When a tooth is severely damaged or infected, you face a critical decision: save it with a root canal or remove it entirely. Both options have their place in modern dentistry, and the best choice depends on your specific situation, budget, and long-term goals for your oral health.
This comprehensive guide compares root canals and tooth extractions across every factor that matters—cost, success rates, recovery time, long-term outcomes, and when each option makes the most sense.
Quick Summary: Root canals cost $700-$1,500 but save your natural tooth with a 95% success rate. Extractions cost $150-$600 but require tooth replacement ($500-$6,000) to prevent long-term complications. In most cases, saving a tooth is better than pulling it—but not always.
Root Canal vs Extraction: Side-by-Side Comparison
| Factor |
Root Canal |
Extraction |
| Procedure Cost |
$700 - $1,500 |
$150 - $600 |
| Total Cost (with restoration) |
$1,500 - $3,000* |
$650 - $7,000** |
| Success Rate |
95% (10+ years) |
100%*** |
| Procedure Time |
1-2 hours (1-2 visits) |
20-45 minutes |
| Recovery Time |
1-3 days |
3-7 days |
| Preserves Natural Tooth |
✅ Yes |
❌ No |
| Prevents Bone Loss |
✅ Yes |
❌ No (without implant) |
| Adjacent Teeth Affected |
❌ No |
✅ May shift over time |
*Includes crown ($800-$1,500)
**Includes replacement: bridge ($500-$5,000) or implant ($3,000-$6,000)
***Extraction itself is always successful, but complications can occur
What Is a Root Canal?
A root canal (endodontic therapy) is a procedure that saves a damaged or infected tooth by removing the diseased pulp tissue inside, cleaning and disinfecting the canal system, and sealing it to prevent reinfection.
How Root Canals Work
- Numbing: Local anesthesia completely numbs the tooth and surrounding area
- Access: The dentist creates a small opening in the crown of the tooth
- Pulp removal: Infected or dead pulp tissue is carefully removed
- Cleaning: The canal is cleaned, shaped, and disinfected
- Filling: The canal is filled with a rubber-like material (gutta-percha)
- Restoration: The tooth is sealed and typically crowned for protection
✅ Root Canal Pros
- Saves your natural tooth
- Maintains natural chewing ability
- Preserves jawbone
- Natural appearance
- Protects neighboring teeth
- No need for tooth replacement
- High long-term success rate
- Often cheaper long-term than extraction + replacement
What Is a Tooth Extraction?
Tooth extraction is the complete removal of a tooth from its socket in the jawbone. There are two types:
- Simple extraction: For visible teeth that can be loosened and removed with forceps ($150-$300)
- Surgical extraction: For broken, impacted, or difficult-to-access teeth requiring incision ($200-$600)
✅ Extraction Pros
- Lower upfront cost
- Faster procedure
- Immediate problem removal
- No risk of root canal failure
- Sometimes the only option
- May be covered more by insurance
Cost Comparison: Root Canal vs Extraction
While extraction seems cheaper at first glance, the true cost includes tooth replacement:
Root Canal Total Cost
| Root canal procedure |
$700 - $1,500 |
| Crown (usually required) |
$800 - $1,500 |
| Total |
$1,500 - $3,000 |
Extraction + Replacement Cost
| Tooth extraction |
$150 - $600 |
| + Dental implant |
$3,000 - $6,000 |
| OR + Dental bridge |
$1,500 - $5,000 |
| OR + Partial denture |
$500 - $2,500 |
| Total (with implant) |
$3,150 - $6,600 |
The Bottom Line on Cost: A root canal with crown ($1,500-$3,000) is often cheaper than extraction plus an implant ($3,150-$6,600). Even extraction with a bridge ($1,650-$5,600) often costs more than saving the tooth. The exception: if you're not replacing the extracted tooth, extraction is cheaper—but this leads to other problems.
When Is a Root Canal the Better Choice?
Root canal is typically recommended when:
- The tooth can be saved: Enough healthy tooth structure remains
- Infection is treatable: The infection is contained to the pulp chamber
- You want to preserve natural teeth: Most dentists prefer saving teeth when possible
- The tooth is in a visible location: Front teeth are harder to replace aesthetically
- You're young: Saving a tooth early means decades of use
- Your jawbone is healthy: No need to risk bone loss from extraction
- Budget is a concern: Root canal is often cheaper long-term
Root Canal Success Statistics:
- 95-97% success rate over 10 years
- 85% of root canal-treated teeth last a lifetime
- Retreatment success rate: 80-90%
- Most common reason for failure: crown not placed (tooth fracture)
When Is Extraction the Better Choice?
