Root Canal Alternative: Endodontics vs Extraction

Unfortunately, if your dentist has advised you that root canal treatment (RCT) is necessary, there is only one other viable option. This is because no other current procedure can successfully relieve a dead or dying pulpal nerve. The only current root canal alternative is to have the tooth extracted.

It is not advisable to leave an infected tooth untreated in your mouth, as this can be a drain on your body’s immune system. It may also be a danger, with a risk of leading to severe infection. You may then  decide to have a denture, bridge or dental implant placed in order to fill the space left after an extraction.


Which is the Best Alternative? – Root Canal vs Extraction

There is no single answer to this common question. Which of the two alternative choices to opt for depends on a lot of factors.extraction-choice-rct

The choice can be a difficult one for some teeth, while for others it is a more straightforward one. You may wish to have a very bad back molar taken out rather than root treated. You will usually want to hold onto a front tooth rather than extract it. Your dentist may also give you his/her opinion on the likely success of any root treatment, based on the current state of the tooth.

Factors that might influence your decision on whether to opt for a root canal vs extraction:

  • Condition of your other teeth. If you have few or no other missing teeth, you are more likely to want to keep a tooth. Although on the other hand, if you have few remaining teeth, you might be advised to hold on to what you have left!
  • Having a denture. If you already have a denture, you may prefer to have the tooth taken out and added to it. Bear in mind that another tooth extraction may make your denture less stable and sometimes can have a really bad effect on its retention.
  • Cost. On the face of it, removal will be a cheaper option than RCT. But what if you later want to replace the lost tooth? A dental bridge or implant may end up being a lot more expensive than holding onto the tooth with endodontics. Therefore you may be saving in the short term by having a tooth extracted, but end up paying a bigger price in the future. Note that a dental crown is often needed after RCT. Read more on root canal cost here.
  • Fear of the treatment, and pain specifically with root canal compared to extraction. There is no need to let this put you off. Modern-day dentistry is pain-free and RCT should be no exception here. Read the article on why the treatment does not hurt here.
  • Fear of the treatment not working. No procedure is guaranteed 100% to be successful. However success rates for endodontics are very high. In some circumstances a tooth may be harder to get a good chance of success (eg if it has a complicated anatomy or a severe infection), but your dentist will advise you of this before you decide.
  • General health. There are some medical conditions and/or drugs (such as bisphosphonates) that affect the ability of the jaw bone to heal after a dental extraction. In such cases removal is to be avoided if at all possible.


A note on baby teeth – These are very rarely root treated. The only common reason for doing so would be if the permanent successor is missing. Even then, they are unlikely to last long into adulthood. But it can be useful to hold onto them for as long as possible in such cases, they may keep the space open for an implant later. Sometimes, if a tooth nerve is damaged but there is hope that it may recover, “direct pulp capping” with calcium hydroxide (which can help reduce inflammation of the nerve) may be placed under a temporary filling.


Male dentist

Talk to your dentist about the pros and cons of each option

Summary Notes And Further Reading

As things stand, there is no real alternative to RCT other than removal of the tooth. The decision of which is best to opt for will depend on a lot of factors. Your dentist will help talk you through these and help you decide on whether to opt for root canal or extraction when faced with the choice.

Return here for our main page on root canal treatment.

A look at possible complications of RCT and of extraction

A look at the procedure involved

Do I need a root canal? What are the tell-tale symptoms?

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