Root Canal vs Extraction: Which Option Is Better?

What Is a Root Canal Treatment?

Root canal treatment is a procedure designed to save a tooth that has become infected or inflamed internally. Rather than removing the tooth altogether, the aim is to preserve the natural tooth structure while eliminating the source of infection.

During root canal treatment, the dentist removes the infected pulp tissue from inside the tooth, cleans and shapes the root canals, and seals them with a biocompatible material. In many cases, a crown is placed afterwards to protect the treated tooth and restore its strength.

Root canal treatment is typically considered when the infection has not spread beyond the point of effective treatment and when enough healthy tooth structure remains to support a restoration.

What Does Tooth Extraction Involve?

Tooth extraction involves the complete removal of a tooth from its socket in the jawbone. It is a common dental procedure that is performed under local anaesthetic to keep the patient comfortable.

Extraction may be necessary when a tooth is too severely damaged to be restored, when infection is extensive, or when keeping the tooth could put surrounding teeth or overall oral health at risk.

After extraction, the gap left behind may need to be addressed with a replacement option such as a dental implant, bridge, or denture — depending on the location of the tooth, the patient's oral health, and their preferences.

Benefits of Choosing a Root Canal

Where clinically appropriate, preserving a natural tooth through root canal treatment offers several advantages:

• Keeping the natural tooth — your own tooth is almost always the best option for function and feel, provided it can be maintained long-term
• Maintaining bite and alignment — a preserved tooth helps keep surrounding teeth in their correct positions, preventing shifting or tilting
• Avoiding a gap — retaining the tooth eliminates the need for a replacement, which simplifies ongoing care and reduces the overall treatment involved
• Natural appearance — a restored root-treated tooth, particularly when protected with a crown, looks and functions like a natural tooth

It is worth noting that root canal treatment is not suitable for every situation. The tooth needs to have sufficient remaining structure and the infection needs to be manageable for this approach to be a viable long-term option.

Situations Where Extraction May Be Recommended

Extraction is not a last resort or a sign of failure — it is a considered clinical decision that may be the most appropriate option in certain circumstances:

• Severe structural damage — if the tooth is fractured below the gum line or has lost too much structure to support a restoration
• Advanced infection — when the infection has progressed significantly and is unlikely to resolve with root canal treatment alone
• Poor long-term prognosis — if the tooth is unlikely to function well long-term even after treatment, extraction may offer a more predictable path forward
• Periodontal involvement — extensive gum disease or bone loss around the tooth may make saving it impractical

Your dentist will explain the reasoning behind an extraction recommendation clearly and discuss what replacement options are available.

Pain and Recovery Comparison

Concerns about pain are natural when considering either treatment. Both root canal treatment and extraction are performed under local anaesthetic, so sharp pain during the procedure is typically prevented.

During treatment:

• Both procedures involve numbing the area thoroughly before any work begins
• Patients may feel pressure or vibration during either treatment, but this is generally not painful
• Individual experiences can vary, and your dentist will check in with you throughout

Post-treatment recovery:

• Root canal — mild soreness and tenderness around the treated tooth for a few days is common, usually manageable with over-the-counter pain relief
• Extraction — some swelling and discomfort around the extraction site is expected. Recovery may take a little longer, particularly for more complex removals

Neither treatment should involve significant pain during the procedure itself. Post-treatment discomfort varies between individuals, and your dentist will provide aftercare guidance tailored to your situation.

Long-Term Implications of Each Option

The decision between root canal and extraction has implications that extend well beyond the initial appointment. Understanding these helps inform a more complete picture:

• After extraction — the gap left by a missing tooth may need to be filled with a replacement such as an implant, bridge, or denture. Without replacement, surrounding teeth may shift over time
• After root canal — the treated tooth will need a permanent restoration, typically a crown, to protect it. With proper care, a root-treated tooth can function well for many years
• Impact on surrounding teeth — keeping a natural tooth in place helps maintain the alignment and function of neighbouring teeth, whereas a gap may lead to gradual changes in bite and spacing

Both options can lead to good outcomes when chosen appropriately. The key is making an informed decision based on the specific condition of the tooth and your broader oral health.

Cost and Treatment Planning Considerations

Cost is a practical factor that many patients consider when choosing between treatments. It is important to think about both the immediate and longer-term financial picture:

• Immediate costs — the upfront cost of root canal treatment, including a crown, may be higher than a straightforward extraction
• Long-term costs after extraction — if a replacement tooth is needed, the combined cost of extraction plus an implant, bridge, or denture can be considerable
• Personal priorities — some patients prioritise preserving their natural tooth, while others may prefer a different approach based on their circumstances

Your dentist can outline the costs involved with each option during your consultation, helping you make a decision that works for both your oral health and your budget. You can also review the practice's fee guide for further information.

How Dentists Decide Between Root Canal and Extraction

The recommendation your dentist makes is based on a thorough assessment of several clinical factors. This is not a one-size-fits-all decision — it is tailored to your individual situation.

Factors your dentist will consider include:

• Tooth condition — how much healthy tooth structure remains, whether there are cracks or fractures, and whether the tooth can support a restoration
• Gum and bone health — the condition of the surrounding tissues plays a significant role in determining whether a tooth can be maintained long-term
• Overall oral health — the health of neighbouring teeth and the patient's general dental condition are taken into account
• Patient preferences — your priorities, concerns, and practical considerations are all part of the conversation

A good dentist will explain the reasoning behind their recommendation clearly, outline the alternatives, and support you in making an informed choice.

What Happens If a Tooth Is Extracted and Not Replaced?

After an extraction, some patients wonder whether they actually need to replace the missing tooth. While not every extraction requires an immediate replacement, leaving a gap can have consequences over time:

• Tooth movement — neighbouring teeth may gradually shift or tilt into the gap, affecting alignment
• Bite changes — an uneven bite can lead to discomfort, uneven wear on remaining teeth, or jaw tension
• Bone loss — the jawbone in the area of the missing tooth may gradually lose volume over time without the stimulation a tooth root provides

Your dentist will discuss whether replacement is recommended based on the location of the extracted tooth and how the gap may affect your oral health over time. In some cases — such as wisdom teeth — replacement is typically not needed.

Discussing Treatment Options in London

At our London practice, we believe patients should feel informed and supported when making decisions about their dental care. When it comes to choosing between root canal treatment and extraction, our approach is always assessment-led and transparent.

What you can expect:

• Honest assessment — we examine the tooth thoroughly and explain what we find in clear, straightforward terms
• Balanced recommendations — we explain the pros and cons of each option as they apply to your specific tooth and situation
• Support in decision-making — we welcome your questions and ensure you have the information you need to feel confident in your choice

If you are unsure whether a root canal or extraction is more suitable for your tooth, a consultation can help explain the options based on your individual situation.