Root canal vs. extraction

Usually, but not always. Keeping a natural root preserves bone, avoids a prosthesis and keeps future options open, so a restorable tooth with a reasonable prognosis is generally worth treating. It stops being the better choice when the tooth is not restorable, when there is a vertical root fracture, when periodontal support is severely compromised, or when repeated treatment would simply postpone an inevitable extraction at significant cost. The judgment is about the specific tooth, not a general principle.

Root canal treatment plus the crown that usually follows is typically less than extraction plus implant plus crown, but the comparison should include the whole path, not the headline procedure. Extraction alone is the cheapest option on the day. The cost arrives later with the replacement, or is deferred indefinitely if you choose not to replace. Use your actual quotes for both complete pathways instead of comparing a root canal fee against an implant fee.

It depends on how much sound tooth remains above the bone, whether there is enough structure for a restoration to grip, whether a crack extends below the gum, and how much periodontal support is left. This is a clinical assessment made with examination and radiographs, sometimes after removing an existing restoration to see what is underneath. It is a fair and important question to ask explicitly before agreeing to root canal treatment, because the answer determines whether the treatment is worthwhile.

If the tooth has not been assessed for restorability, or if root canal treatment was not discussed as an alternative, then yes. That is not an accusation of bad faith, extraction and implant is sometimes clearly the right plan, but it is a more expensive pathway, and the comparison deserves to be explicit. A second opinion from someone who would not be doing the implant work is a proportionate step for an irreversible decision.

Options then include retreatment, surgery at the root tip, or extraction and replacement. Late failure is usually caused by bacteria re-entering through a leaking restoration, by canal anatomy that could not be fully cleaned, or by a fracture. Importantly, having had root canal treatment does not remove the extraction option: it defers it. This asymmetry is part of why treating first is often reasonable where the prognosis is decent: it keeps the more drastic option available.

For some teeth, yes: a rear molar with a stable bite and no over-eruption of the opposing tooth may need nothing. What tends to happen over time is drift, over-eruption, bite change and cleaning difficulty, though the degree varies considerably by tooth and individual. The important thing is that it is a decision made with information and monitored, instead of a default. Discuss it before the extraction, since socket preservation is only possible at that appointment.

Both are performed under local anesthetic, so neither should be painful during the procedure itself. Post-procedure discomfort differs by case, not by which was chosen. A heavily infected tooth can be uncomfortable to treat or remove either way, and recovery experience depends more on the individual case's complexity than on the choice between the two procedures.

Many general dentists perform root canal treatment routinely and well. Referral to an endodontist tends to reflect complex canal anatomy, previous treatment needing redoing, or persistent difficulty instead of a rule that all root canals need a specialist: ask how often your general dentist performs the procedure and their threshold for referring.

The ridge continues to resorb over time without a root to maintain it, which can reduce future options: narrowing bone available for a later implant, for instance. This does not mean replacement must happen immediately, but a long, indefinite delay narrows what is achievable later more than a short, monitored one.

Both are typically covered as basic or major services depending on the plan, but the total claim differs because root canal treatment is usually followed by a separately billed crown, while extraction may be followed by a separately billed replacement or nothing at all. Compare the complete insured cost of each pathway, not just the immediate procedure fee.

Not always: some cracks are only fully visible once old fillings are removed or during treatment itself, and a crack's exact extent can be genuinely uncertain beforehand. This uncertainty is a legitimate reason a prognosis is sometimes stated as a probability instead of a certainty.

For some borderline teeth, yes, and the honest position is that the certainty of outcome differs by case. A tooth with clearly favorable anatomy has a much more confident prognosis either way than one with genuinely uncertain restorability.