A patient came in last month with a back tooth that had been giving them trouble for years. The decay had gone deep, the nerve was infected, and they had two questions for us:
- Can we save it?
- If not, what is the alternative?
This is one of the most common decisions in dentistry. Here is how we think about it.
The two real options
When a tooth is badly damaged but not destroyed, you have two paths:
- Root canal treatment — clean out the infected nerve from inside the tooth, fill the empty space, and protect the tooth with a crown.
- Extraction — remove the tooth, then replace it (eventually) with an implant, a bridge, or a denture.
There is no third option that lets you keep the tooth without treating the infection. Leaving it alone causes pain, abscess, and possibly damage to the surrounding teeth and jawbone.
When root canal makes sense
Most of the time, if the tooth is structurally sound enough to take a crown afterwards, root canal is the better long-term choice. Here is why:
Your own tooth is the best tooth. The root sitting in the bone keeps the bone healthy. The shape and feel are exactly right. Even after a root canal and crown, it is still your tooth.
Replacement is not cheaper. An extraction costs less in the short term, but doing nothing afterwards is not a real option for back teeth — the neighbouring teeth slowly tilt into the gap and the opposite tooth grows down. By the time you replace it with an implant or bridge, the total cost is usually higher than saving the tooth was.
The procedure is not what it used to be. Modern root canal treatment is done under proper anaesthetic, with rotary instruments and good imaging. It is no more involved than a deep filling. The myth that root canals are painful is decades out of date.
When extraction makes sense
Sometimes saving the tooth is not the right call:
- The tooth is structurally too far gone. If there is not enough healthy tooth left to crown after the root canal, the long-term outlook is poor.
- There is a vertical crack running into the root. These usually do not heal. Better to remove and replace.
- The tooth has had a failed root canal already and re-treatment would be complex. Sometimes starting over with an implant gives a longer-lasting result.
- It is a wisdom tooth. These usually do not warrant the cost and effort of a root canal — they are not essential for chewing.
How to actually decide
The honest answer is that you cannot decide from a blog post. The decision depends on:
- How much tooth structure is left
- The exact location of the decay or crack
- The state of the supporting bone and gum
- Your own preferences and budget
What we can promise is this: if you come in with this question, you will leave with a clear recommendation, the reasons for it, and a written quote for both options if you want them. You decide.
What we usually recommend
For most patients with a back tooth that can still be saved, root canal plus crown is the right call. It keeps your own tooth doing its job for another 15 to 20 years, on average. By the time you might need to replace it, the situation has often changed anyway.
For a front tooth, root canal is almost always preferred because the cosmetic outcome of a crown on your own root is hard to beat.
For a tooth that is cracked deep into the root, an implant is usually the simpler long-term answer.
If you have a tooth giving you trouble and you want a second opinion before deciding, come in for a consultation. A 20-minute look and a quick X-ray usually tells us everything we need to know.
