Millions of teeth are extracted every year and most dentists are doing everything possible to save teeth. But many patients feel that having a painful tooth extracted is the most economical way to solve their problem. Patients need to be told that if root canal treatment and restoration can be used to save the tooth; that getting the treatment is preferable over the long term to maintain their quality of life and ability to chew food. The patient’s own description of their pain is an important diagnostic aid. The diagnosis of pulp, periodontal tissue and dentin status should follow a consistent and logical order to ensure that a tooth is given the most appropriate endodontic treatment. A comprehensive endodontic examination is not restricted to a hot tooth and should be performed on all new and existing patients. The ideal radiograph will show the crown and cervical aspects of the tooth. Diagnosis is part science and part experience. Avoiding pitfalls will improve the success of endodontic treatment. There are appropriate and inappropriate endodontic treatments based on the pulp sensibility and differential diagnosis of the tooth. The best treatment plan is the one most likely to benefit the patient and provide them with the highest quality longest lasting endodontic care.