Extraction or root canal?
A tooth that hurts does not have to come out. If it can still be kept, a root canal removes the source of the infection and leaves your tooth in place on its own root. Extraction becomes the choice when the tooth can no longer be kept, and that is decided at the examination and on the x-ray.
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The answer in detail
The two options treat the same problem by two different routes. A root canal works inside the tooth. It cleans the inflamed or dead tissue out of its core, disinfects the canals, fills them, and seals the tooth from the top. Your tooth stays where it is, on its own root, held in the bone. An extraction takes the whole tooth out, root and all. It ends the pain at its source, but it leaves a gap behind.
Our principle: we protect your tooth before we think about extraction. Not out of stubbornness. A natural tooth on its own root has no exact substitute: it chews the way you are used to, it keeps the bone around it, and it stops its neighbours from drifting. Every replacement after an extraction, however well made, is an attempt to give back something you already had.
Does a tooth that hurts have to come out?
No, it does not. Pain usually means there is inflammation or infection, in the nerve inside the tooth or in the tissue around its root. It does not tell you whether the tooth can be kept. Many teeth that hurt this way are kept with a root canal, and the pain goes because its source is removed. Strong pain sometimes makes people say “just pull it and be done”, and that is understandable. But a decision made at the height of the pain lets the pain decide for you, and an extraction cannot be undone.
What the doctor looks at to decide
The decision is not about the tooth that hurts alone; it is about everything around it. The main things seen at the examination and on the x-ray:
- How much of the tooth is left above the gum. A filling or a crown needs something to hold on to. A tooth eaten by decay down below the gum is not the same as a tooth with deep decay but standing walls.
- Where the break is, if there is one. A break in the visible part of the tooth is one thing; a break running below the gum or into the root is another. The x-ray, sometimes more than one from a different angle, helps show how far it goes, and sometimes the answer is only confirmed on direct examination, because a cracked root cannot be seen by eye.
- The root itself. Its length, whether it is cracked, and whether it has been treated before. A sound root is what makes keeping the tooth possible.
- The bone and gum around it. A tooth needs bone and gum to hold it. If the bone has receded a long way or the tooth has become loose, the decision changes even if the nerve is treated.
- The infection or abscess. On its own, it is not a reason to extract, because cleaning the tooth from inside removes its source and lets the bone heal. What makes the difference is whether the infection keeps coming back after each treatment.
- Where the tooth sits and what it does. A front tooth that shows, a molar that chews, and a tooth with no partner in the opposite jaw each have a different calculation. Your general health and your medicines come into it too.
Everything about the two procedures themselves is on The tooth that hurts at night and Extractions and wisdom teeth. And the cost? It is discussed after the examination, and what decides it is explained on What decides the cost of your treatment.
When extraction becomes the choice
When the tooth can no longer be kept. Not when it hurts, and not when the treatment would take longer. These are the situations where extraction is the right choice for that tooth:
- A break that reaches below the gum. When the fracture line runs below the level of the gum and the bone, nothing clean is left to build on, and the bacteria in the mouth reach the break. In a limited number of cases, if enough root is left, there are ways to expose the break or bring the root up a little so the tooth can be kept. The examination decides whether your tooth is one of them.
- A root cracked along its length. A crack that runs down the root cannot be sealed. Bacteria get in through the split, and the bone around it starts to recede. It is often seen in teeth that were treated before and never crowned.
- Nothing left to build on. Wide decay that has eaten the tooth down below the gum, or a tooth that has broken several times before with little of it left. A root canal cleans the root, but the filling and the crown need a tooth to hold on to.
- An infection that returns after re-treatment. A root canal was done, the infection came back, the treatment was repeated, and it came back again. At that point the options narrow. Sometimes a small surgical step at the root tip is tried before extraction, if the tooth is worth it. Sometimes extraction is what protects the bone and the teeth beside it. The examination and the x-ray decide.
- Gum and bone that no longer hold it. This one has nothing to do with the nerve. Bone loss from advanced gum disease makes the tooth loose, and a tooth with no bone to hold it cannot be kept with a root canal.
A wisdom tooth is a case of its own. The question there is not “can it be kept?” but what it looks like on the x-ray, how close it sits to the nerve, and how often it gets infected. The detail is on Extractions and wisdom teeth.
