Root Canal or Extraction: How to Choose

If the tooth can be saved, a root canal is usually the better choice. Your own tooth chews better than any replacement, and saving it means no gap to fill later.

An extraction makes more sense when the tooth is too broken, too loose or too infected to rebuild. Your dentist decides that with an exam and an X-ray, and you get a say in it too.

What is the difference between a root canal and an extraction?

Inside every tooth is soft tissue called the pulp, with the nerve and blood vessels. A deep cavity or a crack can let germs reach it, and then it gets infected and hurts.

A root canal cleans that infected pulp out of the inside of the tooth. Your dentist then fills and seals the space, and most back teeth get a crown on top.

An extraction takes the whole tooth out, roots and all. The infection goes with it, and you are left with a space where the tooth used to be.

When is a root canal the better choice?

A root canal works best when there is enough solid tooth left to rebuild. These are the cases where we usually lean toward saving the tooth.

• A deep cavity has reached the nerve, and the walls of the tooth are in good shape.
• An infection has formed at the tip of the root, and the bone and gums around it are healthy.
• The tooth is a front tooth, where a gap would show every time you smile.

Many people worry about the pain. A root canal is done with the tooth numb, and the visit feels a lot like getting a large filling. We wrote more on that in do root canals hurt.

When is an extraction the better choice?

Some teeth cannot be rebuilt in a way that lasts. In those cases, taking the tooth out is the kinder plan for your mouth.

• A crack goes down below the gum line and splits the root.
• So little tooth is left above the gum that a crown has nothing to grip.
• Gum disease has loosened the tooth in the bone.
• A wisdom tooth is stuck under the gum or gets infected again and again.

Sometimes a tooth that already had a root canal gets infected again. A second root canal is one choice, and pulling the tooth is another, and your dentist will show you the trade offs of each.

What happens after a root canal?

Most people feel sore for a few days, and an over the counter pain reliever is usually enough. The tooth then chews and feels like it did before.

A tooth with no pulp inside gets more brittle over time. That is why a back tooth almost always needs a crown to protect it from cracking.

What happens after an extraction?

The socket heals over a few weeks. The first three days need the most care, and we wrote a full guide to the first 72 hours after a tooth comes out.

The bigger question is the gap. Over time, the teeth next to it can tip into the space, and the bone under it can shrink.

The usual ways to replace a missing back tooth are an implant, a bridge or a partial denture. A wisdom tooth is the usual exception, since most people do fine without it.

Which one costs more?

Pulling a tooth costs less on the day. Replacing that tooth later with an implant or a bridge often costs more than saving it would have.

Ask for both plans side by side, with the full path for each one. Then you can compare the two choices with all the steps in view.

How we help you choose

We start with a digital X-ray and a close look at the tooth under our dental microscope. The microscope shows cracks that are hard to see with the eye alone.

Then we show you the images and talk through both options in plain words. You leave knowing what each choice means for that tooth five and ten years from now.

Our page on root canal in Chicago explains that visit step by step. If the tooth needs to come out, our page on tooth extraction in Chicago covers what to expect.

Tooth pain in Bucktown or Logan Square?

A tooth that throbs at night, aches with hot drinks or has a pimple on the gum near it needs a look soon. Infections do not heal on their own, even if the pain fades for a while.

Swelling that spreads toward your eye or your neck is different. Go to the emergency room for that, or if you have trouble swallowing or breathing.

For everything else, call our front desk or tap Book Now at the top of this page. We are at 1908 N Western Ave in Bucktown, near the Western Blue Line stop.