Endodontic disease is disease that affects the living tissue inside of the tooth, called the pulp. The pulp can become diseased due to tooth fracture, concussive trauma (impact that can cause damage without breaking the tooth), periodontal disease, tooth degeneration (tooth resorption, cavities), congenital defects (birth defects), and other causes. When the pulp becomes damaged, the tooth may die and/or become chronically infected with bacteria. When the pulp has been irreversibly compromised, the affected tooth must be treated with either root canal therapy or extraction.
Extraction results in removal of the entire tooth, including the diseased endodontic tissues. However, extraction is much more painful and damaging to the oral structures than root canal, and has more potential complications. Extraction also results in the loss of the structure and function of the extracted tooth. Some teeth, like the canine teeth and the large chewing teeth, have a more important structural and/or functional purpose than other teeth in the mouth. The decision of doing extraction or root canal depends on which tooth is involved, the overall health of the tooth other than the endodontic disease, and the overall health of the patient.
For major teeth or teeth with structural/esthetic benefits, root canal is a reasonable approach to preserving the tooth. In some circumstances alternative or additional endodontic procedures such as vital pulp therapy, apexification, or apicoectomy should be performed.