Extraction may be recommended when:
- Severe decay or fracture: Not enough healthy tooth structure to restore
- Vertical root fracture: Crack runs down the root (can't be saved)
- Failed root canal: Previous root canal that can't be retreated
- Severe periodontal disease: Bone loss makes the tooth unsupportable
- Crowding or orthodontic needs: Extraction creates space for alignment
- Tooth is non-functional: Wisdom teeth or severely malpositioned teeth
- Systemic health concerns: Immunocompromised patients may need extraction to eliminate infection risk
- Cost is prohibitive: If you truly cannot afford root canal + crown
Warning: If you extract a tooth and don't replace it, you risk:
- Adjacent teeth shifting into the gap
- Opposing tooth over-erupting (growing into the space)
- Bone loss in the jaw (20-50% in the first year)
- Bite problems and TMJ issues
- Difficulty chewing and speaking
- Facial appearance changes over time
Recovery Comparison
Root Canal Recovery
- Day 1: Mild tenderness, ibuprofen usually sufficient
- Days 2-3: Sensitivity decreases, can eat normally
- Week 1: Fully healed, no restrictions
- Return to work: Same day or next day
- Pain level: 2-4/10 (comparable to a filling)
Extraction Recovery
- Days 1-3: Swelling, bleeding, moderate pain
- Days 4-7: Swelling subsides, stitches may be removed
- Weeks 1-2: Soft foods, no smoking, careful cleaning
- Week 3+: Gum tissue heals, bone begins remodeling
- Return to work: 1-3 days depending on job
- Pain level: 4-6/10 initially
Recovery verdict: Root canals have an easier, faster recovery. Most patients return to normal activities the same day. Extractions require more downtime and careful aftercare to prevent dry socket and infection.
Long-Term Outcomes
After Root Canal
A successfully treated tooth with a crown can last your entire lifetime. Key factors for longevity:
- Get a crown placed within 1-2 weeks of root canal
- Practice good oral hygiene
- Avoid biting hard objects (ice, hard candy)
- Regular dental checkups and X-rays
After Extraction (Without Replacement)
Missing teeth cause progressive changes:
- 6 months: Adjacent teeth begin shifting
- 1 year: 20-30% bone loss in extraction site
- 5 years: Significant bite changes, possible TMJ issues
- 10+ years: Facial collapse in severe cases (multiple missing teeth)
After Extraction (With Implant)
A dental implant can last 25+ years and prevents bone loss. However, the process takes 3-6 months from extraction to final crown.
What Dentists Recommend
The American Association of Endodontists and most dental professionals follow this general guideline:
The Priority Order:
- Save the natural tooth whenever possible (root canal)
- Replace with an implant if extraction is necessary
- Replace with a bridge if implant isn't possible
- Partial denture as a last resort or temporary solution
"A natural tooth is almost always better than an artificial replacement." — American Dental Association
Questions to Ask Your Dentist
Before making your decision, get answers to these questions:
- "Is my tooth saveable with a root canal?"
- "What's the success rate for a root canal in my specific case?"
- "If I extract, what replacement options do I have?"
- "What happens if I don't replace the extracted tooth?"
- "What are the total costs for each option, including restoration?"
- "What does my insurance cover for each treatment?"
- "Are there any factors that make one option significantly better for me?"
- "Can I get a second opinion?"
Making Your Decision
Choose Root Canal If:
- ✅ Your tooth can be saved (dentist confirms)
- ✅ You want to preserve your natural tooth
- ✅ The tooth is in a visible area
- ✅ You want easier recovery
- ✅ You're thinking long-term value
- ✅ Your bone and tooth structure are healthy enough
Choose Extraction If:
- ✅ The tooth cannot be saved (dentist confirms)
- ✅ There's a vertical root fracture
- ✅ Severe periodontal disease has destroyed supporting bone
- ✅ The tooth has already failed a previous root canal
- ✅ It's a wisdom tooth or causing crowding
- ✅ You plan to get an implant for replacement
Get Expert Advice on Your Options
Find experienced oral surgeons and endodontists who can evaluate your specific case and recommend the best treatment for your situation.
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The Bottom Line
In most cases, saving a tooth with a root canal is better than extracting it. Root canals have a 95% success rate, preserve your natural tooth and jawbone, and are often more cost-effective long-term than extraction plus replacement.
However, extraction is the right choice when a tooth truly cannot be saved—severe fractures, advanced periodontal disease, or failed previous root canals. If you do need an extraction, replacing the tooth with an implant or bridge prevents the long-term complications of missing teeth.
The most important step is getting an accurate diagnosis. A thorough exam with X-rays (and sometimes a 3D scan) will reveal whether your tooth can be saved. If your dentist recommends extraction but you're unsure, getting a second opinion from an endodontist (root canal specialist) is always worthwhile.
Key Takeaway: Your natural teeth are worth saving when possible. A root canal might seem intimidating, but modern techniques make it no more uncomfortable than a filling—and it keeps your smile intact for years to come.
