When severe tooth pain or infection strikes, knowing whether to save the tooth or have it removed is one of the most important decisions you can make for your long-term oral health.
A persistent toothache, swelling, or sensitivity to hot and cold can be deeply unsettling — and the fear of the unknown often makes it worse. The two most common treatments your dentist may discuss are root canal treatment (which aims to save the tooth) and extraction (which removes it entirely).
Both options can relieve pain and resolve infection, but they differ significantly in terms of long-term outcomes, recovery, and cost. This guide compares them side by side so you can approach your appointment feeling informed and confident.
The right treatment always depends on individual clinical assessment. The information below is for general guidance only.
Procedure purpose
Root Canal
Save the natural tooth by removing infected pulp tissue
Extraction
Remove the tooth entirely when it cannot be saved
Treatment time
Root Canal
Typically 60–90 minutes per session (may require 1–2 visits)
Extraction
Usually 20–45 minutes for a straightforward removal
Pain management
Root Canal
Performed under local anaesthetic — typically minimal discomfort during treatment
Extraction
Performed under local anaesthetic; sedation available for complex cases
Longevity
Root Canal
A well-treated tooth can last many years, often decades, with proper care
Extraction
Permanent removal — replacement options required for long-term function
Impact on surrounding teeth
Root Canal
None — the natural tooth root maintains jaw structure and alignment
Extraction
Adjacent teeth may drift over time if the gap is left unrestored
Aesthetics
Root Canal
Natural tooth preserved; crowned if necessary for a seamless appearance
Extraction
Visible gap unless replaced with an implant, bridge, or denture
Indicative cost (UK)
Root Canal
From approximately £450–£900*
Extraction
From approximately £150–£350* (replacement adds further cost)
Recovery time
Root Canal
Mild tenderness for a few days; normal function resumes quickly
Extraction
Soft-tissue healing 1–2 weeks; bone remodelling takes several months
*Indicative prices for private treatment. Final costs depend on clinical findings. See our full treatment fees.
Root canal treatment — sometimes called endodontic therapy — is a procedure designed to save a tooth that has become infected or badly decayed. The dentist removes the damaged pulp (the soft tissue inside the tooth containing nerves and blood vessels), cleans and shapes the root canals, and seals them to prevent reinfection.
The goal is straightforward: preserve your natural tooth so it continues to function normally within your bite, avoiding the need for extraction and subsequent replacement.
Root canal treatment is generally recommended when the tooth has enough healthy structure remaining, the infection is contained within the pulp, and the roots are intact. It is often the treatment of choice for teeth that are important for chewing or visible when you smile.
Tooth extraction is the complete removal of a tooth from its socket. It is typically considered when the tooth is too damaged, decayed, or infected to be saved, or when keeping it poses a risk to surrounding teeth and overall oral health.
Extractions range from straightforward (simple forceps removal of a visible tooth) to surgical (where the tooth is impacted, fractured below the gumline, or otherwise complex to remove).
Patients whose teeth are beyond restoration, those with severe structural damage, or cases where keeping the tooth would compromise the health of surrounding teeth or jawbone.
The most fundamental difference: root canal treatment saves your natural tooth, while extraction removes it permanently. Preserving a natural tooth avoids the need for prosthetic replacement and maintains your jawbone density.
Root canal treatment is more intricate — cleaning, shaping, and sealing tiny canals inside the tooth requires precision and experience. Extraction is usually quicker, though surgical extractions for impacted or fractured teeth can be complex in their own right.
Root canal patients typically experience mild tenderness for a few days. Extraction recovery involves soft-tissue healing over 1–2 weeks, and full bone remodelling can take several months. Surgical extractions may involve swelling and a more gradual recovery.
A preserved tooth keeps your bite stable and your jawbone stimulated. After extraction, bone resorption begins in the empty socket, and neighbouring teeth may shift — which is why replacement is strongly recommended for most extraction sites.
Root canal treatment costs more upfront than a simple extraction. However, extraction often leads to additional costs for replacement (implant, bridge, or denture). When factoring in the total cost of care, saving the tooth can be the more cost-effective choice long term.
Advantages
Considerations
Advantages
Considerations
The hidden cost of extraction: While extraction is cheaper upfront, the total cost of care often includes a replacement tooth. A single dental implant, for example, typically costs significantly more than a root canal and crown combined. If you are weighing up costs, consider the full picture — including the long-term investment in preserving your natural tooth. View our full fee guide for a detailed breakdown.
*Prices are indicative and may vary following clinical assessment. Costs at other practices may differ.
The right treatment depends on the condition of your tooth, your overall oral health, and your priorities. Use the guidance below as a starting point — your dentist will confirm the most appropriate path after a thorough examination.
If the tooth has enough healthy structure and the infection is limited to the pulp, root canal treatment preserves your natural tooth, maintains your bite, and avoids the need for replacement.
When a tooth is fractured below the gumline, structurally unsound, or when root canal treatment has previously failed, extraction removes the problem definitively and allows planning for a suitable replacement.
Extraction has a lower upfront cost, but remember to factor in replacement options. Root canal treatment may cost more initially yet prove more economical long-term by keeping your natural tooth.
Wherever clinically possible, preserving a natural tooth is better for jawbone health, bite stability, and overall function. Your own tooth, properly treated and crowned, can be an excellent long-term investment.
Every case is different. Our experienced team will assess your tooth, explain your options clearly, and recommend the treatment that gives you the best long-term outcome — with no pressure and no jargon.
Visit us in South Kensington (open 7 days) or at our City of London clinic — no registration required.