Root Canal Treatment vs Extraction — Understanding Your Choice
When a tooth is badly infected or damaged at the root, you may need to choose between root canal treatment and having the tooth out. This guide explains both honestly. It covers what each involves, the costs and the long-term effects.
Why you may be facing this choice
Inside the root of each tooth is soft tissue called the pulp. It holds nerves and blood vessels. If the pulp becomes infected or damaged for good, the tooth cannot heal by itself. This usually happens because of deep decay, a cracked tooth or an injury.
At this point, you usually have two main choices:
- Root canal treatment (RCT). The infected pulp is cleaned out. The root canals are disinfected and sealed, so the tooth can stay in your mouth.
- Extraction. The tooth is taken out. If you want, it can then be replaced with an implant, bridge or denture.
Both are valid choices. The right one depends on the state of the tooth, the health of your mouth, what you prefer, and sometimes cost. This leaflet explains both fairly. It can help you decide with your dental team.
Option 1 — Root canal treatment (RCT)
Root canal treatment removes the infected or inflamed pulp from inside the roots. The canals are disinfected and filled with a rubber-like material to seal them. Then the tooth is repaired, usually with a filling. Back teeth usually also get a crown. This lets the tooth keep working as normal.
What to expect during treatment:
- You have a numbing injection (local anaesthetic), so you should not feel pain during treatment
- A rubber sheet (dental dam) is placed around the tooth to keep it clean and dry
- Fine tools are used to clean and shape each root canal
- The canals are filled and sealed
- A crown or large filling is placed at a later visit
- Most cases take 1–3 visits, depending on how complex they are. Cases seen by a specialist may take longer.
Good points:
- You keep your natural tooth. In general, keeping a tooth is better than losing one.
- You avoid a gap and the need for a false tooth (implant, bridge or denture)
- Keeps the bone around the tooth root
- A tooth that is treated well can last many years, and sometimes for life
- Clears the infection and eases pain
Downsides and risks:
- More complex than an extraction, and often needs more visits
- Costs more at the start. On the NHS, root canal treatment is part of the Band 2 charge (England: £76.60). If you also need a crown, the course is charged at Band 3 (England: £332.10). Some complex cases are sent to a specialist. Privately, it usually costs £500–£1,500. This depends on the tooth and on whether you need a specialist (endodontist). Your treatment plan will confirm your exact cost. Fees vary between practices and depend on how complex your case is.
- A crown is usually needed after root canal treatment on back teeth. This adds to the cost.
- Success is not guaranteed. Overall, about 85–95% of treatments work over 5 years. But some teeth may get infected again or fail.
- A treated tooth can become more brittle over time. It is more likely to break without a crown.
- Some roots have a complex shape, and full cleaning may not be possible
- If the treatment fails, you may need it done again, or a small operation at the root tip (apicectomy). In the end, the tooth may need to come out.
How long it lasts: A root-treated tooth that is well repaired can last 10–20 years or more. Many last for life. Results depend a lot on the quality of the final crown and on how well you clean your teeth.
Option 2 — Extraction
Extraction means taking the whole tooth out. For most teeth with one root, this is a simple procedure. It is done with a numbing injection (local anaesthetic) in one visit. Back teeth with several roots, or teeth with curved roots, may be harder to take out.
What to expect:
- The numbing injection numbs the area. You will feel pressure, but you should not feel sharp pain.
- The dentist loosens the tooth and takes it out
- You bite on gauze to help a blood clot form
- The gum over the socket heals in about 1–2 weeks. The bone underneath takes several months.
Good points:
- Deals with the problem tooth for good in one visit
- Often costs less at the start: NHS Band 2 in England (£76.60). Privately, it is around £200–£400 for a simple extraction, or £300–£500 for a surgical extraction. Your treatment plan will confirm your exact cost. Fees vary between practices and depend on how complex your case is.
- That tooth cannot get infected again
- The right choice when a tooth is too damaged or broken down, or is very unlikely to last
Downsides and risks:
- You lose a natural tooth. This is permanent and cannot be undone.
- Over time, the gap can let nearby teeth drift. The tooth opposite can grow too far into the gap (over-erupt).
- The jawbone starts to shrink (resorb) where the tooth was. Over many years, this can change the shape of your face.
- Replacing the tooth costs more overall and takes longer. This is especially true for an implant (usually £2,500–£4,000).
- Some people choose not to replace the tooth. This is fine for some teeth. It is not advised for front teeth, or for teeth that matter for chewing.
- Risks after an extraction include dry socket. This is painful, slow healing. It happens in about 1 in 20 cases. It is more common with lower back teeth and in smokers. Other risks are infection, swelling and a stiff jaw for a short time.
How long it lasts: An extraction solves the problem for good. But think about the long-term effects of losing the tooth, and the cost of any replacement.
Is keeping the natural tooth always better?
Dentists usually prefer to keep natural teeth where they can. A healthy natural tooth is usually stronger, more comfortable and longer-lasting than any false tooth. Professional guidelines support this.
But this is not always the right answer. Sometimes taking the tooth out and replacing it is the wiser long-term choice. For example:
- The tooth is so badly damaged that root canal treatment has a very low chance of working
- Gum disease has caused a lot of bone loss around the root
- The root has split down its length (vertical root fracture). This cannot be treated successfully.
- Saving the tooth would cost far more, and be far more complex, than taking it out and replacing it
- The overall health of your mouth means a nearby implant or bridge would be a more reliable long-term answer
Your dental team should tell you honestly how likely the tooth is to last before they advise root canal treatment. It is fine to ask: "What are the real chances this tooth will still be working well in 10 years?"
What affects the success of root canal treatment?
Research shows that some things make root canal treatment more or less likely to work:
- Better results are linked to: a tooth whose nerve is still alive (a vital tooth); no infection at the root tip (periapical infection) on the X-ray before treatment; a good crown at the end; treatment done to a high standard; and good cleaning at home
- Worse results are linked to: an infection at the root tip that is already there (periapical infection or abscess); a root canal that has failed before (re-treatment); roots with a complex shape; a poor final repair; cracks that reach into the root; and smoking
Your dental team or a specialist (endodontist) can tell you how likely treatment is to work for your tooth. Do ask for this before you decide.
Questions to ask your dental team
Before you decide, think about asking:
- How likely is root canal treatment to work for this tooth?
- How many root canals does this tooth have? Is it simple or complex?
- Would you send me to a specialist (endodontist), or would you do the treatment?
- If root canal treatment fails, what are my options then?
- If I have the tooth out, how would you advise replacing it?
- What happens if I have the tooth out and do not replace it?
- What is the full cost of each option, including the crown after root canal treatment?
- Does the tooth have any cracks that might affect how long it lasts?
NHS charges are set nationally and reviewed each April. Any NHS charge shown here is the England charge from 1 April 2026. Charges differ in Scotland, Wales and Northern Ireland. Private fees are a guide. Your dental team will confirm the exact cost on your treatment plan before you agree to go ahead. NHS availability varies by area. Not all treatments are available on the NHS. Your dental team will talk with you about the best option for your case.
This leaflet is for general information only and does not replace professional dental advice. It is intended to support — not replace — the discussion with your dental team about your individual options, risks, and treatment plan. Your dental team will confirm what is suitable for your specific circumstances before you agree to any treatment.
Sources
- A guide to Good Endodontic Practice, 1st edition. British Endodontic Society, 2022.
- Root canal treatment. NHS website (nhs.uk), reviewed October 2025.
- Dental treatments. NHS website (nhs.uk), reviewed July 2026.
Links checked 18 October 2026.
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