The short answer
If the tooth can be saved and is worth saving, save it — a root canal preserves your bite, bone and chewing power, and usually wins the ten-year math. Extraction is right when the tooth is truly unrestorable — and when it is, plan the replacement before you pull.
The Fork in the Road
Deep decay or a crack has reached the nerve. The tooth is infected, probably aching, and patching is no longer on the menu. Two roads remain: root canal therapy — clean out the infection, seal the canals, usually crown the tooth — or extraction — remove it, and ideally replace it.
The Case for Saving the Tooth
Nothing dentistry makes is as good as the tooth you grew. A root-canaled tooth keeps its root in the bone (which keeps the bone), keeps its position in the bite (which keeps neighbours honest), and chews like a tooth. Success rates for root canal therapy run around 90%+, and a crowned, root-canaled molar routinely serves for decades.
The 10-year math, single back tooth:
| Path | Upfront | Likely follow-on | 10-year total |
|---|---|---|---|
| Root canal + crown | ~$2,300–$3,500 | usually nothing | ~$2,300–$3,500 |
| Extraction + implant | ~$300–$600 + $3,000–$6,000 | usually nothing | ~$3,300–$6,600 |
| Extraction + bridge | ~$300–$600 + $2,500–$4,500 | bridge renewal eventually | ~$2,800–$5,100+ |
| Extraction + nothing | ~$300–$600 | drifting, bite issues, harder future implant | unpredictable — often the most |
The Case for Extraction
Some teeth are past saving, and heroic dentistry on a doomed tooth wastes your money:
- Vertical root fractures — split roots can't be sealed
- Decay below bone level — nothing left to rebuild on
- Severe bone loss from gum disease — a root canal can't fix a loose foundation
- Failed prior root canal where retreatment odds are poor
- Honest budget reality — extraction now with a planned implant later can be a legitimate sequence; we'd rather you lose the tooth safely than delay in pain
When extraction wins, decide the replacement before the appointment — a socket graft at extraction time keeps the bone ready for an implant and costs far less than rebuilding bone later.
Questions to Ask (Us or Any Dentist)
- What are this tooth's odds if we save it — not root canals in general?
- How much tooth remains for the crown to hold?
- What's the total both ways, including the replacement?
- What happens if I do nothing for six months? (Honest answer: usually the decision gets made for you, painfully.)
We answer these with the x-ray on the screen and real numbers on paper — and if you're facing this decision on a tooth right now, don't sit on it. Infected teeth escalate on their own schedule, not yours. Same-day assessments: (613) 491-3300 or book online.