A patient arrives in pain. The molar has been throbbing for four nights. They want it out, today, and they say so before they have sat down.
It is an understandable instinct, and sometimes extraction is the right answer. More often it is not, and the reason is that the calculation people are running in that moment is a one-day calculation for a thirty-year problem.
What a root canal actually does
The nerve and blood supply inside a tooth sit in a chamber that runs down into the roots. When decay or a crack lets bacteria in, that tissue becomes infected. Infected tissue under pressure inside a rigid tooth is what produces the specific, unmistakable throbbing of a dying pulp.
Root canal treatment removes that tissue, cleans and disinfects every canal, and seals them. The outer tooth, the part that does the chewing, stays exactly where it is.
The treatment is not the cause of the pain. It is the end of it.
The cost comparison people do not run
On the day, extraction wins easily. It is faster and it is cheaper.
Over ten years the picture reverses. A missing molar is not a neutral gap:
- The teeth either side tilt into the space, which changes your bite
- The opposing tooth over-erupts because nothing meets it
- Chewing load redistributes onto teeth not designed to carry it
- Bone in the socket resorbs, which is what makes later implants more complicated
Then you replace it, because most people eventually do. A bridge means preparing two healthy neighbouring teeth. An implant means surgery, months of healing and a considerably larger bill than the root canal would have been.
When extraction is the right call
It genuinely is, sometimes, and any dentist who says otherwise is not being straight with you:
- The tooth is fractured vertically through the root
- There is too little sound tooth structure left to restore
- Severe gum disease has destroyed the supporting bone
- A wisdom tooth is impacted and damaging the tooth in front of it
- Orthodontic treatment requires space that cannot be created otherwise
The distinction is whether the tooth can be restored to function. If it can, it should be. If it cannot, removing it promptly is better than nursing it for another two years.
Why "no extractions" keeps appearing in our reviews
Patients who come to us having been told elsewhere that a tooth must come out are often surprised when we test it, image it, and find the tooth is restorable. Not always. But often enough that it has become the thing people write about.
The reason is not a trick. It is that diagnosing whether a tooth can be saved takes longer than deciding to remove it, and it takes someone who does endodontics regularly enough to be confident about what they are seeing.
Does it hurt?
The tooth hurts before treatment. It does not hurt during. You are fully anaesthetised, and the area is tested before anything begins.
Most patients tell us afterwards that the appointment was considerably easier than the week that preceded it. Mild tenderness for a few days afterwards is normal, as the ligament around the root settles.
The part people skip
If it is a back tooth, you need a crown afterwards. This is not optional and it is not an upsell.
A root-treated molar has lost its internal blood supply and becomes brittle over time. Without a crown holding it together under bite force, it will eventually split, usually vertically, and a vertically fractured root cannot be saved. That is the most common way a successful root canal ends up as an extraction three years later.
Budget for the crown when you budget for the root canal. They are one treatment in two parts.
How long the tooth lasts
Properly treated and properly crowned, decades. Failures are almost always traceable to one of two things: a canal that was missed or left under-cleaned, or a tooth that was never crowned.
Both are avoidable, which is precisely why this work belongs with someone who is trained for it.