When a tooth is badly decayed or infected, patients sometimes ask me to "just take it out." Extraction sounds simpler and cheaper, and in a few situations it is the right call. But in most cases, saving the natural tooth with root canal treatment is the better long-term decision. Here is how I explain the trade-off.

What each option actually involves

Root canal treatment removes the infected or inflamed tissue inside the tooth, disinfects the root canals, and seals them. The tooth stays in your jaw, and in most cases we place a crown on top to protect it. Treatment usually takes one or two visits.

Extraction removes the whole tooth. The procedure itself is quick, but the story does not end there. A missing tooth needs replacement - an implant, a bridge, or a denture - and that replacement typically costs more time and money than the root canal and crown would have.

What happens if a gap is left alone

Teeth work as a team. When one is lost and not replaced:

  • Neighbouring teeth drift into the gap, changing your bite
  • The opposing tooth over-erupts because it has nothing to bite against
  • The jawbone in that area slowly shrinks without a root to support
  • Chewing shifts to one side, overloading the remaining teeth

I regularly see patients who had a back tooth removed years ago and now need treatment on two or three more teeth because the bite collapsed.

When extraction is the right choice

To be clear, some teeth cannot or should not be saved:

  • A vertical crack running down the root
  • Decay so extensive that too little healthy tooth remains to hold a crown
  • Advanced gum disease that has destroyed the bone supporting the tooth
  • Some wisdom teeth

In these cases I say so plainly and we plan the replacement properly.

The cost question

A root canal plus crown costs more upfront than an extraction alone. But compare it with extraction plus an implant or bridge - the realistic cost of replacing what you removed - and saving the tooth is usually the more economical path, as well as the one that keeps your own tooth in your mouth.

If you have been told a tooth needs to come out, it is reasonable to ask whether root canal treatment is possible first. A short examination and X-ray will answer it.

Dr. Mohit Bodhwani, MDS (Conservative Dentistry and Endodontics), is an endodontist and founder of The Smile Makers Dental Clinic, Khar West, Mumbai.