same thing, went with option a, as recommended by my regular dentist and the endodontist. Antibiotics were prescribed, which was routine. In my state (like a state in the USA, not my condition), I needed to go back to my regular dentist 2-3 weeks after the root canal so he could put a filling in. The endodontist was not allowed to do that according to the license/law in my state, I was told. So keep that in mind as another potential expense/visit.
posted by dabadoo at 8:55 AM on August 23

Assuming the very back teeth are the wisdom teeth (1, 16, 17, and 32) and that you have had them removed, at least on the top of your mouth:

I recently had severe pain in #18 on your picture and the dentist I went to said that we do less than 2 percent of our chewing on that tooth. I said go ahead and take it and have had no issues since the healing. I have a 6-year-old crown in a second to the last tooth (not counting my removed wisdom teeth) and would really want to keep any other teeth that are not the last ones, but the last ones can go. My root canal experience was really good, and I would not hesitate to have another if I can go to the same endodontist, but this did not seem worth it.

As for shifting, my teeth are already pretty tight, and I think I had some spacing out after my wisdom teeth got pulled. I have not noticed any more spacing with the removal, but it is less than 6 months old. My husband had an implant for one broken crown, and he is happy with it. He chose not to have a second implant on a broken crown further back and is also happy with that decision.
posted by soelo at 10:23 AM on August 23

I'm missing tooth 15 after a long painful journey of multiple failed root canals. It went over 10 years ago. No implant and it's fine.
posted by twelve cent archie at 12:22 PM on August 23

I'm going through this now. Root canal ~5 years ago, all was fine until an infection ~2 years ago, did surgery in through the gum to resolve it, which was fine until ~1 year ago. Options on the table were to re-do the root canal, or pull the tooth. Redoing the root canal is a try-and-get-lucky solution that might or might not fix the underlying problem; pulling the tooth was the only option that gave a definitive resolution. It got pulled.
posted by NotMyselfRightNow at 3:30 PM on August 23

I just had a root canal re-done, the dentist said it is a bit of a risk, but how it goes heavily depends on the skill and equipment of the endodontist. You probably want to go to a larger city and pay a bit more, some place shiny and clean with many endodontists on staff and where the injections take effect immediately and they 3D scan you before. Mine worked great, thank goodness!
posted by meepmeow at 11:57 AM on August 24

I had my first root canal when I was ten. Didn't have a problem with that tooth until I was an adult in my thirties. I then needed to get a crown put on that tooth. Years later that tooth got infected and my dentist send me to an endodontist to get another root canal. I wasn't sure how that was going to work with the crown but the endodontist just drilled through the crown. I had two follow up appointments six months and then a year after the procedure to make sure the surrounding tissue had regenerated. I have not had a problem with that tooth since. Getting the tooth pulled was not an option offered to me but I think my dentist prefers not to have teeth pulled unless here is no other option.
posted by Constance Mirabella at 4:58 PM on August 24

I think I may have had what you're describing. I had an old root canal that was giving me intermittent pain over the course of a year or so. It was also in #15 for me. After getting two estimates of between $12k-$18k for the gum surgery and then the implant, I instead went to Mexico to have the work done.
The dentist there told me that he would go in with the surgery and try to clean out the infection, but based on the Xrays it was likely that I would need the root(?) and tooth removed and an implant.
I got lucky and he was able to clean up the infection during the surgery and I didn't need the implant after all.
I had virtually no pain, or at least no pain that was greater than the pain the tooth was giving me prior, and it was a very easy recovery. The dentist did stress to me that it was important to get the implant if the tooth needing extracting, but tbh, I can't remember why.


Just an FYI for those interested in traveling for affordable dental care:

The total cost for the week in Playa Del Carmen to get the work done was under $2k, including flights from NYC and Airbnb. The dental work portion was just under $1000 (the surgery being $580 of that) if I remember correctly, the total would've been closer to $2500 if I'd needed the implant, and would've taken two more trips to Playa to complete. I highly recommend the dentist I went to, he does a lot of the expats in the area, and had newer tech than the dentists I went to here in Brooklyn. Appts.were arranged via email before I booked my flights, but I think if you book in advance further than I did you could probably find the flights first and then book the appointments, they seemed pretty flexible. He doesn't do anesthesia but even being a giant chicken when it comes to dental work, I had zero issues with pain or discomfort during the procedure.
Anyone interested in the dentists office contact info feel free to memail me.
posted by newpotato at 7:57 AM on August 25 [1 favorite]