In children the decision has other things to weigh: the child’s age, whether the tooth is a baby tooth or a permanent one, and the state of the tooth that is due to come through in its place. That is the doctor’s field, and it is decided at the examination. More on Children’s dentistry.
What you gain and what you lose with each
If the tooth is kept with a root canal
You keep your tooth: its root, its place, its bone, and your chewing as it is. What you lose is that it becomes weaker than before, usually needs a crown afterwards, a molar especially, and takes more than one step. And it can become infected again if bacteria get back in. All of that in detail, and how long it lasts afterwards, is in Your tooth after a root canal: how it stays with you.
If it is extracted
The source of the pain is removed in the same sitting, in one procedure that is usually done in a single visit. The site takes a few days to settle, and the gum closes over within a week or two. What you lose does not show on the same day: the gap that stays. The teeth beside it can tilt into it over time. The tooth opposite, in the other jaw, can drift down towards it. The bone where the tooth stood starts to recede, because there is no longer a root to hold it. And your chewing shifts to the other side.
That is why the gap needs replacing, with an implant, a bridge or a removable partial denture, and the examination decides which suits your tooth and its place. That is a road with its own steps and its own time. The decision about it is made before the extraction, not after, so the plan is complete from day one. The difference between an implant and a bridge: Implant or bridge: what actually differs. If you live abroad or are only in Amman for a stretch, say so first. An implant heals on its own clock, and that shapes what is realistic.
Seen that way, extraction looks like the shorter road. Once you count the replacement after it, it becomes the longer one. A root canal looks like the longer road, and it usually spares you the road of replacement. Not a rule for every tooth, but it is why keeping the tooth is the first thing we think about.
Why is the decision made at the examination, not over the phone?
Because everything that decides it is hidden: how much of the tooth is left under the decay, how far the break reaches, the shape of the root, and the bone around it. None of them can be seen by eye, described over the phone, or judged from photos sent from abroad. The examination and the x-ray show them. Then you hear whether your tooth can be kept, exactly what it needs, and why. And then you decide.
What to do from here
Depending on where you are:
- 1
Hurting now?Do not wait, and do not decide on an extraction from the pain. The earlier you come, the more chance there is that the tooth is kept rather than extracted, because over time the infection affects the bone around the root. Any painkiller is the doctor’s decision, not something to pick up on your own. And do not start an antibiotic on your own. Why it gets worse at night: The tooth that hurts at night. And what to do now, until your appointment: Toothache: what to do right now.
- 2
A piece of the tooth has broken off?Keep the piece if you can find it. Do not try to glue it back with any adhesive, do not chew on that side, and book the earliest visit you can. A break above the gum can often be repaired; a break that runs below it is the one that needs an x-ray to show how far it goes. And nobody can tell you which it is before seeing it.
- 3
Been told it has to come out, and want to be sure?You have every right to understand before you lose a tooth that does not come back. Book an examination and bring any x-ray you have, from here or from abroad. You hear whether it can still be kept or not, and why. And if the answer is that it really cannot be kept, you hear that with the same honesty.
- 4
Decided on the extraction?Ask about the replacement before the extraction, not after, so you know the whole road from its start. Mention any condition you have or medicine you take, diabetes, high blood pressure or blood thinners especially. Do not stop any medicine on your own, because the plan is arranged around it. And you leave the clinic knowing what to do on the first day.
- 5
Book an examinationIt settles everything above, and you decide after it, in your own time, with no pressure.
When to call
Whether you are still deciding, have just had a root canal, or had a tooth out a few days ago, these are the signs that should not wait:
- Call today: strong pain that is getting worse or wakes you at night, or pain that does not settle with the painkiller the doctor decided on.
- Call today: a swelling in the gum or the cheek, a small bump on the gum that leaks pus, a salty taste that does not go away, or a fever.
- Call today: a tooth has broken or become loose, or a temporary filling has fallen out of a tooth in the middle of a root canal.
- Call today: after an extraction, bleeding that does not stop with pressure on the gauze, or pain that started getting worse two or three days later instead of easing.
- Call this week: tenderness when you bite that has not eased a few days after a root canal, or a gum that is red or bleeds around the tooth.
