Extraction needed, and how?

I could be wrong, but it sounds to me as if you've stumbled across some kind of crook!

Clearly you need an X-ray to establish the full nature of the problem and to see whether there's any infection. It's not safe to do an extraction without antibiotic cover if there's even a mild infection in the root.

That being said, you may well end up having to have the tooth removed. I've had two root canals on molars in my time, and both have ended up with the tooth having to be extracted a few years down the line. (Both extractions were done by oral surgeons in a hospital, as the underlying bone had become infected.) On the other hand, I've heard tales of people having root canals that have lasted 20 years or more, so maybe I've just been unlucky.

It does sound to me as if an oral surgeon might be a better bet in your case, particularly given the proximity of the bridge.

Now, about this "twilight sedation" and general anaesthesia... I can't make out which side of the Atlantic you're on from your way of writing, and I do know opinions very greatly. I can only say that when I trained as a general nurse in the UK in the mid-1960s, during our first lecture on the subject the anaesthetist warned us all very gravely never to accept general anaesthesia in a dentist's office. That surprised me, as I'd been used to being given "gas" at the dentist's as a child. He said that GA should only ever be administered in a hospital, where there were full facilities on hand in the event of something going wrong.

In spite of this, "chairside" anaesthesia - usually administered by a local GP - is still being used by some British dentists 50 years later, and is still causing unnecessary deaths. I read reports of these at least twice a year and there are probably others that go unreported. I worked for a year or so on a Casualty department (ER) in 1969-70 and can confirm that in that period I had to deal with one death due to chairside GA and more near-misses than I can remember.

I cannot advise you strongly enough to refuse general anaesthesia outside of a hospital environment, however many times you and your friends or family may have got away with it in the past, and whatever your dentist says. (Obviously, I'm not referring to the emergency roadside GA which occasionally has to be administered to cut someone out of a car wreck, for example.)

Conscious sedation - which is what I assume your dentist means by "twilight sleep" doesn't carry the same dangers as a GA but it's still not entirely safe. I would not accept it outside of a hospital. In fact, where I live - in a continental European country - both doctors and dentists are banned from using either GA or conscious sedation in their offices.

Also, why do you need either? Both my extractions after failed root canals were performed by an oral surgeon in a hospital, and at no point was I even offered GA or sedation. I wouldn't have accepted it anyway, as neither is 100% without risk even in a hospital environment. Both were done under local anaesthesia (injection). The first procedure was uncomfortable, as it involved the top molar next to the wisdom tooth, so access was difficult, and the tooth was also fragmented, like yours. However, I didn't feel any pain and the whole thing was over in 20 minutes. The second one was on a lower tooth (like yours) where access is always easier, and only took about 10 minutes, including the bone-scraping exercise (which caused no sensation whatever).

Sorry it's been long, but to summarise: see another dentist, preferably an oral surgeon, and have the procedure done in the normal way, under local anaesthetic. If you feel you must have sedation or GA, get it done in a hospital.

to clarify I was not told I need GA or twilight sedation for the work quoted, but it is offered in the chair if you want it, seems..