Last updated: July 2026. Sources: NHS.uk, NHSBSA, GOV.WALES, NHS inform Scotland, HSC Business Services Organisation, the General Dental Council, the British Dental Association, and peer-reviewed research in the British Dental Journal, International Endodontic Journal and Scientific Reports.
TL;DR: On the NHS in England, root canal treatment and extraction both sit in Band 2 and cost the same, so the decision is clinical rather than financial. Dentists save a tooth when enough healthy structure remains to rebuild it. Extraction is the right choice when it does not.
Being told your tooth is badly damaged, and then being asked to choose between saving it and losing it, is one of the more unsettling moments in a dental chair. Most people assume the cheaper option is to pull the tooth. In England, on the NHS, that assumption is wrong, and understanding why changes how you should think about the whole decision.
The short answer: when dentists save a tooth, and when they do not
Dentists start from the position that keeping your own tooth is preferable. A natural tooth has a root anchored in living bone, a ligament that senses pressure, and a shape your bite has adapted to over decades. No replacement reproduces all three.
The decision turns on one clinical question: is there enough sound tooth structure left to rebuild something that will survive normal chewing forces? If the answer is yes, root canal treatment is usually offered. If the answer is no, extraction is the honest recommendation rather than a failure.
Cost sits underneath that question rather than on top of it. On the NHS in England both treatments fall in the same charge band, which removes price from the decision entirely for NHS patients. Privately, the picture is different, and we cover that below.
What root canal treatment actually does
Root canal treatment removes infected or inflamed tissue from the centre of a tooth, cleans the space, and seals it. The outside of the tooth stays where it is. Only the pulp, the soft tissue containing nerves and blood vessels, is taken out.
NHS.uk sets out what the appointments involve: treatment usually takes two or more appointments, each lasting one to two hours or sometimes longer, with a temporary filling sometimes placed between visits [5]. The tooth is numbed with local anaesthetic, and NHS.uk states that during treatment you "will be awake but will not feel any pain" [5].
Root canal treatment is not a repair of the visible tooth. It stabilises the inside. The outside still needs restoring afterwards, usually with a filling or, for back teeth, a crown. That second stage matters more than most patients realise, and it is where a lot of the real cost sits.
NHS.uk is direct about the alternative: "If you have an infected tooth and do not have root canal treatment, you may need to have the tooth taken out" [5]. An infected tooth does not settle on its own, and if it progresses to a dental abscess it becomes an urgent problem rather than a planned one.
What extraction involves, and what happens to the gap
Extraction removes the tooth and its root. A simple extraction lifts the tooth out through the socket. A surgical extraction, needed when a tooth is broken at gum level or the roots are awkward, involves a small incision and sometimes sectioning the tooth to remove it in pieces.
Extraction resolves the infection definitively, because the source is gone. It is usually a single appointment, and there is no follow-on restoration to pay for or attend. For a tooth that cannot be saved, it is the correct treatment, not a second-best one.
What extraction leaves behind is a gap, and gaps do not stay still. Research published in Scientific Reports examined the movement of neighbouring teeth after premolar extractions and found that "all the examined teeth had tipped and moved towards the extraction space, leading to space decreases" [14]. Teeth either side lean in, and the tooth in the opposing jaw can drift down or up into the space where its biting partner used to be.
The bone changes too. A paper in the Journal of Dental Biomechanics explains that extraction is followed by a reduction in both the width and the height of the alveolar ridge, the bone that held the root, because the mechanical loading that maintained that bone has gone [13]. The same paper notes that the socket fills with woven bone at around one month, a cortical ridge forms by roughly three months, and remodelling into mature lamellar bone continues to around six months [13].
None of this makes extraction wrong. It makes extraction a decision with a second half, which is what you do about the space. That is covered further down.
The clinical test: is the tooth restorable?
Restorability is a technical judgement, not a preference. A 2025 review in the British Dental Journal on restoring root-filled teeth identified seven tooth-related factors that bear on the outcome, including how much sound coronal tooth structure remains, the tooth type, its position in the mouth, and the health of the surrounding gum and bone [12].
