South Kensington
- 20 Old Brompton Road, London SW7 3DL
- Open seven days a week
- 020 7183 2362
Treatment comparison · Wimpole Street, Marylebone
Root canal or extraction: what to do with a tooth whose nerve has died
When decay or a crack reaches the nerve of a tooth, the pulp inside becomes inflamed or infected and the tooth begins to ache. Two things can be done. Root canal treatment removes the damaged pulp, disinfects the hollow inside the root and seals it, keeping the tooth. Extraction takes the whole tooth out in a single sitting but leaves a space that most people then want to fill. Which is wiser depends on how much sound tooth remains, the shape of the roots and how you weigh a higher fee now against a replacement later.
Decision guide
Which is right for you?
Choose Root canal treatment if…
- The crown of the tooth is largely intact, or can be rebuilt with a filling or crown once the infection is cleared.
- The roots are not fractured and the tooth is firm in its socket.
- You would rather keep your own tooth than begin the process of replacing it.
- You are prepared for one or two longer appointments and, for a back tooth, a crown.
Choose Extraction if…
- The tooth has cracked vertically or broken off at or below gum level.
- A previous root treatment has failed and re-treatment is unlikely to succeed.
- Severe gum disease has already loosened the tooth.
- You want the infection dealt with in a single visit and are happy to discuss a replacement afterwards.
At a glance
Side by side
| Feature | Root canal treatment | Extraction |
|---|---|---|
| What it does | Clears infected pulp from inside the tooth and seals the root | Removes the entire tooth, root included |
| Anaesthetic | Local; the tooth is numb throughout | Local; the area is numb throughout |
| Visits | Usually one or two, each around an hour or more | One |
| Afterwards | Mild tenderness for a few days; a crown is often advised on back teeth | Socket heals over one to two weeks |
| Effect on the jaw | Bone and neighbouring teeth stay as they are | Bone at the site shrinks; adjacent teeth may tilt into the gap |
| Fee at Wimpole Street | From £695 (front tooth) or £895 (molar) | From £250 simple; £450 complicated; £650 surgical |
| Follow-on cost | Crown if needed, from £995 | Implant from £2,950, bridge from £995 per unit or denture |
| How long it lasts | Many years, often for life, particularly when crowned | The gap is for good; replacements have their own lifespans |
| Best suited to | Restorable teeth with sound roots | Teeth that are cracked, hopelessly broken down or repeatedly infected |
In the chair
What the treatment involves
Root canal treatment
The dentist takes an X-ray to see the shape and number of roots, then numbs the tooth and isolates it with a small rubber sheet. An opening is made through the top of the tooth and each root canal is cleaned with fine flexible files and irrigated with disinfectant. Curved or narrow canals, common in molars, take longer, which is why a molar attracts a higher fee. Once clean and dry the canals are filled with a rubber-like material and the opening is sealed. Some teeth are completed in one sitting; others are dressed with an antibacterial paste and finished a week or two later. A back tooth is then normally crowned, because a root-treated molar is more prone to splitting under chewing load.
Extraction
After confirming on the X-ray that the tooth is not worth saving, the dentist numbs the gum and bone around it. Simple extractions involve loosening the tooth with steady pressure until it lifts free, typically in a few minutes. A tooth that has broken down, is brittle after an old root filling, or has curved roots may need to be divided or the gum lifted to reach it, which the fee schedule lists as complicated or surgical. You bite on gauze until a clot forms and are given advice on eating, rinsing and smoking. The socket knits over one to two weeks and the bone beneath remodels over the following months. If you want an implant, a bone graft at the time of removal may be suggested to keep the ridge full.
Fees
Cost and longevity at Wimpole Street
Root canal treatment at Wimpole Street will start at £695 on a front tooth and £895 on a molar, reflecting the extra time that multi-rooted teeth demand. A simple extraction starts from £250, rising to £450 where the tooth is complicated to remove and £650 for a surgical extraction.
The initial figures favour extraction, but the comparison changes once the gap is considered. A crown on a root-treated back tooth adds from £995, giving around £1,900 for a molar kept long term. A bridge starts from £995 per unit and a single implant from £2,950 before its crown, so extraction frequently costs more in the end. Where no replacement is wanted, for instance a wisdom tooth, extraction remains the cheaper choice.
All prices are indicative and are confirmed in a written treatment plan at your consultation. Fees are the same at every Medical & Dental clinic.
Weighing it up
Strengths and trade-offs
Root canal treatment
Strengths
- Your own tooth and root stay in place
- No gap to fill and no drifting of neighbours
- Jawbone at the site is maintained
- Chewing feels the same afterwards
- Well-established with a high long-term success rate
- Usually less to pay overall than extraction plus replacement
Trade-offs
- Higher fee at the outset
- Back teeth generally need a crown as well
- One or two longer appointments
- Not possible where the tooth is cracked or too broken down
- A small proportion need re-treatment later
Extraction
Strengths
- Lower fee on the day
- Resolved in a single short visit
- Removes the source of infection outright
- Sometimes the only option for a fractured tooth
- Prompt relief from severe pain
Trade-offs
- The tooth cannot be put back
- Bone shrinks where the root used to be
- Neighbouring and opposing teeth may move
- A replacement is usually wanted and adds cost
- One to two weeks of healing with a softer diet
FAQ
Common questions
Front teeth usually have a single, fairly straight canal. Molars have three or four, often curved and narrow, and each has to be located, shaped, disinfected and filled. The appointment is longer, which the fee reflects.
On a back tooth, almost always. Removing the pulp and the decay around it leaves the tooth hollower and drier, so it is more likely to split under chewing forces without a crown. Front teeth with little structural loss can sometimes be sealed with a filling alone.
After a root canal the tooth can feel bruised when you bite for two or three days and ordinary painkillers generally suffice. After an extraction the socket is sore for a few days and closes over one to two weeks; a softer diet is normal in that window.
Occasionally. If a canal was missed, the seal leaks or the tooth cracks later, bacteria can re-enter. Re-treatment or a small surgical procedure at the root tip can often rescue it; if neither is viable the tooth is removed at that stage.
A bridge or denture can be made once the gum has settled, usually a few weeks. An implant is generally placed around three months after removal so the bone can heal, although in favourable cases it can be placed at the same visit as the extraction.
Our South Kensington and St Paul’s clinics offer root canal treatment and extractions now, with the same clinicians and fee schedule. Wimpole Street opens on 1 October 2026 and can take over any follow-up.
Marylebone, W1
Wimpole Street opens 1 October 2026
Register your interest and we will contact you when the Marylebone diary opens. If you would rather not wait, the same clinicians can see you at South Kensington or St Paul's now.
Related treatments at Wimpole Street
Opening 1 October 2026
Wimpole Street is not yet seeing patients. Until then, please book or call our South Kensington clinic on 020 7183 2362 or our St Paul's clinic on 020 7183 3709. Questions about the new clinic: wimpolestreet@md.co.uk.
Until we open
Need an appointment before 1 October 2026?
The same clinical team already works from two other Medical & Dental clinics. Book at either one now and, if you prefer, move your ongoing care to Wimpole Street once the doors open.
St Paul's, City of London
- 5 Ave Maria Lane, London EC4M 7AQ
- Open Monday to Friday
- 020 7183 3709
