Keep the tooth or take it out

The two numbers, before anything else

On the Pennsylvania schedule, a molar root canal plus a porcelain crown is $500.00 plus $500.00, a total of $1,000.00. A simple extraction of the same tooth, on the same document, is $65.00. That is 15.4 times as much to keep it as to lose it.

On the Montana schedule the same comparison is $553.28 for the canal, $158.08 for the core build-up and $790.40 for the crown — $1,501.76 in total — against $86.94 for a simple extraction. That is 17.3 times.

Those figures are accurate and they are not the answer. A fee schedule prices an appointment. It has no line for the twenty years afterwards, and no line for the space where the tooth used to be.

What the extraction line does not include

An extraction that is never followed by anything is genuinely the cheap option, and for some teeth — a wisdom tooth, a tooth already lost to decay, a tooth that cannot be saved — it is the only option. But when a molar in the middle of a working bite comes out, a decision about the gap follows it, and that decision has its own prices: a bridge, an implant, a partial denture, or nothing.

Nothing is a real choice, and it is the one the fee schedules are silent about. Neighbouring and opposing teeth sit in a system that has just lost a member of it, and what happens next is exactly the kind of individual question this site refuses to answer from a distance. Your dentist can see the other teeth; we cannot.

What we can say is that the honest comparison is not $1,000.00 against $65.00. It is $1,000.00 against $65.00 plus whatever you do about the gap, plus whatever you do about it again later. Put that way, the gap between the columns gets a great deal smaller, and on many teeth it closes.

What actually decides it, and who decides it

Not the price. The things that decide whether a tooth can be kept are structural, and all of them need somebody looking at the tooth and at an X-ray of it:

• how much sound tooth is left above the gum for a crown to hold on to
• whether the root is cracked, and how far down
• how much bone is still supporting it
• whether the canals can be reached and cleaned at all
• what the tooth is doing in your bite, and what is standing next to it

The American Association of Endodontists — the endodontists' own professional body, so read it as an interested party — states its position plainly: where it is possible, saving the natural tooth is the option it prefers. The NHS page on root canal treatment, last reviewed on 3 October 2025, puts the alternative just as plainly: if you have an infected tooth and do not have the treatment, you may need to have the tooth taken out.

Neither of those is a recommendation about your tooth, and neither is this page. The decision is made in a chair, by somebody with a licence, with the X-ray up on the screen.

The question worth asking out loud

If you are given a choice between the two, the useful question is not "which is cheaper". It is: what is your reason for offering me the choice?

There is a straightforward answer to that — how much tooth is left, what the X-ray shows, what the crack is doing — and a dentist will give it to you. Ask what happens to the gap if the tooth comes out, what that costs, and when it would need doing. Ask what the odds are that the tooth can be saved, in their hands, on this tooth. And if the answer is "it is borderline", ask what a second opinion would look for.

A second opinion on a borderline tooth is one of the few things in dentistry where the maths is easy: another problem-focused exam and X-ray runs $59.28 to $144.00 on the schedules this site prices from, against a four-figure decision that cannot be reversed.

When the choice is not really a choice

Some of this stops being a decision about money. If your face is swelling, if you have a temperature, or if swelling is affecting your breathing or swallowing, the question is not which treatment to buy — it is getting seen today, and emergency care if breathing or swallowing is affected. The infection is the urgent thing; what happens to the tooth is a conversation for afterwards.

Aftercare for an extraction — what to eat, how the socket heals, what to do about the first few days — is a subject in its own right, and it is not one this site covers. Ask the practice that does the extraction for their own written instructions, and follow those rather than anything you read on the internet, including here.