The same paper describes the Dental Practicality Index, an assessment tool that deliberately combines tooth-specific factors with patient factors, including the patient's own wishes and expectations, their financial circumstances, and their oral health motivation [12]. In other words, published clinical guidance already treats your circumstances as a legitimate input, not an inconvenience.
The paper is blunt about what actually kills root-treated teeth: "The greatest risk to the successfully endodontically treated tooth arises from forces that will fracture the tooth where its structural integrity has been compromised" [12]. A tooth that has lost most of its walls is vulnerable to splitting, and no amount of good work inside the root changes that.
Timing matters as well. Evidence cited in that review suggests permanent restorations placed within four months of root canal treatment are associated with roughly three times better outcomes, meaning fewer eventual extractions, than teeth left under temporary or delayed restorations [12]. If you have root canal treatment and then let the follow-up drift, you erode the benefit you paid for.
Broad signs that point towards extraction include a tooth fractured below the gum line, extensive decay leaving little to grip, severe bone loss from gum disease around that tooth, and a root that has split vertically. Signs that point towards saving it include solid remaining walls, healthy surrounding bone, and a tooth doing useful work in your bite.
What each option costs on the NHS
This is where the counterintuitive part lives. In England, root canal treatment and extraction are charged identically.
England
NHS dental charges in England run on three bands, and the rates below took effect on 1 April 2026 [1].
| Band | Charge | What it covers |
|---|---|---|
| Band 1 | £27.90 | Examination, diagnosis including X-rays, preventive advice, scale and polish if needed, fluoride varnish |
| Band 2 | £76.60 | Everything in Band 1 plus fillings, root canal treatment, and extractions |
| Band 3 | £332.10 | Everything in Bands 1 and 2 plus crowns, dentures, bridges and other laboratory work |
NHS.uk describes Band 2 in exactly these terms: "Band 2 (£76.60) covers anything listed in Band 1, plus any further treatment, such as fillings, root canal work or having a tooth taken out (extractions)" [1].
Both options are therefore £76.60 in England. A root canal on a molar and a straightforward extraction of the same tooth carry the identical patient charge. NHS.uk lists extraction as part of the Band 2 line covering "removing teeth (extraction) and other oral surgery procedures", and there is no separate higher band for a surgical extraction [2].
For NHS patients in England, price is not a tiebreaker. The clinical merits of each option are the whole argument. For a fuller breakdown of how the bands work across every treatment, see our guide to NHS dental charges.
The crown changes the arithmetic, though, and it is worth understanding precisely how. A crown is Band 3. NHS.uk states that "if you need a mix of treatments from different bands, you'll pay for the cost of the highest band of treatment you're having" [1]. So if your dentist plans the root canal and the crown together as a single course of treatment, you pay one Band 3 charge of £332.10 covering both, not £76.60 plus £332.10.
Where it gets confusing is follow-up treatment. NHS.uk says that "if you have dental treatment but need further treatment within 2 months, you do not have to pay extra if the further treatment is included in the same band, or a lower band", and immediately adds that "if you need further treatment in a higher band, you'll have to pay the higher band fee" [1]. A crown is a higher band than a root canal. If it is arranged as a separate later course rather than part of the original plan, the two-month protection does not shield you from the Band 3 charge.
The practical takeaway is a question to ask before you agree to anything: is the crown part of this course of treatment, or a separate one? The answer determines whether you are looking at £332.10 in total or £76.60 followed by £332.10.
Wales
Wales moved away from the England-style band system on 1 April 2026, when a new General Dental Services contract took effect. Charges are now built around care packages, each with a published fixed fee, and GOV.WALES states that "there is a maximum total charge of £384 for a course of treatment (or multiple courses delivered at the same time)" [6].
