Root Canal or Extraction: How to Choose, and What Each Path Costs

A root canal costs more on the day. An extraction is the smaller bill until the day you replace the tooth with an implant or a bridge.

What each option does

A root canal saves the tooth

The centre of each tooth holds the pulp: nerve, blood vessels and soft tissue. Bacteria get in through deep decay, a crack or an injury. Treatment removes that tissue, cleans the narrow channels inside the roots and fills them. You keep the tooth and go on chewing with it.

Most back teeth need a crown afterwards. Decay and the treatment opening have weakened them, and they take heavy chewing forces. The crown covers the cusps so the tooth does not split.

An extraction removes it

An extraction takes the tooth out, root and all, and the infection goes with it. A surgical extraction is for a tooth broken at the gum line or harder to reach.

It does not replace the tooth, so what goes in the gap is a second decision with its own cost.

When saving the tooth makes sense

Your own tooth keeps the bone around its root in use and holds its neighbours in place. Nothing else in your mouth has to be reshaped to support it.

Root-treated teeth also last. A US study that followed more than 1.4 million treated teeth through insurance claims found 97% still in the mouth eight years on. It counts teeth kept and not teeth fully healed. Of the treated teeth that were later extracted, 85% had no full crown, which is why we press for the crown.

Signs to watch: pain that lingers after hot or cold, pain on biting, swelling, a darkening tooth. Our root canal treatment page lists them all. We treat front teeth, premolars and molars at the clinic, with no referral needed.

When extraction is the right call

Extraction is the honest answer when:

• The tooth is split down the root. A crack that runs below the gum cannot be sealed
• Too little tooth is left to restore. Decay has taken so much that a crown has nothing to hold
• The bone support is gone. Advanced gum disease has destroyed the bone that holds the tooth
• A treated tooth has failed and no second attempt can work. Retreatment and root-end surgery are both ruled out

A tooth that feels loose is not always lost. Infection at the root tip can loosen a tooth that a root canal can still save. A tooth broken near the gum can be rebuilt after crown lengthening when enough root remains. We do that here.

We tell you which group your tooth is in after the exam and x-ray. If a root canal has a poor outlook you hear that before you pay for one.

Pros and cons at a glance

Root canal vs extraction cost

These ranges come from prices that dental practices in Mississauga and across Ontario publish for each item. They are not our fees. You get your number in a written estimate after the exam.

Ceramic, zirconia and gold crowns cost more than the porcelain crown priced here. A build-up or post under the crown can add to it.

The cheapest day is not always the cheapest decision. Extraction alone is the lowest number on the table. Add a bridge or an implant and the range starts well above saving a molar. A standard complete denture starts at about $1,500 per arch, and it comes out for cleaning.

A premolar root canal runs $900 to $1,100. Treating a tooth a second time costs more than the first. An endodontist referral comes with that office's own fee and estimate.

Side by side

Recovery: what each one feels like

After a root canal

Under local anaesthetic it feels much like a longer filling appointment. The numbness lasts several hours and most people recover in less than a week. Call us if soreness has not settled after a few days.

Until the tooth has its permanent filling or crown, chew on the other side.

After an extraction

You bite on gauze for twenty to thirty minutes and a clot forms in the socket. That clot protects the bone, so no straws, spitting or smoking as it settles. Ask whether any stitches dissolve. Daily life returns in two to three days. The bone takes several weeks to heal, and up to four months after a molar.

The main thing to avoid is dry socket, when the clot is lost early. It follows under 5% of extractions in large studies. Smokers face more than three times the odds. Our tooth extraction page has the full aftercare routine.

Tell us every medicine you take. Bone drugs such as bisphosphonates and denosumab, and blood thinners, change how we plan an extraction. They can favour keeping the tooth.

What happens if you pull it and leave the gap

The teeth next to the gap lean into the space and the opposite tooth grows toward it. The bone where the root sat slowly shrinks. You do not have to replace the tooth that week, but you need a plan. Our post on implant, bridge or denture compares the options.

What else shapes the decision

Your general health, your budget and how you feel about each procedure all count. Tell us if dental visits make you anxious. We take that into account when we plan your care.

CDCP and insurance

Both treatments appear on the Canadian Dental Care Plan's list for people the plan accepts. Redoing a root canal needs the plan's approval before work starts. The crown that follows needs it too, along with any core or post (Government of Canada).

Implants and fixed bridges are excluded. Eligible dentures may be partly covered, subject to the plan's criteria and approval where required. The plan is open to all ages, subject to its income test.

Family income sets your share. Below $70,000 in adjusted family net income you pay nothing toward the plan fee. From $70,000 to $79,999 you pay 40% of it, and from $80,000 to $89,999 you pay 60%. A dentist fee above the plan fee is also yours. See CDCP at our clinic.

Private insurance: we can send your plan a pre-determination, so you see its expected share before you decide. It is an estimate, not a promise to pay. We bill insurers directly.

OHIP does not pay for dental work in a dentist's office.

If you are in pain today

Pain relief and the final decision can happen on different days. At an urgent visit we test the tooth, x-ray it and deal with the pain, and a tooth worth saving can have its canals opened and dressed that day.

Antibiotics have a place when infection spreads or causes a fever, but they never fix the tooth itself. Before you leave, ask us to write down what saving the tooth and removing it would each involve.

Frequently asked questions