When a tooth is badly decayed or infected, it usually comes down to two options: save it with a root canal, or take it out. People often assume extraction is the cheap choice. On the NHS it is not, and the real cost difference shows up afterwards.
What each one involves
- Root canal treatment removes the infected pulp from inside the tooth, cleans and shapes the canals, and seals them. The tooth stays in place. A back tooth that has had a root canal usually needs a crown afterwards to stop it cracking.
- Extraction removes the tooth. Simple extractions take minutes; a broken down or impacted tooth may need a surgical extraction.
What they cost
On the NHS, both are Band 2 treatments at £76.60. If the root canal tooth then needs a crown in the same course of treatment, the whole course becomes Band 3 at £332.10. So on the NHS, extraction is the cheaper course only when a crown would have been needed.
Privately, a root canal is typically around £450 (more for a molar, which has more canals), a crown around £720 on top, and a simple extraction around £160.
The cost that comes after an extraction
This is the part people miss. A gap left by an extraction has consequences:
- Neighbouring teeth can drift into the space and the opposite tooth can over erupt, changing your bite.
- Chewing shifts to other teeth, which wear faster.
- Most people end up wanting the gap filled, and that costs more than the extraction did: a bridge is Band 3 on the NHS or around £720 privately; an implant is private only at around £2,500; a denture is Band 3 or from around £290 privately.
Add those up and saving the tooth is often the cheaper path over ten years, even with a crown.
How well root canals work
Root canal treatment succeeds in the large majority of cases, commonly quoted at around 85 to 90%, and a well done root canal with a crown can last decades. It can fail if canals are missed or the tooth cracks, in which case retreatment or extraction follows.
When extraction is the better call
- The tooth is too broken down to restore, with not enough sound structure left for a crown
- The root is cracked, which a root canal cannot fix
- Severe gum disease has loosened the tooth
- It is a wisdom tooth or another tooth that does not contribute much to your bite
- You cannot commit to the follow up a root canal and crown need
Questions to ask your dentist
- Is this tooth restorable, and would it need a crown afterwards?
- What is the total cost of saving it, including the crown, against extraction plus replacing the gap?
- If I have it out, what happens to the space?
This is general information, not clinical advice. Only the dentist looking at the X ray can say whether a particular tooth can be saved.