Getting a root canal or tooth extraction are common dental procedures, but which one is better for you? Both procedures have their pros and cons, so it’s important to understand the key differences between a root canal and extraction to make an informed decision.
What is a root canal?
A root canal is a treatment used to fix and save a tooth that has become infected or decayed. During a root canal, the dentist will remove the damaged pulp tissue inside the tooth and then clean, disinfect and seal the tooth. Here is a quick overview of how a root canal works:
- The dentist will numb the area around the affected tooth and isolate the tooth with a rubber dam.
- An opening is made through the crown of the tooth into the pulp chamber.
- The pulp tissue is removed from the pulp chamber and root canals.
- The root canals are cleaned, disinfected and shaped in preparation for filling.
- The root canals are filled with a rubber-like material called gutta-percha.
- A temporary or permanent filling is placed to seal the opening.
- A crown is usually recommended to help restore full function and protect the tooth.
The goals of a root canal are to remove infection and inflammation from inside the tooth, and then seal it to prevent further infection. This can help save a damaged tooth that might otherwise require extraction.
What is a tooth extraction?
A tooth extraction is a procedure to remove a tooth from the mouth. A dentist will recommend an extraction if a tooth is too damaged or decayed to be repaired with other treatments. Some reasons for tooth extractions include:
- Severe tooth decay
- Advanced periodontal disease
- Injury or trauma that fractures the tooth
- Needed to make space for orthodontic treatment
- Supernumerary or impacted teeth that need removal
There are two main types of extractions – a simple extraction for teeth visible in the mouth, or a surgical extraction for impacted or broken down teeth. The steps involve numbing the area, removing the tooth, and closing the socket where the tooth was removed.
Key differences between root canals and extractions
When deciding between a root canal and extraction, there are a few key factors to consider:
| Factor | Root Canal | Tooth Extraction |
|---|---|---|
| Goal of procedure | Save and restore the natural tooth | Remove the entire tooth |
| Success rate | 85-95% success rate long-term | Extraction is 100% effective at removing the tooth |
| Procedural pain | Minor to moderate pain during procedure | Varies, moderate to severe pain is possible |
| Recovery time | Little downtime, resume normal activity next day | Up to 1 week of swelling and healing |
| Cost | Around $1000-$1500 per root canal | $75-$300 per simple extraction |
As you can see, the main advantage of a root canal is preserving your natural tooth structure and function. However, root canals take more time, cost more, and have a risk of failure. Extractions provide a quick and definitive solution, but you lose the tooth completely.
When is a root canal the better choice?
There are several situations where a root canal may be recommended over extraction:
- Front teeth – Root canals are strongly preferred for visible front teeth for cosmetic reasons.
- Restorable tooth – If the tooth can be restored with a root canal and crown, this is generally better than losing the tooth.
- Adjacent teeth – Extracting one tooth can increase risk of problems with neighboring teeth. A root canal helps preserve bone.
- Crucial tooth – Sometimes a molar or premolar plays an important role in chewing or bite function, making a root canal advised.
- Young patients – For children and teenagers, keeping natural teeth as long as possible is ideal.
- Multiple extractions – If more than one tooth needs removal, saving one with a root canal may be better.
Factors like the location of the tooth, your symptoms, age, and oral health status all play a role in determining if a root canal is the right choice.
When is extraction the better option?
There are also instances where an extraction may be the better course of treatment:
- Advanced infection – If the tooth is severely infected, an extraction may be necessary.
- Decay under crown – It may not be worth doing a root canal on a tooth with decay extending under an existing crown.
- Periodontal disease – Teeth with advanced gum disease may be better extracted.
- Fractured tooth – If the tooth is cracked below the gumline, extraction is often the only option.
- Other infections – Some dental infections like an abscess may be treated with extraction.
- Failed root canal – If a root canal has already failed, an extraction may be the next step.
Extractions are typically faster, simpler and less expensive than root canals. For teeth that are unrestorable or badly damaged already, extraction is usually the most reasonable option.
Root canal vs extraction: Success rates
Root canal success rates are generally high – around 85-95% based on long-term studies. However, there are some instances where root canals fail over time:
- Re-infection of the tooth can occur in about 5-15% of root canal cases.
- The tooth becomes cracked or fractured.
- There are complications with the root canal procedure.
- Decay under a crown causes failure.
- Other restorative treatments like crowns fail.
With extraction, there is no chance of failure – once the tooth is removed, it is definitively gone. However, extraction comes with its own risks during healing such as:
- Dry socket (severe pain from exposed bone)
- Infection at the site
- Accidental damage to neighboring teeth
- Sinus involvement with upper teeth
While extractions are simple in nature, complications can arise in a small number of cases. Root canals offer a good chance of long-term success when performed properly and cared for after.
Cost comparison: Root canals vs extractions
The costs for root canals versus extractions can vary significantly. Some general estimates include:
| Procedure | Estimated Cost Range |
|---|---|
| Root Canal (front tooth) | $700 – $1500 |
| Root Canal (back molar) | $900 – $2000 |
| Simple Tooth Extraction | $75 – $300 per tooth |
| Surgical Extraction | $150 – $650 per tooth |
As shown above, root canals typically cost more than extractions on a per tooth basis. However, a root canal allows you to keep your natural tooth. Lost teeth often require replacement with bridges, implants or dentures, which have their own costs and maintenance.
Recovery: Root canal vs extraction
The recovery time for each procedure differs as well:
- Root canal – Most people can resume regular activity the next day. Mild to moderate pain and some medication is common for a few days. Complete healing takes 1-2 weeks.
- Extraction – The extraction site will feel sore for several days afterward. Significant swelling and up to a week of pain, medication use and soft diet may be needed. Full healing takes approximately 1 month.
Because extractions are more invasive, they come with more postoperative discomfort and slower recovery than root canals. However, root canal symptoms from the original tooth infection can take a few weeks to fully resolve.
Procedural pain: Root canal vs extraction
The amount of pain felt during the procedure also differs between root canals and extractions:
- Root canal – The procedure itself is usually not highly painful thanks to local anesthesia. Mild to moderate discomfort is possible during the appointment.
- Extraction – Simple extractions may only cause minor pain. Surgical extractions can cause moderate to severe pain during the procedure if anesthesia is insufficient.
Root canals tend to be less painful during the actual appointment since teeth are numbed very effectively. Extractions sometimes fail to be fully numb, making the procedure more uncomfortable.
Long-term effects: Root canal vs extraction
Over the long-term, both procedures come with some potential consequences:
- Root canal – Teeth may become brittle and prone to fracture. Re-treatment may be needed if infections recur.
- Extraction – Facial structure changes slightly over time. Nearby teeth may shift or develop problems.
Root canals aim to let you keep your natural tooth, but teeth may become weaker and issues can arise years later. Extractions lead to permanent tooth loss and changes to the bite and smile.
Conclusions
Deciding between a root canal and tooth extraction depends on many individual factors. For savable teeth, root canals are usually preferable. But in cases of untreatable decay, fractures below the gum, or advanced periodontal disease, extraction may be the only option. Have an honest discussion with your dentist about the pros and cons for your particular situation.