Deep decay, a crack or trauma has reached the nerve. This one has a deadline — and the choice is essentially save the tooth or lose it.
What is happening inside the tooth
Inside every tooth is a soft core of nerves and blood vessels — the pulp. When bacteria reach it, it becomes inflamed and then infected. The pulp is sealed inside hard tissue with nowhere to swell, which is why the pain can be severe, and why an untreated infection eventually spreads out through the root tip into the bone, forming an abscess.
See a dentist promptly if you have: facial swelling, a fever, pain that keeps you awake, or difficulty swallowing or opening your mouth. A spreading dental infection is a medical problem, not just a toothache.
Antibiotics alone do not cure it. They can calm a flare-up, but the infected tissue is inside the tooth where blood — and therefore antibiotics — cannot reach. The infection returns until the source is removed.
Your treatment options
Option
When it is the right choice
Pros
Cons
Then choose your material
Root canal + crown
The tooth is restorable and worth keeping
Keeps your natural tooth and its root; 85–95% success at ten years; nothing chews like a real root
Multiple visits; the tooth becomes brittle, so it needs a crown afterwards
A front tooth with plenty of structure left — rarely right for a back tooth
Cheaper; one appointment fewer
The tooth is brittle after treatment and can split under chewing — often below the gum, meaning the tooth is lost. Worse with a white composite filling, which shrinks and pulls on the weakened walls.
We do not mark a favourite here: which of these is right for you is decided by the state of your tooth, not by preference. Once the treatment is chosen, the material is a real choice — and there we do have a clear preference.
Whatever you choose: doing nothing is not on this list. An infected nerve does not settle down on its own, and the tooth becomes harder to save the longer it waits.
No — that reputation is decades out of date. With modern anesthetic the treatment itself should not hurt; most patients say it felt like a long filling appointment. The toothache that drove you there is usually gone by the next day.
A root-treated tooth has lost its blood supply and usually a lot of structure, so it is more brittle. Most root canal “failures” are actually the tooth fracturing later, unprotected. On a back tooth, skipping the crown is how you lose a tooth that the root canal had already saved.
Usually not, if the tooth can be restored — replacing it properly costs more than saving it. But for a badly broken-down tooth, extraction can honestly be the better choice. A good dentist will tell you which case you are; if they will not, get a second opinion.
Get this treatment for free
We collaborate with models and content creators: you record honest videos about your treatment experience, and we cover the dental work.
This guide is general information, not personal medical advice. Every mouth is different — always discuss your situation with a dentist before deciding on treatment.
