Carmel Dental Clinic
Patient guide
Root canal or extraction: how the decision is made
When a tooth is badly infected there are usually two options: treat the inside of the tooth and keep it, or take it out. Extraction can look like the quicker, cheaper choice. Sometimes it is. Often it is only cheaper on the day.
General information from Carmel Dental Clinic, last reviewed . Not a diagnosis.
What each option involves
A root canal treatment removes the infected or inflamed tissue from inside the tooth, cleans and disinfects the canals, and seals them. The tooth stays in your mouth with its root in the bone and goes on chewing. A back tooth usually needs a crown afterwards, because a root-treated tooth becomes more brittle.
An extraction removes the whole tooth. The infection goes with it, and it is usually done in one visit. What it leaves behind is a gap - and a gap is not neutral.
What a gap tends to do over time
Not always, and not all at once, but these are the changes a missing tooth commonly causes.
- The teeth on either side can tilt into the space, and the opposite tooth can drift towards it.
- Food traps more easily around teeth that have moved, making decay and gum disease more likely.
- The jawbone where the root used to be gradually shrinks, because nothing is using it.
- Chewing shifts to the other side, putting more load on those teeth.
- A missing tooth you can see usually gets replaced, and an implant, bridge or denture costs more than the extraction saved.
When saving the tooth usually makes sense
When enough sound tooth remains to restore it with a filling or crown, the gum and bone around it are healthy, and the tooth is useful - a molar you chew on, or a front tooth you see.
In that situation a root canal and crown often cost less over the years than an extraction followed by a replacement, and no replacement works quite like your own tooth.
When extraction is the better choice
When the tooth is split through the root, broken down below the gum, or so decayed that nothing is left to hold a crown. When gum disease has destroyed the bone that supports it. When a wisdom tooth has nothing to chew against and keeps causing trouble. And sometimes, simply, when the patient has weighed both options and prefers it.
A tooth with a poor outlook is not worth spending money on, and you should be told so plainly when that is the case.
Questions we are actually asked
Is a root canal more painful than an extraction?
Both are done with the area numb, so neither should hurt during the procedure. Some tenderness for a few days afterwards is normal with either. The pain people remember is usually the infection before treatment, not the treatment itself.
Can a root-treated tooth get infected again?
It can, though most do not. A tooth that is sealed well and protected with a crown where needed has a good long-term outlook. If one does become reinfected, it can sometimes be treated again.
How long does a root-treated tooth last?
With a good seal, a crown where needed and healthy gums, many last for decades. The most common reasons they fail are fracture of an unprotected back tooth and new decay at the edge of the filling or crown.
Can I decide after the examination?
Yes. You will be told what the examination and X-ray show, what each option involves and costs, and what happens if you wait. The decision is yours, and taking time to think it over is normal.
Read more about each option
Not sure which applies to your tooth?
An X-ray usually settles it. Book an examination and you will leave knowing both options for that tooth and what each would cost.
This page describes a dental procedure in general terms. It is not a diagnosis and not a treatment plan, and outcomes vary from person to person. What is right for you is decided after a clinical examination at the clinic. See our terms and medical disclaimer.