Root Canal or Extraction? How to Decide

You’ve been told a back tooth needs a root canal, and the quote looks steep. Then someone mentions that you could just have it out for a fraction of the price. Most people stop the comparison there, and it’s the wrong place to stop. An extraction is cheaper for about a month. After that you’re living with a gap, and gaps cost money to fill. Leave it unfilled and you can end up paying in other ways.

My view is that if a dentist says the tooth can be saved with a reasonable chance of success, a root canal is usually the better deal over ten years. Below are the numbers, the survival odds and the few situations where pulling the tooth really is the smarter choice.

What each option actually involves

In a root canal (endodontic treatment), the dentist removes the infected or dead pulp from inside the tooth, cleans and shapes the canals, then seals them. You keep your own root, which stays anchored in the bone. A back tooth usually needs a crown afterwards, because a root-filled molar is brittle and tends to crack.

An extraction takes the tooth out. That’s the end of the infection, but you now have a gap. You can leave it, or fill it with an implant, a bridge or a partial denture.

People often lose sight of this in the dentist’s chair. “Extraction” is half a treatment. The quote in front of you won’t include the replacement unless you ask.

The ten-year cost, worked through

Private treatment: a lower molar

These are typical 2026 private fees outside central London. Your practice will differ, so swap in the figures from your own quote.

The “leave the gap” column looks unbeatable, and on paper it is. In practice, the tooth above a lower gap slowly over-erupts into the space and the teeth either side tip in. That makes food traps, changes your bite and can make a future implant harder or impossible without orthodontic work. Some people live happily with a missing back tooth for decades. Many don’t, and they end up paying for the implant anyway, often after paying for the grafting the original gap made necessary.

NHS treatment in England

The NHS figures make an even stronger case for saving the tooth. For 2025/26 the charges in England are:

• Band 1: £27.40 (examination, X-rays, scale and polish)
• Band 2: £75.30 (fillings, root canal treatment, extractions)
• Band 3: £326.70 (crowns, bridges, dentures, plus everything in Bands 1 and 2)

A root canal and an extraction cost exactly the same on the NHS. You pay one charge per course of treatment, so if the root canal and the crown are done in the same course, the total is £326.70, not £75.30 plus £326.70. Implants are almost never available on the NHS, so if you extract and later want an implant, you’ll be paying around £2,000–£3,000 privately.

So on the NHS, saving a molar costs £75.30 to £326.70. Extracting it and replacing it properly costs £75.30 plus several thousand pounds. If your dentist offers an NHS extraction without mentioning that root canal sits in the same band, ask why. (Charges are different in Scotland, Wales and Northern Ireland, so check your nation’s current list.)

How likely is the tooth to survive?

Price only matters if the tooth lasts. Here’s what the research broadly shows:

• Large studies put root-filled teeth at roughly 85–95% still in the mouth after 8–10 years.
• Back teeth that get a crown after root canal last far longer than those that don’t. One widely cited study found uncrowned root-filled molars were lost at about six times the rate of crowned ones. If you can’t afford the crown, the root canal may be wasted money.
• Implants do well too, at around 95% survival at ten years, but “survival” hides a lot of maintenance: screw loosening, gum inflammation around the implant (peri-implantitis) and replacement crowns.
• A tooth that’s been treated before and needs retreatment has lower odds, often quoted at 70–80%.

The tooth-specific factors matter more than the averages. Ask your dentist directly about these:

1. How much sound tooth is left above the gum? Dentists talk about a “ferrule”, a collar of healthy tooth for the crown to grip. Without it, the crown is likely to fail.
2. Is there a crack running down the root? A vertical root fracture usually means the tooth can’t be saved, whatever anyone charges you.
3. How healthy are the gums and bone around it? Advanced gum disease can doom a tooth even with a perfect root canal.
4. Is this a complex tooth? Curved or calcified canals in upper molars might be better handled by a specialist endodontist, typically £900–£1,500 per molar.

When extraction really is the right call

There are a few situations where I’d go with extraction:

• The tooth is unrestorable: too little left to crown, a split root or decay below the bone.
• It’s a wisdom tooth, or a back molar with no opposing tooth to bite against, so the gap barely matters.
• You honestly won’t fund the crown, and you’re happy to accept a gap at the very back of your mouth. Plenty of people chew comfortably without their last molar.
• Your medical situation (for example, certain heart conditions or difficulty sitting through long appointments) makes multiple long visits a real problem. Discuss this with your dentist rather than deciding alone.

If none of those apply, cost-cutting is the main argument for extraction, and the table above shows that saving doesn’t hold up over ten years.

Using ChatGPT (or Claude, Gemini, Copilot) to check your quote

AI tools are good at explaining jargon and spotting gaps in a quote. They can’t examine your mouth or read your X-rays, so treat what they say as a list of questions to bring back to your dentist, not as a second opinion. Remove your name, NHS number and date of birth before you paste anything in.

Here’s a prompt you can adapt. Paste your treatment plan where indicated:

I'm in the UK and have just received this dental treatment plan:

[paste plan, with personal details removed]

I'm deciding between root canal treatment and extraction for tooth [number, e.g. LR6].
Please:
1. Explain each line of the plan in plain English.
2. Tell me whether this is NHS or private pricing, and if NHS, which band applies.
3. List what is NOT included that I would need later (e.g. crown, replacement for the gap).
4. Build a 10-year cost comparison table for: root canal + crown, extraction + implant,
   extraction + bridge, extraction + partial denture, extraction + leaving the gap.
5. Give me 6 specific questions to ask my dentist about whether this tooth can be saved.
Do not tell me which option to choose. Flag anything in the plan that looks unusual.

A few follow-ups get good results. Try “What does LR6 mean?” (dentists number teeth by quadrant, and LR6 is the lower right first molar), “Is £1,100 for a molar root canal high for Manchester?”, and “What does ‘guarded prognosis’ mean on my plan?”. If the AI quotes a price range wildly different from your quote, ask it where the figure came from. These tools sometimes give out-of-date or American prices, so ask for UK figures explicitly.

To compare the replacement options in more depth, including bridges against dentures and how long each lasts, our treatment options compared guide sets them side by side.

Questions to put to your dentist before you sign

Take these on paper or on your phone:

• “On a scale you’re comfortable with, what’s the chance this tooth is still here in ten years if we do the root canal and crown?”
• “Is the crown included in this quote, or is it separate?”
• “If I have it out, what would you recommend to replace it, and what would that cost here?”
• “Would you refer this to an endodontist, and if not, why not?”
• (NHS patients) “Can the root canal and crown be done as one Band 3 course?”

If the answers are vague, or you’re only being offered extraction on a tooth that seems fixable, get a second opinion. Another NHS practice or a private endodontist consultation (often £100–£200) costs much less than replacing a tooth you didn’t need to lose.