Root canal or extraction for top back molar?

[Jenny27]

My back molar on the top right hand side is dead and cracked, with an abscess at the tip of the root. Some background - I think it's been like this for a couple of years . Around 2.5 years ago, I was getting a lot of pain around the tooth and really bad headaches. My dentist at the time (now retired) insisted that it wasn't an abscess and was just from my tooth grinding, which is quite severe. I had a bite guard fitted and the pain stopped not long after that, so nothing more was done. It now seems likely that the reason the pain stopped was because that was when the tooth died, and the timing with the biteguard was just coincidental.

Anyway the tooth is now definitely dead and there's an abscess showing up clearly in an x-ray. The new dentist has given me two options: root canal treatment or extraction, but is not giving any recommendation either way. The factors to take into account are:

- The dentist has estimated an 80% chance of success with root canal treatment. The tooth has a fairly large crack in it. She removed some of the temporary filling to check how far in the crack goes. It's not so far that that it would rule out root canal but as I understand it, it does affect the likelihood of success.
- Cost: The estimate for the root canal treatment and crown is £1500. This is not an amount I can easily afford at the moment, but I don't want it to be the deciding factor. If it's genuinely more beneficial for my future dental health to have the treatment then I'd rather just pay the money. Whereas if there's not much to separate the two options, obviously I'd rather not have to pay money I can't really afford.
- Chance of any unwanted consequences as a result of extraction - e.g. will the gap where the tooth was be uncomfortable in the long term? Will it affect my bite/tooth alignment etc?

Any thoughts, especially from anyone who's experienced a similar situation, would be very much appreciated!

 

[Dr M]

If you are unsure and it is a molar tooth, it might be a good idea to get a second opinion from an endontist, who is a specialist. The specialist will take a CBCT scan of the tooth, which gives a 3D image of the tooth. He will then be able to more accurately determine the extent of the crack, as well as any additional canals, which also influences success of the treatment. If the crack goes to deep, an alternative such as extraction and implant, might be a better long term solution.

 

[Brause]

I was in a similar situation in Canada and the cost was about the same. Later extraction was another 500 GBP equivalent.

My friend lacks a back molar [2nd molar that is]...and he can live without it.

I need an implant for a first molar, which is >2000 GBP equivalent...and a crown over it costs another 1000 GBP.

As to diagnosis and treatment: I always went to an endodontist who made a CBCT scan and an X-ray. The CBCT scan is 3D. Both CBCT and X-ray give the clinician complementary information.

I would not put my fate into the hands of a regular dentist when it comes to such complicated matters.