Tooth Extraction

A tooth extraction is the removal of a tooth.

An oral surgeon, not a dentist, may extract a tooth when the situation is more complicated. In many cases, they extract third molars or wisdom teeth.

The dentist or surgeon will numb the tooth first to make the person more comfortable. While a tooth extraction may still be unpleasant, it can be key for relieving dental pain and preventing future problems.

In this article, we outline the different types of tooth extraction and why people need them.

Reasons for Extraction

Severe Tooth Damage/Trauma: Some teeth have such extensive decay and damage (broken or cracked) that repair is not possible. For example, teeth affected by advanced gum (periodontal) disease may need to be pulled. As gum disease worsens, the tooth — supported by less surrounding bone — often loosens to such an extent that extraction is the only solution.

Malpositioned/Nonfunctioning Teeth: To avoid possible complications that may result in an eventual, negative impact on oral health, your dentist may recommend removing teeth that are malaligned and/or essentially useless (teeth that have no opposing teeth to bite against).

Orthodontic Treatment: Orthodontic treatment, such as braces, may require the removal of teeth to make needed space for improved teeth alignment.

Extra Teeth: Also referred to as supernumerary teeth, extra teeth may block other teeth from erupting.

Radiation: Head and neck radiation therapy may require the extraction of teeth in the field of radiation in order to help avoid possible complications, such as infection.

Chemotherapy: Chemotherapy weakens the immune system, increasing the risk of tooth infections, heightening the risk of extraction.

Organ Transplant: Immunosuppressive medications prescribed after organ transplantation can increase the likelihood of tooth infection. As such, some teeth require removal prior to an organ transplant.

The Two Types of Extraction

Simple Extractions: These are performed on teeth that are visible in the mouth. General dentists commonly do simple extractions, and most are usually done under a local anesthetic, with or without anti-anxiety medications or sedation.

Surgical Extractions: These involve teeth that cannot easily be seen or reached in the mouth, either because they have broken off at the gum line or they have not fully erupted. Performed by dentists or oral surgeons, surgical extractions require some type of surgical procedure, such as bone removal, removing and/or lifting and folding back all or part of the gum tissue to expose the tooth, or breaking the tooth into pieces (called tooth sectioning). Surgical extractions can be done with local anesthesia and/or conscious sedation. Patients with special medical conditions and young children may receive general anesthesia.

Prior to a extraction, your dentist or oral surgeon will discuss your medical and dental histories and take X-rays. Some dental professionals will prescribe antibiotics to be taken before and after surgery. Antibiotics are more likely to be given to patients with infection or weakened immune systems at the time of surgery, those undergoing longer surgeries, or young or elderly people.

To avoid possible complications, inform your dentist about all the medications you are taking. For example, aspirin slows the blood-clotting process; gingko biloba and ginseng also affect clotting.

What to Expect During Treatment

At the extraction appointment, your dentist will numb, or anesthetize, the tooth to be extracted, as well as the jawbone and gums surrounding it. Typically, a local anesthetic such as novocaine or lidocaine is injected to eliminate discomfort.

Simple Extraction: Your dentist will grasp the tooth with specialized pliers called extraction forceps and move them back and forth to loosen the tooth before removing it. Sometimes, a surgical cutting instrument called a luxator — which fits between the tooth and the gum — is used to help loosen the tooth. Dentists also use “elevators,” which are levers that look similar to small screwdrivers. Usually a dentist will first use an elevator to wedge between the tooth and the surrounding bone. The elevator places pressure on the tooth, which helps to expand the tooth’s socket and separate its ligament.

Surgical Extractions: These procedures generally are more complicated, so your dentist may sedate you before numbing your tooth, then use a dental drill, apply pressure to your tooth with an elevator or extraction forceps, and remove your tooth. Greater surgical effort may be needed in other cases. For instance, gum and/or bone tissue may cover or surround a tooth in a way that makes it difficult for your dentist to view and/or access it. If so, your dentist will need to cut and lift back or remove this tissue. Sometimes a tooth is so firmly anchored in its socket that your dentist must cut the tooth into pieces in order to remove each portion individually.

Your dentist may need to place stitches and/or add bone (natural or synthetic) in the extraction site after the procedure. Some stitches are absorbable and will disintegrate on their own; others require removal by your dentist, usually about a week after surgery.

Aftercare

Since bleeding is normal after an extraction, your dentist will have you bite on a piece of gauze for about 45 minutes to put pressure on the area and allow the blood to clot. Some swelling and discomfort are normal after treatment.

Other aftercare tips include:

Do not rinse your mouth for the first 24 hours immediately following treatment.

Stick to a soft or liquid diet (milk, ice cream, mashed potatoes, pudding) the day of and the day after a tooth extraction, gradually progressing to eating other easy-to-chew foods. Chew with teeth that are far from the extraction site.

Brush and floss the other teeth as usual, but avoid the teeth and gum next to the extraction socket.

After the first 24 hours, for at least five days after extraction, gently rinse the socket with warm salt water (1/2 teaspoon of salt in a cup of water) after meals and before bed.

Things to Avoid After Treatment

In addition to the aforementioned aftercare considerations, it’s also important to avoid certain foods and activities.

Avoid anything that might dislodge the blood clot and delay or prevent normal healing.

Do not smoke, vigorously rinse or spit, engage in strenuous activities, or drink through a straw for at least two days after an extraction.

Healing Time

Healing from a tooth extraction takes about five to seven days. The gum area should be fully healed in three to four weeks. If the jaw is damaged, full healing may take up to six months.