Advice please root canal on tooth or remove and implant?

[Imdunfer]

Anyone got any advice? I'm waiting to see if my tooth goes painful again after finishing antibiotics on Monday morning, which the dentist thinks it will. He's 95% sure I will need a root canal filling or an extraction. He's only 75% confident that a root canal filling will work.

Would you just have it extracted and then go for an implant or try the root canal first?

If at the back just get it pulled, I did last year and didn’t notice once it was healed, no pain afterwards either unlike my wisdom tooth

I had the root canal and crown. It lasted abiut 6 years before I had it pulled due to constant infections. I looked into implants… but I need bone grafts and it just seemed very long winded and complicated, not to mention £££ and painful! I now have a little denture. It clips in a bit like a plastic moustache you’d get in a cracker!

What des it clip into? My dentist mentioned this. I’m still going round in circles not knowing what to do. Not helped by different messages from different dentists.

i now have 2 nhs dentists . I have decay on molar 6 and 7 next to each other (upper molars). 7 is worse. First nhs dentist doesn’t know about tooth 6 and said get tooth 7 pulled. Or she could refer me to her colleague who would do a root canal for 1k. She says if I have it pulled there won’t be any problems.

dentist 2 also nhs also says he won’t do a root canal but he can refer me elsewhere. He seemed to be leaning more towards root canal. He said if I have them pulled I will have problems and need implants or dentures.

then I saw a third dentist at the hospital who I have to go back and see in a few weeks for X-ray. He hasn’t advised yet but said my nhs dentists should be referring me on the nhs for root canal if a root canal is possible. Says it’s disgusting they’re only referring private. He said always save a tooth if possible

Root canals are the most unhealthy thing you can do for your overall health. It’s the equivalent of leaving a necrotic piece in your body. I can’t believe they are even a thing still in 2026. Extraction every time, then implant later if you can afford it.

With the information I now know I believe that root canal work will be banned as unethical at some time in the future.

In early 2025 I had a rotted tooth root (the product or a botched hospital coronectomy ten years before) removed from my jaw. The silent infection that had been there for years is known to cause rheumatoid arthritis and cutaneous vascultis. In early 2025 I was diagnosed with both, with no family history of either.

Dentist here. There’s not really the evidence to back up your theory.
additionally if you opt for extraction then implant at a much later date, it might be too late for the implant as you will have allowed bone remodelling/potential bone loss to occur.
best practice is to have the tooth extracted by the surgeon who will do the implant as they can time it best and ascertain whether grafting is required. They also have specialist equipment to conserve as much bone as possible during extraction

Want to pick up on this thread as a dentist. Interesting to read re robotics in endodontics. We have AI assisted technology for reading radiographs but robotics being used by endo specialists in the UK is not something I have come across as yet. Yes the technology is being developed.
What we do have is CT scanning for accurate imaging, microscopes, apex locators to check we’ve reached the bottom of a canal, loupes, rotary instruments and better filling materials.
robotics? Not that I’ve heard are being used routinely yet.

Duplicate

There's evidence to back up mine, which is effectively the same claim but with specific diseases. Apical infections are known to trigger RA and cutaneous vasculitis.

I'm glad to see you recommend immediate extraction.

All very well but for the vast majority, extraction and then an implant is totally unaffordable, unless you go abroad.

I ve had 2 RC, follow up x rays show no infection and i'm pleased with the outcomes.

My dentist discussed RA with me, as i had read about this, he showed me research that does link it to infection inc gum/root but also to any infection, left untreated.

The point though, is that because the root has been denerved, you can't feel the pain. The RA is linked to long standing infection, and having a pain free infection that you know nothing about and is therefore long standing is very common with root canal treatment.

Your dentist was very on the ball, I only found out about it by accident trying to find out why I had RA when there's no autoimmune disease of any kind in my family.

I had follow up x rays. Dentist said no infection. I’d felt ill for a long time. Too long to list my symptoms and how it all developed over the years but once my suspicions that it could all be caused by root canals, within two days of the teeth being extracted I felt like a new person. I couldn’t believe it but the relief that I was right was immense.

Oh. 25% chance it’ll work as pp said. How skilled is he in root canals? Mine worked and has been fine for 2-3 years and was a complex one too (not curved roots). But I have no crystal ball to see into the future re it. Just have to pray I won’t need anything else. I had no infections beforehand though. I’d say try to save the tooth too. Maybe get a second opinion. A few dentists ime, don’t like doing root canals as it takes so long to do.

