For patients facing severe dental decay or injury, the choice between pulling a tooth (extraction) and getting a root canal is often driven by cost. While extraction is significantly cheaper immediately, this initial saving often disappears when long-term dental health and subsequent restorative procedures are factored in. The choice ultimately comes down to a trade-off between the immediate low price of removing the tooth and the long-term value of saving the natural tooth structure. A root canal procedure, or endodontic therapy, saves the tooth by removing the infected pulp and nerves from the inside, whereas an extraction simply removes the entire infected unit. The overall cost calculation must account for the mandatory follow-up work required for both options.
The Immediate Cost Comparison: Extraction vs. Root Canal Therapy
Focusing solely on the initial procedure, a tooth extraction is almost always the least expensive option. A simple extraction, which involves removing a visible, non-broken tooth, typically ranges from $75 to $450. If the tooth is impacted, broken below the gumline, or requires surgical removal, the price for a surgical extraction increases, often falling between $150 and $650 or more.
The immediate cost of a root canal procedure alone is substantially higher because it is a more complex internal restoration. An endodontic treatment on a single-rooted front tooth generally ranges from $620 to $1,100. Back teeth, or molars, have multiple roots and canals, making the procedure more intricate and raising the cost to a range of $890 to over $2,000.
The Long-Term Financial Cost of Tooth Removal
The decision to extract a tooth carries a significant hidden cost because leaving an empty space can lead to a cascade of problems requiring future, expensive intervention. Once the tooth root is removed, the jawbone in that area loses the necessary stimulation it received during chewing. Without this stimulation, the body signals that the bone tissue is no longer needed, leading to a process called bone resorption.
The jawbone can lose up to 25% of its width in the first year following an extraction, which can change the facial structure over time. Furthermore, the adjacent teeth will begin to shift and tilt into the empty space, and the opposing tooth may super-erupt, causing bite misalignment. To prevent these issues, the missing tooth must be replaced.
The most common replacement options are a dental bridge or a dental implant. A traditional three-unit bridge, which requires crowning the two adjacent healthy teeth for support, typically costs between $2,000 and $5,000. The most comprehensive replacement is a dental implant, which is a prosthetic root placed directly into the jawbone, costing a total of $3,000 to over $7,000 per tooth, including the crown.
The Total Investment in Tooth Preservation
The total financial investment required to save a tooth includes the root canal therapy plus the necessary final restoration. After the infected pulp is removed, the tooth loses its natural internal blood supply and moisture, making the structure brittle and prone to fracture. Therefore, most root canal-treated teeth, especially molars that absorb high chewing forces, require a crown to protect them.
This protective dental crown acts as a full-coverage cap, restoring the tooth’s strength and stability to withstand chewing pressure. The cost of this restorative crown generally ranges from $800 to $2,500, depending on the material used. When the root canal and the crown costs are combined, the total investment for tooth preservation typically falls between $1,420 and $4,500. This complete cost of saving the natural tooth is often considerably less than the total expense of extraction plus subsequent implant replacement.
Non-Financial Factors and Insurance Variables
The final decision is often influenced by factors beyond the direct procedural price tag, especially the complexity of the tooth and dental insurance coverage. Most dental insurance plans categorize root canal therapy as a major procedure, meaning they typically cover 50% to 80% of the cost after the deductible is met. Conversely, extractions are often listed as a basic procedure and may be covered at a higher percentage, sometimes 70% or more, making the immediate out-of-pocket payment for an extraction seem even lower.
The location of the tooth also affects the final bill. A specialist endodontist is often required for a complex root canal, while an oral surgeon may be needed for a difficult surgical extraction, both adding to the professional fees. Beyond cost, preserving the natural tooth maintains the original bite mechanics and prevents the bone loss that immediately follows an extraction. The long-term biological benefit of keeping the natural root structure is an irreplaceable advantage, making tooth preservation the preferred clinical option.