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. We also describe preparation and what to expect after the procedure.
- dental cavities
- gum disease
- dental infections
- trauma or injury to the tooth or surrounding bone
- wisdom teeth complications
- preparation for a dental prosthesis
- preparation for dental braces, if the teeth are very crowded
- baby teeth not falling out at the proper age
The right type of tooth extraction depends on the tooth’s shape, size, position, and location in the mouth. Dental surgeons may classify extractions as simple or surgical. A simple extraction involves a tooth that is visible above the gums and that a dentist can remove in one piece. A surgical extraction is more complicated and involves the removal of gum tissue, bone, or both. The surgeon may need to remove the tooth in pieces. Wisdom teeth are the last to erupt and usually the first to require extraction because in many people, they are impacted. This means that they have not fully emerged from the gums. Wisdom teeth extraction is a common procedure in oral surgery.
A person will have a consultation with their dentist or oral surgeon prior to the extraction. During the consultation, the doctor will ask for a thorough medical history. They will also ask about any medications that the person is taking. Some people need to stop or start taking certain medications in the days leading up to the surgery, depending on the amount of teeth, bone, or both to be removed. A person may also receive certain medications on the day of the surgery.
Stopping blood thinnersMany people take blood thinning medication to prevent the formation of blood clots in vessels. These medications can lead to more bleeding during surgery. A dental surgeon can usually control bleeding at the site of the extraction by:
- using topical clotting medications on the gums
- packing the tooth socket with foam or dissolvable gauze
- stitching up the extraction site
Starting antibioticsIn a few circumstances, a dentist may prescribe antibiotics before a tooth extraction. For example, they may do so to treat dental infections with widespread symptoms, such as a fever or malaise, along with local oral swelling. Toothaches without swelling do not require antibiotics. Always take antibiotics exactly as directed by a doctor, and avoid unnecessary use. A person may need antibiotics if they have a high risk of infective endocarditis, an infection of the heart valves or the interior lining of the heart chambers. According to the American Heart Association (AHA), people with certain heart conditions have an increased risk of developing this infection following dental surgery. The AHA and American Dental Association recommend, therefore, that people with any of the following take antibiotics prior to dental surgery to reduce the risk of infection:
- a prosthetic cardiac valve
- a history of cardiac valve repair with prosthetic material
- a cardiac transplant with structural abnormalities of the valve
- certain congenital heart abnormalities
- a history of infective endocarditis
Anesthesia during surgeryThe person will receive an injection of local anesthetic close to the site of the extraction. This will numb the area so that the person will not feel any pain. The numbness will continue for a few hours after the surgery. A person can request additional anesthetic or sedative medication to minimize anxiety during the procedure. The dentist or surgeon may offer:
- nitrous oxide, also known as laughing gas
- an oral sedative medication
- intravenous, or IV, sedation
- general anesthetic
Before starting the extraction, the surgeon will take an X-ray of the person’s tooth. This imaging will help them evaluate the curvature and angle of the tooth’s root. Once the local anesthetic has numbed the area, the surgeon will begin the extraction. They may remove the tooth in several pieces. If the tooth is concealed beneath gum tissue or bone, the doctor may need to cut away the gum or remove the obstructing area of bone. A person should not feel pain, but they can expect to feel pressure against the tooth. They may also hear grinding and cracking of bone or teeth. Some people find the experience unpleasant and distressing. If a person does feel any pain, they should notify their dentist or oral surgeon immediately. The doctor will administer more numbing agent. After the extraction, stitches or additional procedures to control the bleeding may be necessary. The dentist or surgeon will place a thick layer of gauze over the extraction site and have the person bite on it to absorb the blood and start the clotting process.
Below, find ways to help reduce discomfort and promote healing after a tooth extraction.
Changing dental gauzesFollowing an extraction, the dentist or surgeon will lay a thick layer of gauze over the site. Biting down on the gauze with firm, consistent pressure will help control bleeding. The gauze must remain in place for at least 20–30 minutes. The person will then need to replace the gauze whenever it becomes soaked with blood. The bleeding will likely continue for 1–2 days after the surgery.
Controlling painThe numbness from the local anesthetic should only last for a few hours following an extraction. Contact the dentist if the numbness persists. The dentist may prescribe medication to alleviate pain and inflammation after the procedure. Typically, though, over-the-counter medications such as acetaminophen or ibuprofen are enough to control the pain after a routine extraction.
Controlling swellingPeople may experience mild facial swelling in the area of the extraction. This is normal. Applying ice to the face may help alleviate the swelling.
Avoiding disturbing the extraction siteThe first 24 hours after an extraction are extremely important. Disturbing or irritating the area can keep blood clots from forming effectively and slow the healing process. People should therefore avoid:
- sucking on the extraction site
- touching it with their tongue
- using a straw
- eating solid — especially crunchy — foods
- rinsing the mouth vigorously
- drinking alcoholic beverages or using mouthwash that contains alcohol
Taking care when eatingAfter a tooth extraction, drink plenty of fluids and eat soft, nutritious foods. When chewing becomes comfortable again, slowly reintroduce solid foods. The dentist will recommend chewing on the side opposite from the extraction site until the wound has fully healed.
Brushing and flossingContinue to brush and floss as usual after a tooth extraction, but be careful not to disturb the blood clotting. Starting the day after surgery, people can also rinse every few hours with warm salt water. To make this, add half a teaspoon of salt to 1 cup of water.
One complication of tooth extraction is dry socket. This is not an infection — it involves bone in the area of the extraction becoming exposed, either because the blood has not clotted or because the clot has become dislodged. Dry socket can cause intense, radiating pain that usually starts a few days after the procedure. It can also cause bad breath. If a person has severe pain that starts 2–3 days after the surgery, they should speak to their dentist. Treatment will involve rinsing the area and placing medicinal paste on top of the exposed bone to protect it. People can usually prevent dry socket by following their dentist’s aftercare instructions — especially by not smoking after surgery. Infection is another complication, and it can occur when bacteria infect the gumline in and around the socket within 1–2 days after surgery. A person with any of the following symptoms of infection should contact their dentist:
- persistent swelling
- pus and redness in or around the site
- a fever
- swollen glands in the neck
The cost of a tooth extraction varies, depending on factors such as:
- where the person lives
- the type of extraction
- how complicated the extraction is
- who performs the procedure, as specialized oral surgeons usually charge more than general dentists, for example
Before having a tooth extracted, a person will meet with their dentist or oral surgeon to discuss the procedure. During this consultation, the doctor will take a full medical history. They will ask about past and ongoing health issues and treatments to ensure that the right safety measures are in place. The person should ask about costs and raise any concerns about additional sedation. Before extracting the tooth, the dentist or oral surgeon will numb the area with a local anesthetic. Although the procedure is not painful, it may cause discomfort. A person can do several things to help speed their recovery. Ultimately, it is crucial to avoid disturbing or irritating the extraction site. This will help the blood to clot and the wound to heal.