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Updated on November 3, 2022

Root Canal vs. Tooth Extraction

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What’s the Difference Between a Root Canal and Tooth Extraction?

If you're experiencing tooth pain, you may need a root canal or tooth extraction. These common dental procedures can alleviate pain but differ in purpose and outcome. 

Dentists typically recommend root canals when the tissue inside a tooth becomes infected or inflamed. This tissue (pulp) contains nerves and blood vessels and extends from the tooth’s crown to the end of the root beneath the gum line. When damaged, pain and infection can occur. 

Root Canal vs. Tooth Extraction

Root canals involve removing the damaged tissue and cleaning the affected tooth's pulp canal(s). The dentist then fills it with a rubber-like material to seal and protect the tooth. In most cases, a root canal can save a tooth that would otherwise need to be extracted.1

Tooth extractions, or pulling a tooth, are typically reserved for teeth that are too damaged or decayed to be saved by a root canal. Dentists also commonly remove impacted wisdom teeth. The procedure involves numbing the area around the tooth and removing it from its socket with forceps. 

Both root canals and extractions can be performed in a dentist's office. Some people experience mild discomfort after either procedure, but this can be alleviated with over-the-counter (OTC) pain medication.

If you're experiencing tooth pain, see your dentist. They can determine if you need a root canal, tooth extraction, or another treatment.

When Should a Tooth Be Removed?

Because tooth removal is a last resort, an endodontist may first try to save the tooth with a root canal or other procedure. However, the damage is sometimes so extensive that it's best to remove the tooth. 

Some conditions that may warrant tooth removal include:2

Dentists commonly remove impacted teeth because they can damage nearby teeth, lead to gum disease, become infected, or cause severe pain if they grow into the gum tissue.

Tooth Extraction Procedure 

First, the dentist numbs the area around the affected tooth with a local anesthetic. They then use forceps and other dental instruments to loosen and remove the tooth. 

If the tooth is severely decayed or has broken off at the gum line, they may need to make incisions in the gums to access the tooth. 

After the extraction, the dentist will clean and disinfect the socket. They may place stitches to close the extraction site. At the end, they will have you apply pressure on some gauze in your mouth to help stop any bleeding.

Expect some discomfort and swelling after the procedure. Your dentist may prescribe pain medication or suggest over-the-counter (OTC) options to ease the pain. 

Benefits

Tooth removal may be the best option for your oral health. Benefits of the procedure include:3

  • Relieves pain — if a tooth is severely decayed or impacted, removing it can provide relief.
  • Stops the spread of infection — infected teeth can spread bacteria to adjacent teeth and parts of your body, causing serious health problems.
  • Helps oral function — crowded teeth make it difficult to chew and speak properly. Removing them can improve your ability to eat and communicate.
  • Improves esthetics — decayed teeth affect your smile. Removing them can improve cosmetics. 

Side Effects and Risks 

Tooth removal is a relatively safe procedure with few risks besides light bleeding. However, as with any surgery, there are potential complications, including:4 

  • Pain and swelling — expect discomfort after the procedure, but you should be able to manage it with pain medication.
  • Infection — there is a small risk of infection after tooth removal. Signs include redness, swelling, pain, and pus.
  • Nerve or tooth damage — the dentist could damage a nearby tooth or nerve while removing the tooth.
  • Dry socket — this happens when the blood clot that forms after an extraction is dislodged accidentally. Activities like smoking, using a straw, or rough brushing or rinsing can lead to a dry socket.

Aftercare and Recovery 

After tooth extraction, follow your dentist’s care instructions, which might include:5

  • Avoiding mouthwash, hot food and drinks, and strenuous activity for the first 24 hours
  • Gently rinsing your mouth with warm salt water at least 3 times daily after the first 24 hours
  • Brushing your teeth carefully to avoid dislodging the blood clot in the tooth socket
  • Taking pain medication if needed
  • Using a cold compress to ease swelling
  • Eating soft foods for a few days
  • Avoiding smoking and using straws
  • Contacting your dentist if pain or swelling worsens

Cost

The cost of a tooth extraction varies. A simple extraction without insurance costs around $75 to $250 per tooth. But if you need a surgical wisdom tooth extraction, it can cost $300 or more.

When Can a Tooth Be Saved?