Interesting. My DM developed RA in her 50s. She’s also had loads of Harley Street dental work with a great dentist and family friend, Colin Hall-Dexter (now sadly dead) who was employed by Colgate I think, he taught dentistry too, when she was younger, when she could afford it and later on when she also used a very good cheaper recommended dentist, but don’t think root canal after RA diagnosis. She’s had bridges, implants and root canals. not sure of when it happened. I think her dentist advised implants too rather than root canals. No RA in our family either. Will have to ask her more.

I have had two teeth removed. They are either side lower rear. They are not in my ‘smile line’ so I’m happy with having gaps. I was told a root canal may work but it was 50/50 so went straight for the extraction.

I'd had x rays over 10 years too. I was vomiting in the morning and thought I was really ill. Then suddenly one day it caused excruciating pain in the tooth next door. My newly qualified dentist rejected a senior's advice that the tooth that seemed to be hurting should be root canal filled and sent me to a maxillofacial surgeon who said the coronectomy had been done completely wrong. When the tooth root came out it was obvious, and I stopped throwing up in the morning. For 10 years I hadn't felt a thing but from the state of the root it had been rotting for years, and eaten a channel up the side so it could drain into my mouth at night! I've kept it as a souvenir.

I'm in remission from both diseases it caused at the moment, without medication, and hoping it will stay that way. I'm glad yours got fixed too.

Jeeez that sounds horrendous, v glad you re ok now.

I always thought that even with the nerve removed, infection around the root would cause swelling in the gum tissue (which still has its nerve supply) as it does in a normal tooth? nerve can die even in a tooth without any RC work also.

Infection within the tooth root shouldn't happen as its packed tightly with a gel like substance.

RA is more likely to occur in women and has genetic factors too.

Doing a great job of convincing myself this is all scare stories as i spent £4k on dental work recently, inc a very deep RC filling 😂

I'm so sorry, I did think that I would worry people writing this stuff but I felt it was more important that people should know. Please push your dentist for frequent x rays. I'd show you a photo of my painless tooth root but you probably wouldn't want to see it!

Apologies again for unsettling anyone with root canal work.

I googled any link between implants and RA & yes there is "some" evidence there too

But as far as i can tell, the connection seems to be in people with a pre disposition for RA, the failed RC triggering the immune response.

Anecdotally, my Aunt has 4 RC's, is 83, drinks a bottle of red every night and is as fit as a fiddle - hope i have some of her genes!!

I don’t get the save the tooth at costs moto, I have seen the root cause documentary. I will always got for extraction. It’s worth a watch @Imdunfer it was removed from Netflix, but still on YouTube

Dentist here with 30 years experience of doing root canal treatment. Please be reassured that generally the treatment works, it’s conservative, can save your teeth, it’s painless with the right anaesthetic.
it’s rare for a procedure to fail, and never once have I come across a case of a root treated tooth triggering another health concern. Im
not saying that it doesn’t happen, but in all my years its never been a reported concern to me, and on the balance of probability it’s an extremely remote possibility.
I just want to keep the thread balanced, and reassure people.

I really appreciate your balance added to the thread. Thank you.

While you're here, can you explain the pressure there seems to be to save the tooth root at all costs?

I don’t think there is pressure to save at all costs, definitely not. The GDC are very clear that all options should be given where appropriate. In some cases our clinical opinion would be a definite suggestion to extract, for instance if the infection isn’t clearing, if there’s a crack in a root, if there isn’t enough tooth substance to ultimately restore - “building castles on sand” and of course if root canal is deemed unaffordable. But being conservative is always a good idea.

the reasons why root canal are a good option-

1. it conserves bone
2. to prevent possible complications in medically compromised patients- such as those in bisphosphonates have a high risk of MRONJ after an extraction ( osteonecrosis) or those on blood thinners might bleed a lot
3. 3. to prevent possible surgical complications such as oral antral communications, roots going into sinus, roots fracturing and requiring complicated surgery
4. to prevent dry sockets especially in smokers
5. to prevent the need for dentures, as not everyone wants these or indeed can tolerate them
6. to prevent the need for a space at the front of the mouth in the aesthetic zone. Tooth removal here can be particularly upsetting
7. to keep occlusion balanced and prevent bone loss, drifting or over eruption of adjacent teeth
8. to present a cheaper option than implant or bridge. A bridge to fill an extraction site compromises adjacent teeth

Have to remember that in the vast majority of cases, RC doesn't lead to RA.

In my case, the RC i had done recently, was one of the front teeth, an extraction would have looked horrible and i couldn't afford an implant.

To me, this is like vaccines, yes sometimes there are bad reactions but for most, they pose no issues and save lives and illness.

Super thank you.

Given my RA+CV, history I'll always have an extraction if needed in future. I had an incredibly bad reaction at just 12 weeks to bisphosphonates, I couldn't chew anything for the pain in all my teeth. That's supposed to take years. I've probably got quite a reactive system!