The published care package fees relevant to this decision are:
| Care package | Fee |
|---|---|
| Urgent care | £37.50 |
| New patient assessment | £27.21 |
| Simple restorative | £36.03 |
| Extensive restorative | £68.75 |
| Anterior root canal | £91.18 |
| Posterior root canal | £182.72 |
| Crown, bridge, inlay, onlay or veneer | £140.44 |
Source: GOV.WALES, updated 1 April 2026 [6].
Wales is therefore the one part of the UK where the two treatments are not automatically priced the same. A root canal on a back tooth carries a £182.72 package fee, which is the highest single package on the schedule apart from the combined cap. The published list does not include a standalone extraction package, so ask your practice which package your treatment falls under before you decide.
When the Welsh Government announced the contract in September 2025 it described the charging principle as patients paying "50% of their treatment package value", capped at £384 [7]. The current charges page implements this as the fixed fee schedule above rather than restating a percentage, so treat the fixed fees as the operative figures.
Dental examinations in Wales are free for anyone aged under 25 and anyone aged 60 or over [6].
Scotland
Scotland works differently again. NHS inform states that "everyone in Scotland is entitled to free NHS dental examinations (including review examinations)" [8].
Treatment is free for everyone aged under 26 [8]. For adults aged 26 and over who are not otherwise exempt, NHS inform sets out the charge: "NHS patients who pay for their treatment pay 80% of the treatment costs. This continues to be capped at a maximum of £384 per course of treatment", and confirms that "you will never pay more than £384 per course of treatment" [8].
Because the charge is a proportion of the underlying fee rather than a flat band, a more complex root canal will cost a Scottish patient more than a simple extraction, up to that £384 ceiling.
Northern Ireland
Northern Ireland uses a percentage model as well. The Business Services Organisation, the official HSC body, states that "the patient is required to pay 80% of the gross cost of the treatments up to a maximum of £384" [9].
One caveat worth knowing: that £384 cap is recorded on the BSO page as dating from 1 April 2007, and nidirect, the official citizen portal, points readers to the annual Statement of Dental Remuneration for the current fee scale rather than restating the figures. Check the current charge with your practice before committing.
Who gets free NHS dental treatment
If you qualify for free NHS treatment, the entire cost comparison disappears and the decision becomes purely clinical. In England you are entitled to free NHS dental treatment if you are [3]:
- Aged under 18, or under 19 and in full-time education
- Pregnant when treatment starts, or have had a baby in the 12 months before treatment starts, including stillbirth
- Staying in an NHS hospital and treated by the hospital dentist, though this does not cover dentures or bridges
- Receiving War Pension Scheme or Armed Forces Compensation Scheme payments, where the treatment relates to the accepted disability and the Veterans Welfare Service has agreed it in advance
- Receiving, or the partner of someone receiving, Income Support, income-related Employment and Support Allowance, income-based Jobseeker's Allowance, Pension Credit Guarantee Credit, or Universal Credit where you meet the earnings criteria
- Named on, or entitled to be named on, a valid NHS tax credit exemption certificate
- Under 20 and a dependant of someone receiving one of those benefits
- Holding a valid HC2 certificate through the NHS Low Income Scheme
If you narrowly miss out, the NHS Low Income Scheme can still help. NHS.uk states that "if you're not eligible for free NHS dental treatment and you're on a low income, you may still be able to get help with paying part of the cost from the NHS Low Income Scheme", which issues an HC3 certificate showing how much you will pay [4]. Our full eligibility guide walks through how to apply.
What each option costs privately
Here we have to be straight with you about the limits of what can be verified. No official UK body publishes private dental fee data. The NHS, NHSBSA, the General Dental Council, the British Dental Association, NICE and the Royal College of Surgeons of England all publish extensively on dentistry, and none of them publishes a private price list or a survey of typical private fees.
Every specific private figure circulating online traces back to individual practice marketing pages or comparison sites, which is not a basis on which we will quote you a number. What we can tell you is the shape of the market rather than the price of it.