A tooth can be saved if there is enough solid tooth structure remaining. If the tooth is broken at the gum line or has a large cavity that reaches the bone, this is unlikely.

Warning signs the tooth isn't salvageable include:6

  • It's very loose
  • It's broken off below the gum line
  • There's a dental abscess
  • The tooth has already had more than one root canal procedure

If the infection has caused too much decay and weakening, the exterior may not be strong enough to save with a root canal. In this case, your dentist will extract the tooth. 

Root Canal Procedure 

For a root canal, you'll receive a local anesthetic to numb the area. Then, your endodontist will use dental instruments to create an opening in the tooth to access the pulp chamber and remove the infected pulp. 

Next, they will clean and disinfect the pulp chamber and root canal and fill the space with a rubber-like material called gutta-percha. A temporary filling seals the tooth and prevents bacteria from entering. 

Most people need a dental crown to protect the treated tooth and restore its normal function and appearance. Because the crown is custom-made, you'll need to wait around 2 weeks for its fabrication. When ready, your dentist will cement the permanent crown onto the tooth.7

Benefits

Root canal therapy has several benefits, including:7

  • Preventing infection from spreading to other teeth
  • Relieving the symptoms of an infected tooth
  • Reducing the risk of jawbone damage from an infection 
  • Eliminating the need for tooth extractions

Side Effects and Risks 

There are potential side effects and risks to a root canal treatment. In some cases, root canal therapy can fail, leading to the following symptoms:7

  • Pain
  • Swelling
  • Pus
  • Tooth discoloration
  • Gum abscess
  • Sinus problems

Aftercare and Recovery 

Following a root canal treatment, it's important to keep the area clean. Maintain good oral hygiene with regular brushing, flossing, and using an antibacterial mouthwash. If your dentist prescribed antibiotics, take them as instructed. 

Eat soft foods like pasta, mashed fruit, and yogurt for the first few days. Then, gradually introduce solid food as the discomfort eases.

It's also best not to bite or chew with the treated tooth until the permanent dental restoration is in position.

Cost

Root canal cost starts at around $600 for a front tooth and up to $1,500 for a molar without insurance. The cost with insurance varies according to your policy and coverage. 

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Which Procedure is Right for You?

The best way to determine if an extraction or root canal therapy is right for you is to schedule an appointment with your dentist. They can evaluate the severity of the problem and make a recommendation. 

Root canal therapy is the preferred way to treat an infected tooth. But, if the tooth has suffered extreme damage, an extraction may be best. Also, an extraction may be the only way to correct the problem in cases of crowding and impaction. 

When deciding between the procedures, consider the pros and cons, like cost, recovery time, and long-term effects on oral health.

Summary

A root canal is an endodontic treatment to repair and save a tooth that's badly decayed or infected. It involves removing damaged tissue, cleaning, and filling the tooth. Often times, you'll then have a crown placed. 

Tooth extraction is a last resort when a tooth is too damaged to be saved. It involves removing the tooth from its socket in the jawbone.

Both procedures have risks and side effects. The best way to determine the right option is to consult your dentist.

7 Sources Cited
Last updated on November 3, 2022
All NewMouth content is medically reviewed and fact-checked by a licensed dentist or orthodontist to ensure the information is factual, current, and relevant.

We have strict sourcing guidelines and only cite from current scientific research, such as scholarly articles, dentistry textbooks, government agencies, and medical journals. This also includes information provided by the American Dental Association (ADA), the American Association of Orthodontics (AAO), and the American Academy of Pediatrics (AAP).
  1. AlRahabi, M. K. “Evaluation of complications of root canal treatment performed by undergraduate dental students.”  Libyan Journal of Medicine. 2017.
  2. Tooth Extraction.” Cleveland Clinic. 
  3. 4 Benefits of Tooth Extraction That You Might Not Expect.” South Florida Oral & Maxillofacial Surgery. 2022.
  4. 4 Potential Complications of Extractions and How to Avoid Them.” Rabel Family Dentistry. 2019. 
  5. Your guide to having teeth removed.” National Health Service.
  6. Carlile, Dr. “Save or Extract a Problem Tooth.” Eleven Eleven Dental. 2020.
  7. Root Canal.” Cleveland Clinic. 
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