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Root Canals and Extractions

Root Canals and Extractions – When you have a toothache that is sensitive to pressure, biting
or wakes you up at night, this is most likely caused by an infection source compressing the
bone around the base of the tooth.  Even though the infectious bacteria got into the nerve of
the tooth through the dentinal tubules in an ignored cavity, once the bacterial population within
the tooth grows in the nutrient rich nerve canal, the bacteria and decaying exudate (1.e puss)
follows the path of least resistance through the larger whole in the apex or tip of the root where
the nerve enters the tooth.  This pressure builds up in the bone, causes the tooth to super-erupt
causing you to hit on the tooth harder, leading to ian increase in inflammation cell, etc, etc etc.
In other words… it becomes extremely painful!

The only way to remove the pain is to remove the pain is to remove the source of the infection.
This means cleaning out and sterilizing the inside of the tooth, or removing the tooth entirely.
Cleaning out the inside of the tooth will almost always provide for immediate relief, where as
removing the tooth gets rid of the infection but brings upon another pain associated with the
extraction.  I always look to see if 1) the tooth is restorable and 2) how it fits into the patient’s
current and future dental restorative scheme.  Though it takes an extra visit or to to save a tooth
and it costs a bit more money, the overall cost of an extraction can be compound if that tooth is
not replaced.  You CAN NOT take a part of the system out and expect the engine to run as
effectively or as long.  There are many, many sequelae (complications) from extracting a tooth
such as additional tooth loss, improper mastication and digestion, a  long term TMJ or jaw joint
pain to name a few.

Sometimes you may have a toothache in a tooth that doesn’t even have a cavity.   Sometimes the
source of the infection is a pocket of gum tissue that has receded due to periodontal disease.  The
destruction of the bone seen with periodontal disease can affect the furcation or split area of a
multi rooted tooth, or it can progress all the way to the apex of the tooth and infect to nerve of
the tooth.  Anywhere you cannot clean can and will become infected.  Most periodontal disease
is irreversible and the prognosis for keeping a periodontally involved tooth if often poor.

As with any condition in our body… it is always better to have an early diagnosis and treatment.
This is why routine exams and cleanings are important.  No one ever has to have a toothache.
I know I won’t  because I know what will happen to my teeth if I ignore them… they’ll go away!