When a dentist tells you that you need a root canal or you'll lose the tooth, it's natural to pause and ask: Do I really need this? Wouldn't it be simpler to just pull it?
Here's what Dr. Doug Hudoba wants you to know upfront: No one's ever died of a missing tooth. Losing a tooth is always an option. But the consequences of that choice often take years to become apparent—and they're usually not what patients expect.
Let's start with the most counterintuitive fact: when you lose a tooth, you don't actually lose just one. From a functional standpoint, you lose two.
"A tooth is only as good as its partner," Dr. Doug explains. If you lose a bottom tooth, the top tooth that was chewing into it loses its purpose. That upper tooth can drift, migrate, or eventually be compromised. So a single extracted tooth effectively eliminates your ability to chew properly in that spot.
But the domino effect goes deeper. Every time a tooth is removed, the remaining teeth carry a larger burden than they started with. And here's the pattern that emerges: the greatest predictor of losing a second tooth is having lost a first tooth. Lose a second, and your odds of losing a third increase. It's a cascade.
What else happens when a tooth disappears?
The teeth on either side of the gap drift out of position. The bone underneath the missing tooth—which only exists to hold your teeth in place—begins to recede. Without the stimulation of a tooth, your body has no reason to maintain that bone. It gets thinner, less dense, and smaller. This bone loss can trigger recession in neighboring teeth and compromise their long-term health.
Now let's talk about what actually works.
When dentists face an infected or severely damaged tooth, the choice usually comes down to: root canal and crown, or extraction. The statistics here are surprisingly compelling.
A root canal followed by a crown has a 92-93% success rate at 10 years. That means more than 9 out of 10 patients who undergo this treatment have that tooth healthy and functional a decade later.
Dr. Doug puts this in perspective: "Very little of what we can do in all facets of medicine have that kind of success and predictability."
The catch? You have to do your part afterward. The treatment only works if you're brushing, flossing, and visiting your dentist. But if you are—if you're maintaining your mouth—you have better than a 90% chance that tooth will be happy and healthy 10 years later.
For comparison, dental implants have similar success rates at 10 years (also about 9 out of 10). So they're statistically equivalent in terms of predictability. But there's a crucial difference in how you should think about them.
Here's where things get interesting, especially if you're young.
Imagine you're in your 40s or 50s with a tooth that needs a root canal. An implant might seem like the "permanent" solution. But dental implants that need to last 40 or 50 years? We don't yet know how predictable that is. The further out you go from placement, the less certain the outcome becomes.
Now consider this alternative: Do the root canal and crown now, understanding it might last 7 to 10 years. In a decade, if it fails, you can get an implant. What have you accomplished? You've bought yourself 10 years with your natural tooth. And critically, you've reduced the burden on your implant—now it only needs to last 30 years instead of 40.
"Sometimes a treatment that we know may not be forever is an educated choice," Dr. Doug says, "so long as we understand the prognosis and the risk."
There's another advantage: implant technology in 10 years will almost certainly be vastly better than it is today. You're not locking yourself into today's technology.
This is what Dr. Doug calls "buying down the amount of time the implant has to work for." It's a strategy that changes the whole calculus of the decision.
So when should you actually save the tooth versus pull it?
First, understand that almost everything in dentistry short of extracting an infected, abscessed tooth is elective to some degree. You don't technically need fillings, root canals, or crowns. But they're value propositions. The alternative—leaving the bacteria in place—risks pain, infection, or eventual tooth loss anyway.
Second, have an honest conversation with your dentist about these specific factors:
"Communication and honesty with your provider, making sure that you're educated about the benefits and the risks, is the way to ensure that you make decisions that make sense for you," Dr. Doug emphasizes. "Without all the information, you can't possibly know what's best."
Losing a tooth sets off a chain reaction. Your remaining teeth work harder. Bone recedes. Neighboring teeth drift. Your bite changes. More teeth fail.
Saving a natural tooth with a 92% success rate—especially if you understand it might not be forever—often beats extracting it and hoping for the best.
