Side by side
| Root canal | Extraction | |
|---|---|---|
| Keeps your own tooth | Yes | No |
| Visits | Usually 1–2, then a crown | One, then a replacement later |
| Recovery | Mild tenderness for a few days | Socket heals over 1–2 weeks |
| Cost on the day | Higher | Lower |
| Cost including a replacement tooth | Root canal and crown | Extraction plus implant, bridge or denture, usually more |
| Long-term | Most teeth still in place 8–10 years on | Gap can let teeth drift and bone shrink if not replaced |
When a tooth can usually be saved
- The infection or inflammation is inside the tooth, and the roots and bone around them are sound.
- Enough tooth remains to hold a crown.
- The gums and bone support the tooth well.
When extraction is the better choice
- The tooth is split down the root.
- Decay goes below the bone and the tooth can’t be rebuilt.
- Severe gum disease has left the tooth loose with little bone.
- A previous root canal has failed and re-treatment or surgery isn’t likely to work.
- The tooth isn’t useful, such as some wisdom teeth.
What the research says
A systematic review of tooth survival after root canal treatment found that 86% to 93% of teeth were still in place two to ten years later. Teeth survived best when they were crowned after treatment, had teeth on both sides, weren’t holding a bridge or denture, and weren’t molars. That’s why we recommend a crown for most root-treated back teeth.
Get it checked soon
Toothache that keeps you awake, swelling in the face or gum, or pain when you bite all need prompt attention. We’re open 10am to 8pm every day and check the earliest available appointment for tooth pain. Call us; if the swelling is spreading to your eye or neck, or you’re struggling to swallow or breathe, call 112 or go to the nearest hospital emergency department.
How we decide
Our endodontist examines the tooth and takes X-rays to see the roots, the bone and any cracks, then tells you honestly whether it can be saved. If it can’t, Dr. Adish Chaudhary plans the replacement with you, sometimes as an immediate implant. See root canal treatment and the root canal cost guide.
Questions patients ask us
Which is more painful, a root canal or an extraction?
Both are done under local anaesthetic, and neither should hurt during treatment. Afterwards, a root canal usually causes a little tenderness for a few days; an extraction leaves a socket that is sore for several days and needs more care.
Is a root canal cheaper than an extraction?
On the day, extraction is cheaper. But replacing the tooth with an implant or bridge usually costs more than a root canal and crown together.
Root canal or extraction for a back molar?
Molars do most of the chewing, so saving them is usually worth it if they can be restored. A root-treated molar needs a crown to protect it from splitting.
Root canal or extraction for a wisdom tooth?
Often extraction, because wisdom teeth are hard to reach and clean, and many don't do much chewing. If it's a well-placed, useful wisdom tooth, a root canal can be considered.
Root canal or extraction for a cracked tooth?
It depends on where the crack runs. A crack confined to the crown can often be treated with a root canal and crown. A crack running down the root usually means extraction.
Can I have an implant straight after extraction?
Often, yes. An immediate implant can be placed at the same visit when the bone and gum allow.
Sources
Ng et al., tooth survival after root canal treatment: systematic review, Int Endod J, 2010 ↗NHS: root canal treatment ↗ADA MouthHealthy: root canals ↗Last updated 22 October 2026.