Privately, root canal treatment costs more than a simple extraction, and the gap is usually substantial. Root canal treatment is a lengthy procedure requiring specialist instruments and often two appointments, and the fee typically rises with the number of root canals, so a molar costs considerably more than an incisor. A crown afterwards is a separate fee again, involving laboratory work.
A simple extraction is quicker and involves no laboratory component, so it sits at the lower end. A surgical extraction costs more than a simple one. The private cost order, from lowest to highest, is generally simple extraction, then surgical extraction, then root canal treatment, then root canal treatment plus a crown.
The only reliable way to know your own numbers is a written treatment plan. Ask for one covering both options, itemised, before you decide. Our detailed root canal cost guide and tooth extraction cost guide explain what each fee is actually paying for.
The hidden cost of extraction: replacing the tooth
The comparison most people run in their head is root canal against extraction. The comparison that actually reflects the money is root canal against extraction plus whatever you do about the gap.
Because neighbouring teeth tip into an extraction space and the opposing tooth can over-erupt [14], and because the ridge bone resorbs once the root is gone [13], leaving a gap indefinitely is a decision with consequences rather than a neutral non-decision. For a back molar with a healthy tooth in front of it, many people do leave the gap and manage perfectly well. For a visible tooth, or where the gap destabilises the bite, replacement is usually recommended.
The three replacement routes are a denture, a bridge, or an implant. On the NHS in England, dentures and bridges are Band 3 treatments at £332.10 [1]. Implants are only very rarely available on the NHS and are generally a private treatment.
Privately, an implant is typically the most expensive single-tooth treatment in dentistry, comfortably exceeding the cost of a root canal and crown on the same tooth. A bridge sits below an implant, and a denture below that. Our guide to replacing a missing tooth compares all three, and there are detailed cost breakdowns for implants, bridges and dentures.
Set against that, saving a tooth that can genuinely be saved is usually the cheaper long-run choice as well as the better clinical one.
How long does a root-treated tooth last?
This is the fair challenge to root canal treatment: is it worth doing if the tooth fails anyway? The peer-reviewed evidence says the odds are good.
A systematic review in the International Endodontic Journal pooled data from 14 studies published between 1993 and 2007 and found tooth survival following non-surgical root canal treatment of 86% at two to three years, 93% at four to five years, and 87% at eight to ten years, with a 95% confidence interval of 82% to 92% at the longest follow-up [10].
A separate ten-year cohort study in the European Journal of Oral Implantology followed 411 patients and 1,175 root-treated teeth and reported that "the life-table analysis showed 93% of teeth surviving at 10 years after endodontic treatment" [11]. In that study 84.1% of teeth achieved complete success and 90.2% showed complete radiographic healing [11].
Taken together, roughly 7% to 13% of root-treated teeth are lost within eight to ten years. The other 87% to 93% are still there and still working.
The systematic review also identified four factors that significantly improved survival: a crown placed after the root canal treatment, the tooth having contact points on both sides, the tooth not being used as an abutment for a denture or bridge, and the tooth not being a molar [10]. The first of those is the one within your control, and it is a strong argument for not skipping or delaying the crown.
Pain, recovery and time off
Fear drives more extraction requests than any clinical factor, which is worth naming plainly. Root canal treatment has a reputation it has largely outgrown.
NHS.uk states that local anaesthetic means you "will be awake but will not feel any pain" during the procedure [5]. On recovery, it says "the area around your tooth may feel swollen and sore but it should get better in a couple of weeks", and suggests paracetamol or ibuprofen if you need pain relief [5].
The trade-off with root canal treatment is time rather than pain. Expect two or more appointments of one to two hours each [5], which means arranging time away from work or childcare more than once.
Extraction is typically one appointment, but the recovery is more eventful. Discomfort and swelling usually build over the first few days before settling, and a blood clot has to form and stay in the socket for healing to proceed normally, which is why practices advise against rinsing vigorously, sucking through a straw or smoking in the first day or so. Dry socket, where that clot is lost, is a recognised and painful complication your dentist will warn you about.
