When the nerve inside a tooth becomes badly inflamed or infected, there are usually two main options: root canal treatment to save the tooth, or removing it. Both are common, and both can be the right choice in different situations. This guide explains how they compare so you can talk it through with your dentist.
Why a tooth might need either treatment
Inside every tooth is the pulp, a soft tissue containing nerves and blood vessels. Deep decay, a crack, a large filling or an injury can let bacteria reach the pulp. The pulp can become inflamed (pulpitis) or die and become infected, sometimes forming an abscess at the tip of the root. Signs include lingering pain with hot or cold, throbbing toothache, pain when biting, swelling or a pimple on the gum. Sometimes there are no symptoms at all and the problem shows up on an x-ray.
An infected pulp doesn’t heal on its own. Antibiotics may help settle a spreading infection, but they don’t fix the source. The infected tissue has to be removed, either by cleaning out the inside of the tooth or by removing the tooth.
What root canal treatment involves
Root canal treatment removes the infected or inflamed pulp, cleans and shapes the canals inside the roots, disinfects them and seals them. It’s usually done under local anaesthetic over one to three visits. Afterwards, the tooth needs a strong final restoration. Back teeth in particular often need a crown, because a root-treated tooth can become brittle and more likely to crack. Read more about root canal therapy.
What an extraction involves
An extraction removes the whole tooth under local anaesthetic. Many extractions are straightforward; others, such as broken teeth or those with curved roots, may need the tooth to be divided or a small amount of bone removed. The socket then heals over several weeks. Read about tooth extraction.
The case for saving the tooth
- You keep your natural tooth, including its root, which helps preserve the jawbone around it.
- Neighbouring teeth stay put. When a tooth is removed, nearby teeth can drift or tilt into the gap, and the opposing tooth can over-erupt, changing your bite.
- Chewing feels natural, because the tooth’s own ligament stays in place.
- It may cost less long term than extracting and then replacing the tooth with an implant or bridge.
When extraction may make more sense
- The tooth is cracked through the root, or broken below the gum, so it can’t be restored.
- There isn’t enough healthy tooth left to hold a crown.
- Severe gum disease has destroyed much of the supporting bone.
- It’s a wisdom tooth or another tooth that isn’t needed for chewing or appearance.
- Root canal treatment has already been tried and failed, and retreatment isn’t feasible.
What happens after an extraction?
Leaving a gap is an option for some back teeth, but many people choose to replace the tooth. The main replacement options are:
- Dental implant: a titanium post in the bone with a crown on top. See dental implants.
- Bridge: a false tooth held by crowns on the neighbouring teeth. See dental bridges.
- Partial denture: a removable plate with one or more false teeth.
Each of these adds time and cost, which is worth factoring in when comparing extraction with root canal treatment.
Comparing costs
At Parramatta Dentistry, root canal treatment ranges from $800 to $2,000, depending on the number of roots in the tooth. That price doesn’t include the final crown or filling. Tooth extractions range from $200 to $600. Root canal treatment plus a crown usually costs more than a simple extraction on the day. But if you plan to replace the tooth afterwards, an extraction plus an implant or bridge may cost more overall. As a guide, crowns at Parramatta Dentistry start from $1,800 and a simple single implant in a back tooth, without bone grafting, starts from $4,500. Your dentist will give you a written quote for each option. Conditions apply.
Success and risks
Root canal treatment has a high success rate when the tooth is well restored afterwards, but it isn’t guaranteed. Some teeth develop new infection, which may need retreatment, a minor surgical procedure at the root tip, or extraction. Root-treated teeth can also fracture. Extractions carry risks such as bleeding, infection, dry socket and, for lower back teeth, nerve injury. Your dentist will explain the risks that apply to your tooth.
Questions to ask your dentist
- How likely is root canal treatment to succeed on this tooth?
- Will it need a crown afterwards, and what will the total cost be?
- If I have it removed, what are my options for replacing it?
- What happens if I do nothing for now?
If you have toothache or swelling now, see our emergency dentist page.
Frequently asked questions
Is root canal treatment painful?
Root canal treatment is done under local anaesthetic and, for most people, feels similar to having a filling. The tooth may be tender for a few days afterwards. Often, the treatment relieves the pain caused by the infection.
Can I just take antibiotics instead?
Antibiotics may help control spreading infection, but they don’t remove the source of infection inside the tooth. Without root canal treatment or extraction, the infection is likely to return.
How long does a root-treated tooth last?
A well-restored root-treated tooth can last many years. Placing a crown on back teeth after root canal treatment helps protect them from cracking.
What happens if I leave an infected tooth?
Infection can spread, causing swelling, pain and, rarely, serious illness. The tooth may also break down further, making it harder to save. If you have swelling that affects breathing or swallowing, go to an emergency department or call 000.
Will removing a back tooth affect my bite?
It can. Neighbouring teeth may drift into the gap and the opposing tooth may over-erupt, which can change how your teeth meet. Your dentist will discuss whether to replace the tooth.
Can a failed root canal be redone?
Sometimes. Retreatment cleans and reseals the canals again. In some cases a small surgical procedure at the root tip is an option. If neither is suitable, extraction may be recommended.
Book at Parramatta Dentistry
Parramatta Dentistry is at Suite 25, Level 3, 27 Hunter Street, Parramatta, a short walk from Parramatta Station. We’re open Monday to Friday, 9am to 6pm, and HICAPS is on site, so you can claim from your health fund on the day and pay only the gap, if there is one. Call (02) 8090 1109 or book online.
This article is general information only and isn’t a substitute for personalised advice from your dentist. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.