A tooth extraction (sometimes called “pulling a tooth”) is a dental surgical procedure where a tooth is removed from its socket. Dental extractions that can be done without making any incisions in the gums and without using any special techniques are often called “simple extractions.” Those that require more complex procedures are often referred to as “surgical extractions.”

There are many reasons one might need a tooth extraction. In this article, we will cover common reasons for tooth extractions, tooth extraction preparation tips, procedure information, tips for tooth extraction after-care, and potential procedure complications.

What are the most common reasons for tooth extraction? 

Reasons for extractions include, but are not limited to, the following:

• Tooth decay, when there is not enough solid tooth left to restore with a crown or filling
• Gum disease, when not enough bone is left around the tooth to support it
• Dying or dead tooth when a root canal cannot be performed or was unsuccessful
• A fractured tooth or trauma
• Infection
• Orthodontic treatment/crowding to allow adequate space for teeth to align
• Wisdom teeth removal 
• Baby teeth not falling out 

Tooth extraction preparation 

Consult with your dentist  to determine what to expect before, during, and after the extraction and what the options are to restore the missing tooth, if necessary.

Your dentist can determine from an exam and x-rays what procedures will be needed to remove the tooth. Some considerations are the amount of tooth structure remaining, the size and curvature of the roots, the tooth's position, and the amount of bone around it.

If a surgical extraction is needed, you might be referred to an oral surgeon. It is possible that you might need to stop or start taking certain medications in preparation for your tooth extraction. For example, blood thinners can prevent clotting, which is essential for successful healing and recovery. Your dentist might also start you on antibiotics if you’re at high risk for infection. 

Sedation or anesthesia options

Besides local anesthesia to numb the area, most oral surgeons and some general dentists will offer sedation/general anesthesia for people who have dental anxiety, or for more difficult and complicated extractions.  Options include:

• Nitrous Oxide (laughing gas) – Gas delivered through a mask providing light sedation. (You can drive yourself home from the appointment.)
• Oral conscious sedation – Sedation provided in pill form to relieve anxiety. This can be used in combination with nitrous oxide or IV sedation. (You will need someone present to drive you home.)
• Intravenous (IV) sedation – Sedative and pain medications are delivered directly into your bloodstream through an IV line, and there is usually very little memory of the procedure. (You must have someone to drive you home after the appointment.)
• General anesthesia – More complex cases are often done in a hospital setting or a well-equipped outpatient facility with appropriately trained and certified staff. Oral and maxillofacial surgeons typically receive extensive training in all forms of sedation and anesthesia.

Tooth extraction procedure

1. Numbing the tooth extraction area

First, you will receive local anesthesia to numb the tooth and gum area. For a simple extraction, the dentist will use special instruments to loosen the tooth and remove it from the socket. For more complex surgical extractions, you may first be given sedation or general anesthesia. This will relax you and make you more comfortable during the procedure.  

2. Inspecting to plan for the procedure

If a tooth is covered by gum tissue and sometimes bone as well, it is considered to be “impacted” and the procedure will be more difficult. For this type of extraction, the surgeon will need to incise (cut) the gum to expose the tooth and may need to remove some of the bone or divide the tooth into sections to allow for easier removal. Sutures are usually placed to replace the gum tissue and close the extraction site.

3. Removal of the tooth/teeth

A tooth extraction should not be painful. However, you should expect to feel pressure as the tooth is being extracted. If you do feel any pain, however, you should alert your dentist or oral surgeon immediately.

4. Placing bone graft

In some cases, a dental bone graft material may be placed in the tooth socket to preserve the remaining jawbone. 

5. Post-extraction

After the extraction, you will be asked to bite on a layer of gauze that will be placed over the spot where the tooth was extracted, to control the bleeding.

Tooth extraction aftercare

It is crucial that you take steps to keep the area of extraction clean and prevent infection. The type of aftercare and the number of post-operative symptoms you may experience can vary based on several factors, particularly the complexity of the extraction and the need to remove bone or section the teeth. The following are some common aftercare tips:

1. Apply pressure

Bite down firmly, but gently, on the gauze packs that have been placed over the surgical areas. Ensure the gauze remains in place, undisturbed for 30 minutes, then reapply clean gauze until the bleeding has stopped. Bleeding will usually stop within an hour or two, although you may experience some oozing for the next day or two.

2. Alleviate pain and inflammation

Use over-the-counter medications to relieve pain and inflammation.  Contact your  dentist or oral surgeon if pain increases, so they may also provide a prescription for other pain medication.

3. Avoid disturbing the blood clot

Avoid rinsing your mouth or spitting the first day to avoid disturbing the blood clot that forms in and protects the tooth socket. Protecting the blood clot is key to the initial healing process. 

4. Apply ice 

Apply cold packs to your face to lessen facial swelling. Keep it on for 15-20 minutes at a time, take a break, and repeat for 48 hours after surgery. 

5. Avoid irritating the extraction site

Avoid brushing and flossing around the area of extraction on the first day. 

6. Rinse with salt water

Rinse your mouth every few hours with warm salt water (a teaspoon of salt in an 8-ounce glass of warm water) starting the day after surgery. On the second day, you can also start brushing your teeth, even those close to the extraction site. Keep the surgery site as clean as possible. 

7. Stick to liquids and soft foods

Stick to liquids and soft foods for the first 24 hours after to avoid irritating the extraction site. Avoid foods or drinks that are very hot or cold.

8. Stay hydrated

Drink more water and eat soft foods. Don’t use drinking straws for the first week. The suction may disturb the clot. Sleep with your head slightly propped up instead of flat.

9. Rest

Rest and avoid heavy lifting and strenuous activities for at least two days.  

What are the potential complications of a tooth extraction? 

While tooth extraction is considered to be a safe and low-risk procedure, there are potential complications that you should be aware of. 

• It is possible that you could develop a dry socket, which is caused by either the blood not clotting, or the clot becomes dislodged. If you develop severe, radiating pain two to three days after the surgery, you should contact your dental provider for treatment. 
• Infection is also another potential complication. This occurs when bacteria infect the extraction area one to two days after surgery. 
• Understand that nerve injury when removing impacted molars can result in some residual numbness. 
• Know that perforation of the maxillary sinus could occur when removing upper molars.

You can help prevent some of these complications by following your dentist’s aftercare instructions. Your dentist might schedule a one-week follow-up appointment to ensure that the site of extraction is healing properly. Most likely, you will recover in a week or less. However, the spot where your tooth was extracted will heal and fill in with new bone during the next few months. If you experience continuing pain, follow up with your dentist right away.

A tooth extraction might be done for many reasons and presents varying degrees of difficulty. However, with modern dental techniques, your dentist or oral surgeon will strive to provide a safe, comfortable, and relatively painless procedure. It’s important to have a dentist or oral surgeon you feel comfortable and confident with for your extraction. Find an in-network dentist using our find a dentist tool and our cost estimator to estimate how much your extraction could cost. 

Sources:

^{1. Archibald, Jennifer. Caporusico, Jessica. What to know about tooth extraction. (2019, November 30) from https://www.medicalnewstoday.com/articles/327170}

^{2. Tooth Extraction: Simple vs. Surgical Tooth Removal. (2019, June) from https://myoms.org/what-we-do/extractions-and-dentoalveolar-surgery/simple-vs-surgical-extraction/} 

^{3. Extractions (n.d.) from https://www.mouthhealthy.org/all-topics-a-z/extractions}