If anxiety is what is pushing you towards extraction rather than the state of the tooth, that is worth separating out and addressing on its own terms. Sedation and desensitisation approaches are widely available, and our guide to dental anxiety covers what to ask for.
When you cannot get an NHS appointment
There is an access dimension to this decision that no clinical guidance covers, and pretending otherwise would be dishonest.
NHSBSA statistics for England show that 18 million adults received NHS dental care in the 24 months to 31 March 2025, which is 40% of the adult population [15]. On the same figures, 35 million courses of treatment were delivered in 2024/25 and 24,655 dentists carried out NHS activity, at a ratio of 42 dentists per 100,000 people [15].
The British Dental Association put unmet need for NHS dentistry in England at 13 million adults, over one in four, in analysis reported in 2024, against a pre-pandemic level it describes as having hovered around 4 million, or one in ten [16]. Those are 2024 figures and should be read as such, but they describe a gap that has not closed since.
The practical consequence is that some patients are offered extraction not because the tooth is unsaveable but because urgent appointments are easier to obtain than a course of restorative treatment. If you are in acute pain and the only appointment available is an emergency slot, extraction may be presented as the realistic option.
You are entitled to ask whether the tooth is restorable in principle, even if the practice cannot deliver that treatment quickly. That answer tells you whether it is worth seeking a course of treatment elsewhere or paying privately for a root canal. It is a different question from what can be done today.
Your right to understand the options
The General Dental Council's Standards for the Dental Team place a clear duty on your dentist. Standard 3.1 states: "You must obtain valid consent before starting treatment, explaining all the relevant options and the possible costs" [17].
The standard requires dentists to discuss the treatment options and their risks and benefits, why a particular treatment is appropriate, the likely prognosis, the recommended option, the cost, and what may happen if the proposed treatment is not carried out [17]. A recommendation of extraction should therefore come with an explanation of whether saving the tooth was possible and why it was ruled out.
You are not obliged to accept a recommendation on the spot. Asking for the reasoning, asking for a written plan covering both options with costs, and taking time to think are all consistent with the consent process rather than obstructive to it. If you want a further opinion, you are free to seek one.
Frequently asked questions
Is it better to have a root canal or an extraction?
Root canal treatment is generally better when enough sound tooth structure remains to rebuild the tooth, because keeping a natural tooth preserves the root, the surrounding bone and your existing bite. Extraction is better when the tooth is fractured below the gum, severely decayed, or has lost too much supporting bone to be reliably restored.
Is an extraction cheaper than a root canal on the NHS?
No. In England both root canal treatment and extraction are Band 2 treatments charged at £76.60 from April 2026, so they cost the patient exactly the same [1]. In Scotland and Northern Ireland, where you pay 80% of the fee up to a £384 cap, a root canal usually costs more. In Wales the two sit in different care packages.
How long does a root canal tooth last?
Peer-reviewed research puts survival at 87% eight to ten years after non-surgical root canal treatment in a pooled review of 14 studies [10], and at 93% at ten years in a cohort of 1,175 treated teeth [11]. Placing a crown afterwards significantly improves the odds of the tooth surviving.
Can I just leave the gap after an extraction?
Sometimes, particularly for a back molar with a stable neighbouring tooth. Research shows adjacent teeth tip and move into an extraction space [14], and the ridge bone resorbs once the root is gone [13]. Discuss with your dentist whether your particular gap needs replacing or can safely be left.
Does the NHS do root canal treatment on back teeth?
Yes. NHS.uk lists root canal treatment as a Band 2 item without restricting it by tooth position [2]. Molars have more root canals and take longer, so treatment may involve more appointments or a referral, but the patient charge in England remains the Band 2 fee of £76.60.
Is a root canal more painful than an extraction?
Neither should hurt during the procedure, because both are carried out under local anaesthetic. NHS.uk states that with root canal treatment you "will be awake but will not feel any pain" [5]. Afterwards, root canal soreness typically settles within a couple of weeks [5], while extraction discomfort tends to peak earlier and then improve.
