When a tooth is infected, severely decayed, or traumatized, the decision often comes down to two options: save it with a root canal, or remove it with an extraction. Both are valid treatments—but they're not interchangeable. The right choice depends on the condition of the tooth, your overall oral health, and your long-term goals. Here's what you need to know to have an informed conversation with your dentist.
What Is a Root Canal?
A root canal removes the infected or damaged pulp (the soft tissue inside the tooth containing nerves and blood vessels) while preserving the tooth itself. The canals are cleaned, disinfected, and sealed. A crown is typically placed on top to protect and restore function. The result? You keep your natural tooth—and with proper care, it can last a lifetime.
What Is an Extraction?
An extraction removes the entire tooth from its socket. It's often recommended when a tooth is too damaged to save, when infection is too severe, or when saving the tooth isn't feasible. After extraction, the gap can be left as is (not ideal for function or appearance), or replaced with an implant, bridge, or partial denture.
When a Root Canal Is Usually Better
In general, saving your natural tooth is preferred when possible. Natural teeth:
- Preserve your bite and chewing function
- Maintain the bone and gum structure around them
- Don't require replacement hardware
- Often feel more natural than artificial options
Root canals have a high success rate—typically 90% or more—and when combined with a crown, the tooth can function normally for decades. If your dentist determines the tooth can be saved, a root canal is usually the first choice.
When Extraction May Be the Right Choice
Extraction may be recommended when:
- The tooth is too severely damaged or fractured to support a restoration
- A previous root canal has failed and retreatment isn't viable
- There's insufficient bone support around the tooth
- The tooth is severely loose due to advanced gum disease
- Cost or timing factors make extraction more practical (though this should be weighed against long-term implications)
Extraction is a legitimate solution—but it creates a gap that may need to be addressed. An implant, bridge, or denture adds cost and complexity. It's important to factor that into your decision.
The Long-Term Picture
Choosing extraction without a replacement plan can lead to:
- Shifting of adjacent teeth
- Bone loss in the jaw
- Changes in bite and chewing ability
- Aesthetic concerns, especially for visible teeth
If extraction is necessary, discuss replacement options with your dentist. An implant, for example, can restore function and prevent bone loss—but it requires a separate procedure and healing time.
How to Decide
The best approach is to get a thorough evaluation. Your dentist will assess the tooth's condition, the extent of damage or infection, and your overall oral health. Together, you can weigh the pros and cons and choose the option that makes the most sense for your situation. The goal is always the same: a healthy mouth, a functional bite, and a plan you can live with for years to come.