But ultimately, it's your choice. Just make sure you're making it with your eyes open, understanding the real costs of both options, and with a dentist who's willing to be honest about the odds.
They work together but do different things. A root canal removes the infected nerve and pulp from inside the tooth. A crown is the protective cap that goes over the tooth afterward to restore its strength and function. You typically need both: the root canal treats the problem, and the crown protects the tooth long-term. Dr. Doug emphasizes that the combination of these two—root canal plus crown—is what achieves that 92-93% success rate.
Root canals have a reputation for being painful, but modern root canals with proper anesthesia are no more uncomfortable than having a filling done. The pain you might experience before the root canal—from an infected or damaged tooth—is typically much worse than the procedure itself. Once the infected nerve is removed, the pain usually goes away.
Modern root canal techniques and materials are very effective at removing infection and sealing the tooth. The main reason treatment succeeds is if you maintain your mouth afterward. Brush, floss, see your dentist regularly, and avoid chewing hard foods on that tooth. The success rate assumes you're taking care of your teeth post-treatment.
If a tooth with a root canal and crown fails, you still have options. You can get a retreatment (another root canal attempt), or you can extract it and move forward with an implant. The key advantage of doing a root canal now instead of jumping straight to an implant is that you've bought time—and if it does eventually fail, an implant will be more predictable because it won't have to last as long.
Younger patients (especially 40s-50s) often benefit more from the root canal route because it buys time before committing to an implant that might need to last 40+ years. Older patients might lean toward implants since they have fewer years ahead of them. But it really depends on your specific situation, your health, and your dentist's assessment of how predictable each option is for your tooth.
It depends on whether you're in pain. If you have an abscess or severe infection, waiting can make the problem worse and limit your options. If the tooth isn't hurting, you can often wait a bit while you gather information and make a thoughtful decision. Just don't ignore it indefinitely. Dr. Doug recommends getting assessed by your dentist so you understand what you're dealing with.
Treat it like your other teeth: brush twice daily, floss daily, and see your dentist regularly for checkups and cleanings. The main difference is avoiding chewing hard, sticky, or crunchy foods directly on that tooth until the crown is placed. After the crown is on, you can eat normally, but be mindful not to use it to crack nuts or chew ice.
The tooth won't have sensation like it did before because the nerve has been removed. You won't feel hot and cold as intensely in that tooth, which is actually fine—it's one of the trade-offs. You'll still feel pressure from chewing, so you'll know if something's wrong. Most patients adapt quickly and forget which tooth was treated.
The bone underneath the missing tooth begins to resorb (shrink and recede) because your body only maintains bone where it's needed—and without a tooth stimulating it, the bone has no purpose. The gums recede as the bone recedes underneath them. This can take months or years, but it's a real consequence of tooth loss. Neighboring teeth may shift, and the bone loss can make future implant placement more complicated and expensive.
Implants are typically more expensive upfront than root canal and crown, but the timeline is longer—usually 3-6 months from extraction to implant placement to final restoration (your body needs time to heal). A root canal and crown can often be completed in 2-3 visits over a few weeks. However, both have similar 10-year success rates, so cost shouldn't be the only factor.
If you ignore an infected or severely damaged tooth, you risk escalating pain, abscess formation (which can spread infection), and eventually losing the tooth anyway—plus all the downstream problems of tooth loss. Treating it early, when you have options, is almost always better than waiting until the tooth is beyond repair. By then, extraction might be your only choice, which is the exact scenario you want to avoid.
Absolutely, especially if you're facing a major decision between root canal and extraction. A second opinion from another dentist can give you confidence in the diagnosis and help you understand your options better. Dr. Doug believes in honest communication with patients—if your dentist isn't willing to discuss the pros and cons of both options, that might be a sign to seek another perspective.
Root canal success hinges on understanding that treatment isn't forever but doesn't need to be—it buys you time, reduces implant lifespan pressure, and lets technology improve before your next decision.