What if I cannot afford the treatment my dentist recommends?
Check first whether you qualify for free NHS treatment, which covers under-18s, pregnancy and the 12 months after birth, and several qualifying benefits [3]. If not, the NHS Low Income Scheme may cover part of the cost through an HC3 certificate [4]. Ask your practice about staged treatment plans as well.
Do I have to have a crown after a root canal?
Not always, but it is strongly advised for back teeth. The pooled evidence identifies a crown placed after root canal treatment as one of four factors that significantly improve long-term tooth survival [10]. Ask whether the crown is part of the same NHS course of treatment, because that determines the total charge.
Making the decision
Ask your dentist three questions. Is this tooth restorable, and if not, what specifically rules it out? If we save it, what does the full plan cost, including any crown, and is that one course of treatment or two? If we take it out, what would you recommend for the gap, and what does that cost?
With those three answers you can make the decision on the facts rather than on fear or on an assumption about which option is cheaper. In England, on the NHS, cost is not the deciding factor, because both treatments carry the same charge. Everywhere in the UK, the state of the tooth is.
If you need a dentist to give you that assessment, search for a dentist near you on Dentists Closeby and compare GDC-registered practices in your area. Our guide to finding a good dentist covers what to look for.
Sources
- How much NHS dental treatment costs -- NHS.uk, last reviewed 13 March 2025, charges effective 1 April 2026, accessed 2026-07-27
- What is included in each NHS dental band charge -- NHS.uk, last reviewed 13 March 2025, accessed 2026-07-27
- Who can get free NHS dental treatment -- NHS.uk, last reviewed 11 February 2025, accessed 2026-07-27
- Get help with dental costs -- NHS.uk, last reviewed 11 February 2025, accessed 2026-07-27
- Root canal treatment -- NHS.uk, last reviewed 3 October 2025, accessed 2026-07-27
- NHS dental charges and exemptions -- GOV.WALES, last updated 1 April 2026, accessed 2026-07-27
- New contract will improve access to NHS dentistry -- GOV.WALES, published 23 September 2025, accessed 2026-07-27
- Receiving NHS dental treatment in Scotland -- NHS inform, last updated 7 January 2026, accessed 2026-07-27
- Dental charges and fees -- Business Services Organisation, HSC Northern Ireland, accessed 2026-07-27
- Tooth survival following non-surgical root canal treatment: a systematic review of the literature -- Ng YL, Mann V, Gulabivala K, International Endodontic Journal, March 2010, 43(3):171-89, accessed 2026-07-27
- The prognosis of root canal therapy: a 10-year retrospective cohort study on 411 patients with 1175 endodontically treated teeth -- Fonzar F, Fonzar A, Buttolo P, Worthington HV, Esposito M, European Journal of Oral Implantology, Autumn 2009, 2(3):201-8, accessed 2026-07-27
- Principles guiding the restoration of the root-filled tooth -- Patel SR, Youngson C, Jarad F, British Dental Journal, 11 April 2025, 238(7):508-516, accessed 2026-07-27
- Alveolar ridge resorption after tooth extraction: a consequence of a fundamental principle of bone physiology -- Hansson S, Halldin A, Journal of Dental Biomechanics, 16 August 2012, 3:1758736012456543, accessed 2026-07-27
- Three-dimensional analysis of the physiologic drift of adjacent teeth following maxillary first premolar extractions -- Teng F, Du FY, Chen HZ, Jiang RP, Xu TM, Scientific Reports, 2019, 9:14549, PMID 31601925, accessed 2026-07-27
- Dental statistics, England 2024/25 -- NHSBSA, published 28 August 2025, updated 27 March 2026, accessed 2026-07-27
- 13 million unable to access NHS dentistry -- British Dental Association, reported 2024, accessed 2026-07-27
- Standards for the Dental Team, Principle 3: Obtain valid consent -- General Dental Council, accessed 2026-07-27