- And not urgent, but do not put it off: a tooth extracted long ago, here or abroad, with the gap still empty and the teeth beside it starting to tilt. Book an examination, because the longer the replacement waits, the longer a road it becomes.
Call and we will find you the earliest slot, and tell you what to do until you arrive. If the swelling has reached your eye, or it has become hard to swallow or breathe, that is a hospital emergency, not an appointment. And if the clinic is closed and the swelling is growing or you have a high fever, or bleeding has not stopped with pressure on the gauze, go to the nearest hospital emergency department, and let us know as soon as we open.
And who treats you?
The clinic has a team of dentists, Dr. Adnan Alakhras among them. At the first visit you hear the state of the tooth, its roots, the gum around it and your bite. Usually you also hear whether it can be kept at all, before you hear any plan. Sometimes the answer needs a second x-ray. His qualifications are on his page: Read about the doctor and the clinic.
Questions people ask
Extraction or root canal?
It depends on the tooth, not on the pain. If it can still be kept, a root canal removes the source of the infection and leaves your tooth in place on its own root. If it can no longer be kept, extraction becomes the right choice for that tooth, with a replacement for the gap. That means a break that reaches below the gum, a cracked root, nothing left to build on, or an infection that returns even after re-treatment and its options. Our principle: we protect your tooth before we think about extraction. And the decision is made at the examination and on the x-ray, not over the phone.
Does a tooth that hurts have to come out?
No. Pain is usually a sign of inflammation or infection, not a verdict on the tooth. Many teeth that hurt are kept with a root canal, and the pain goes because its source is removed. What decides whether it can be kept is how much of it is left, the state of its root and the bone around it. Those are seen at the examination and on the x-ray, not felt in the pain. If you have been told it has to come out, bring any x-ray you have and you hear a straight answer either way. What to do until your appointment: Toothache: what to do right now.
Does it hurt?
Both are done under local anaesthetic. What you usually feel is pressure and work, not pain, and if you feel anything, you raise your hand and we stop. The pain that brought you in usually came from the infection, and either option removes its source. Afterwards, sensitivity or discomfort for a few days is normal and eases with the days. If it gets worse, you call. Any painkiller is the doctor’s decision. And if fear is the real problem, say so from the first moment and we go at your pace. When the visit is hard.
How long does it take, and how many visits? Can it be done in one trip to Amman?
An extraction is usually one visit. The gum closes over within a week or two, and the bone beneath takes longer. A surgical extraction takes longer in the same sitting. A root canal is usually one or two visits, then the final filling and the crown if it is needed, as separate steps you know about from the start. If the tooth is extracted, the replacement afterwards is a road of its own with its own time, and an implant heals on its own clock. So if you are travelling, tell us your dates before you book. All of it is set out for your case after the examination, as an expectation, not a promise.
If I have the tooth out, do I have to replace it?
Usually yes, unless the doctor decides with you that this particular gap does not matter, a wisdom tooth for instance. A gap left empty lets the teeth beside it tilt over time, the tooth opposite drift down, and the bone recede. The replacement is an implant, a bridge or a removable partial denture, and the examination decides which suits your tooth and its place. The difference between an implant and a bridge: Implant or bridge: what actually differs. And it is decided before the extraction, not after.
I have diabetes or high blood pressure, or take blood thinners. Can I have an extraction?
In many cases, yes, but the plan changes: coordination with your own doctor, sometimes preparation beforehand, and arrangements for bleeding and healing. Do not stop any medicine on your own. Mention every medicine you take at the first visit, because it plays into the decision between keeping the tooth and extracting it.
How much does an extraction or a root canal cost in Amman?
There is no number before the examination. What decides it: a simple extraction or a surgical one, a front tooth or a molar, one canal or three, and whether it needs a crown or a replacement afterwards. You hear every step by name before we begin, so you know what is included before anything starts, and any change is discussed before it is done, not after. What decides the cost of your treatment.
Your next step
The examination. You come in and you are examined, and you hear whether your tooth can be kept or not, exactly what it needs, what happens if you wait, and why. Then you decide, in your own time, with no pressure, whether you live around the corner or are planning a trip.
Pages that go with this one
This is general information, not a diagnosis of your case. The decision is made at the examination.