When the nerve inside a tooth has died or become infected, there are two ways out: clean the inside of the tooth and seal it, or take the tooth out. Both end the pain. Only one leaves you with a tooth.
When a root canal makes sense
When enough of the tooth is left to rebuild. A root canal removes the nerve, cleans the canals, and fills them; the tooth then usually needs a crown, because a tooth without a nerve becomes brittle. If the tooth is structurally sound, this is nearly always the better answer — you keep the tooth, the bite stays as it was, and the neighbours do not drift.
When extraction makes sense
When the tooth is cracked below the gum, when decay has taken most of what was there, or when the bone around it has been lost to gum disease. A root canal on a tooth that cannot be rebuilt is money spent on a tooth you will lose anyway.
An extraction is the cheaper appointment and the more expensive decision. The gap has to be dealt with eventually, and an implant or bridge costs many times what the root canal would have.
What it feels like
A root canal today is no worse than a large filling; the reputation comes from a time before modern anaesthetics, and from the toothache that sent people in, which the treatment ends. Extraction is quick but the days after are the rougher part.
Ask this
“How much of the tooth is left, and what would you do if it were yours?” A straight answer to the second question tells you most of what you need.
