My Tooth Hurts — Does It Need to Be Extracted? How to Know What’s Next
By Dr. Brayden Teuscher, Teuscher Legacy Dental — St. Charles, IL
💬 The Real Question People Ask
“My tooth’s been hurting on and off. Does that mean it needs to be extracted? — or could a filling or crown still save it?”
That’s one of the most common (and stressful) questions we hear.
No one wants to lose a tooth — and the truth is, extraction should always be the last resort, not the first option.
At Teuscher Legacy Dental, our job is to find out why it hurts before deciding what to do.
🔎 Step 1: Understand What the Pain Means
Tooth pain doesn’t always equal extraction.
Here’s how different types of pain often point to different causes:
| Type of pain | What it might mean | Typical solution |
|---|---|---|
| Sharp pain when chewing | Small crack or high bite | Bite adjustment or crown |
| Sensitivity to cold | Reversible inflammation | Desensitizing care or minor filling |
| Lingering ache after hot/cold | Nerve infection | Root canal or extraction |
| Throbbing pain or swelling | Abscess or deep infection | Root canal or extraction with graft |
| Dull pressure pain | Sinus pressure or clenching | Bite adjustment or night guard |
🦷 Step 2: Decide — Save or Extract?
We can usually save a tooth if:
The crack doesn’t extend below the gumline
There’s enough healthy structure for a crown
The bone around the root is stable
The root canal system can be properly treated
Extraction is the better choice if:
A vertical root fracture is confirmed on 3D imaging
There’s chronic infection or bone loss around the root tip
The tooth has failed multiple root canals
Mobility makes the tooth unstable
When extraction is necessary, it’s because the long-term prognosis is hopeless — not simply because the tooth “hurts.”
🧭 Step 3: What Happens After Extraction
If a tooth does need to be removed, your next question should be:
“How do I keep the bone from shrinking?”
That’s where socket preservation (bone grafting) comes in.
By placing bone material right after the extraction, we maintain the shape of your jaw so you can easily replace the tooth later — often with a dental implant.
Learn more: ➡️ A Real Patient Example of a Bone Graft After Extraction
⚖️ Step 4: Implant vs Bridge — What’s the Best Replacement?
When it’s time to replace the tooth, you’ll typically have two main choices (but I wrote a full comparison of these dental implant alternatives here):
1. Dental Implant
Replaces the root and the crown
Preserves bone and surrounding teeth
Can last decades with proper care
Doesn’t rely on neighboring teeth for support
2. Dental Bridge
Uses the two adjacent teeth as anchors
Fills the missing space with a porcelain “pontic”
Can be a good option when implants aren’t feasible (for example, if bone volume or medical conditions limit surgery)
However, a bridge requires reshaping the neighboring teeth — even if they’re otherwise healthy — and it does not prevent bone resorption under the missing tooth.
That’s why the American College of Prosthodontists recommends dental implants as the preferred single-tooth replacement whenever conditions allow:
“Implants demonstrate higher long-term survival rates and superior preservation of alveolar bone compared with conventional fixed dental prostheses.”
— American College of Prosthodontists Clinical Practice Guidelines, 2021
Additionally, a systematic review in the Journal of Prosthetic Dentistry found that:
“Single-tooth implants have a 10-year survival rate exceeding 95%, while fixed dental bridges average 80–85%.”
— (Pjetursson et al., J Prosthet Dent 2018;119(2):220–228)
So, while bridges can be appropriate in certain cases, implants typically provide the most stable, natural-feeling, and long-lasting result.
🤝 Step 5: Our Philosophy
If a tooth can be predictably saved, we definitely save it.
If it can’t, we’ll help you decide the best option for you.
Either way, you’ll understand why — before we do anything.
📍 Serving St. Charles, Campton Hills, Geneva & Elburn IL
Teuscher Legacy Dental provides comprehensive surgical and restorative care — from gentle tooth extractions and bone grafts to guided dental implants and smile makeovers — all under one roof. Come see us!
