I have had two consultations this morning during which I have had the following conversation.
"Which is cheaper, the extraction or the root canal filling?"
"Well that depends on whether we are talking about the immediate costs or the long-term costs?"
"I'm talking about the cost today."
This is a tough conversation to handle. Obviously to lose a tooth is often a heartbreaking decision for someone, but it is also common enough that there seems to be little thought involved in this decision, and the gut reaction is to do whatever seems to be the cheapest. Generally the immediate cost of an extraction is much less than the immediate cost of a root canal filling. A root canal will cost at least triple the cost of an extraction, and maybe more. Is it as simple as that though?
What do you do when the tooth is gone and the socket has healed? Okay you basically have three options with varying degrees of quality and success.
We could make a denture, they are relatively simple to make and can be made to a pretty high quality in terms of aesthetics, but they are often bulky and have to be removed at night and to be cleaned. If you are young, fit and healthy this isn't going to be a desirable solution, and they often cost as much as the original root canal would have been.
The second option would be to make a bridge if the teeth beside the gap are suitable, but whilst this option offers a permanent high quality solution, with excellent aesthetics, they can be as much as twice or three times the price that the original root canal would have been. Keeping the original tooth is starting to look more desirable.
The third option is to get an implant, and this in many cases is the 'Gold standard' the best solution for a single missing tooth provided you meet the criteria, unfortunately it comes with the golden price tag. This is the most costly option, and although likely to last many years, still require careful maintenance. An implant could cost as much as five times the original root canal treatment.
Root canal treated teeth are often in need of a crown at a later date as well though, so it is not always easy to do a direct price comparison.
"Hey! I've an idea, what if we don't replace it at all? It's only a small gap of one tooth, and it's near the back, no one will even see it."
Okay, that makes sense. The decision here is more complicated than you would imagine. Here are some of the long term consequences of leaving a gap in your mouth.
The physical effects are that the teeth beside the gap can drift into the space, tipping out of alignment, leading to issues with malocclusion, cross bite, chewing problems and potentially painful conditions such as TMD (Temporo-mandibular Dysfunction) or even tooth decay. It could also lead to problems with reduced efficiency of chewing (Mastication).
The cosmetic effects of not replacing a tooth can be that the bone in the area dramatically shrinks away, as the teeth tip, it can be harder to clean between the teeth resulting in gum problems, staining and discolouration, the loss of a back tooth puts more force through the surrounding teeth and even the front teeth leading to problems with tooth erosion and attrition, even bits chipping and breaking.
The psychological effects are harder to define, but issues around self-confidence can often arise from missing teeth, people say that the smile is the extremely important part of social interaction, and subconsciously people who mask their smile to hide a gap may come across as less approachable and less friendly.
So I don't think it is an easy call, sure the cost of the extraction today is less, but if we don't promote the salvage of these teeth utilising root canal treatment and crowns, we are exposing our patients to potentially much more costly treatment down the line. I'd hate someone to be making these decisions in the heat of the moment, so there is always the opportunity to take away information and have a good think about it, because a quick decision creates regret.