Root Canal or Extraction: An Honest Comparison
A tooth is badly infected or broken, and you're facing the classic fork in the road: root canal to save it, or extraction to be done with it. The extraction looks cheaper and simpler, and sometimes it genuinely is the right call. But the honest comparison has a hidden line item most people never see until later. Let's walk through it.
What each one actually does
A root canal removes the infected nerve from inside the tooth, disinfects the canals, and seals them — the tooth stays in your mouth, keeps its root, and (usually with a crown on back teeth) works for decades. An extraction removes the whole tooth, root and all. The infection is gone either way; the difference is whether you still have a tooth when it's over.
The real cost comparison
| Path | Up-front cost (our office) | The catch |
|---|---|---|
| Root canal + crown | $700–1,500 + $900–1,300 | Higher today, done for decades |
| Extraction only | $180–650 | The gap starts causing problems |
| Extraction + implant later | $180–650 + $3,200–4,200 | Most expensive total path |
| Extraction + bridge later | $180–650 + $2,700–3,900 | Grinds down two healthy neighbors |
Those are our real fees, set intentionally about 20% below the typical Salem office. And they reveal the honest math: extraction is only the cheap option if you never replace the tooth, and for most teeth, "never replace it" has costs of its own.
The hidden cost of the empty space
A missing back tooth doesn't just sit there politely. The neighboring teeth tilt and drift into the gap, your opposing tooth over-erupts into the space, your bite shifts, and the jawbone under the gap begins to resorb. It shrinks without a root to stimulate it. Two or three years later, fixing the situation costs more than the root canal ever would have, and the bone loss may mean a graft before an implant is even possible. When we recommend saving a tooth, this, not sentimentality — is why.
"But root canals are agony, right?"
That reputation is decades out of date. With modern anesthetic and rotary instruments, a root canal today feels about like getting a large filling — most patients watch a show through it. Here's the part people mix up: the pain you've heard about is the infected tooth before treatment, not the procedure. The root canal is what makes the pain stop. Most of our root canal patients are comfortable by the next morning.
When extraction genuinely wins
- The tooth is cracked below the bone line, no root canal can seal a split root.
- Too little tooth remains to rebuild. A root canal on an unrestorable tooth is money spent on a lost cause.
- Severe gum disease has already loosened the tooth; saving the inside doesn't help if the foundation is gone.
- Budget reality. If a root canal plus crown simply isn't feasible right now, a well-planned extraction with a replacement plan beats an untreated infection every time.
How we decide here: you'll see your own X-ray on the screen, and we'll tell you plainly which category your tooth is in. If it's a lost cause, we'll say so and never sell you a root canal. If it's savable, we'll show you why the math favors saving it — then you decide. Want a quick read on your own tooth first? Take our 60-second save it or pull it quiz.
If you do extract: plan the replacement now
Choosing extraction isn't a bad decision — choosing extraction without a replacement plan usually is. Before the tooth comes out, ask what happens to the space. For a back molar, an implant placed within a few months takes advantage of the bone you still have; wait two years and you may need a graft first. A bridge is faster and cheaper up front but requires reshaping the two neighboring teeth. And for some teeth — a wisdom tooth, or a molar with no opposing tooth — leaving the space empty genuinely is fine. The point is to decide that on purpose, with the costs of each path in writing, not by default.
What OHP covers
The Oregon Health Plan covers extractions outright, and covers root canals case-by-case — more readily for front teeth and for patients under 21. If you're on OHP, don't assume your only covered option is pulling the tooth; bring your member number and we'll verify both paths for free before you choose.
In pain right now? We hold same-day slots for exactly this. Read more about root canals at our office and gentle extractions, then call (503) 555-0123 or book online. You'll get honest options and written prices before anything happens.