Definition
A tooth extraction is a procedure to remove a tooth from its gum socket. It is usually done by a general dentist, oral surgeon or periodontist.
Alternative names
Pulling a tooth; Tooth extraction
Description
The procedure will take place at the dentist’s office or the hospital’s dental clinic. It may involve the removal of one or more teeth. You may be asked to take antibiotics before the procedure.
- You will receive a local anesthetic to numb the area around the tooth so that you do not feel pain.
- Your dentist can loosen the tooth in the gum using a tooth removal tool called an elevator.
- Your dentist will then place forceps around the tooth and pull the tooth out of the gum.
If you need a more complex tooth extraction:
- You may be given sedation to keep you relaxed and asleep, as well as an anesthetic to keep you pain-free.
- The surgeon may need to remove many teeth using the above methods.
- For an impacted tooth, the surgeon may need to cut a flap of gum tissue and remove some of the surrounding bone. The tooth will be removed with forceps. If it is difficult to remove, the tooth may be chipped (broken) into pieces.
After your tooth is removed:
- Your dentist will clean the gum socket and smooth the remaining bone.
- The gum may need to be closed with one or more stitches, also called sutures.
- You will be asked to bite down on a wet piece of gauze to stop the bleeding.
Why is the process running?
There are several reasons why people pull a tooth:
- A deep infection in a tooth (abscess)
- Overcrowded or misaligned teeth
- Gum disease that loosens or damages teeth
- Traumatic tooth injury
-
Impacted teeth that cause problems, such as wisdom teeth (third molars)
Risks
Although uncommon, some problems can occur:
- The blood clot in the socket falls days after the extraction (this is known as a dry socket)
- Contamination
- Nerve damage
- Fractures caused by tools used during the procedure
- Damage to other teeth or restorations
- Bruising and swelling at the treatment site
- Discomfort or pain at the injection site
- Incomplete pain relief
- Reaction to local anesthesia or other drugs given during or after the procedure
- Slow wound healing
Before the Process
Tell your dentist about any medications you are taking, including over-the-counter medications, and your medical history. A tooth extraction can introduce bacteria into the bloodstream. So be sure to tell your dentist if you have or have had conditions that may make you susceptible to infection. These may include:
- Heart disease
- Liver disease
- weakened immune system
- Recent surgery, including heart surgery and bone and joint surgery involving metal material
After the Process
You can go home shortly after the procedure.
- You will have gauze in your mouth to stop the bleeding. This will also help a blood clot form. The clot fills the socket as the bone grows back in.
- Your lips and cheek may be numb, but this will go away in a few hours.
- You may be given an ice pack for your cheek area to keep the swelling down.
- As the numbing medicine wears off, you may start to feel pain. Your dentist will recommend pain relievers, such as ibuprofen (Motrin, Advil). Alternatively, you may be given a prescription for pain medication.
To help with healing:
- Take any antibiotics or other medications as directed.
- You can apply a cold compress 10 to 20 minutes at a time to your cheek to reduce swelling and pain. Use ice in a towel or cold pack. Do not apply ice directly to the skin.
- Avoid excessive physical activity for the first two days.
- Do not smoke or use tobacco.
When you eat or drink:
- Chew from the other side of your mouth.
- Eat soft foods such as yogurt, mashed potatoes, soup, avocados, and bananas until the wound heals. Avoid hard and crunchy foods for 1 week.
- Do not drink from a straw for at least 24 hours. This can disrupt the blood clot in the hole where the tooth was, causing bleeding and pain. This is called a dry socket.
To care for your mouth:
- Begin gently brushing and flossing your other teeth the day after surgery.
- Avoid the area near the open outlet for at least 3 days. Avoid touching it with your tongue.
- You can rinse and spit starting about 3 days after surgery. Your dentist may ask you to gently flush the socket with a syringe filled with water and salt.
- The stitches may loosen (this is normal) and will dissolve on their own.
I follow:
- Follow up with your dentist as directed.
- Visit your dentist for regular cleanings.
Outlook
Everyone heals at a different rate. It will take 1 to 2 weeks for the socket to heal. Affected bones and other tissues may take a little longer to heal. Some people may have changes in the bones and tissue near the extraction.
You should call your dentist or oral surgeon if you have:
- Signs of infection, including fever or chills
- Severe swelling or pus from the extraction site
- Continued pain several hours after extraction
- Excessive bleeding several hours after extraction
- The blood clot in the socket falls off (dry socket) days after extraction, causing pain
- Rash or hives
- Cough, shortness of breath or chest pain
- Difficulty swallowing
- Other new symptoms
bibliographical references
Hall KP, Klene CA. Routine tooth extraction. In: Kademani D, Tiwana PS, eds. Atlas of Oral and Maxillofacial Surgery. St Louis, MO: Elsevier Saunders; 2016: chapter 10.
Hupp JR. Principles of routine extraction. In: Hupp JR, Ellis E, Tucker MR, eds. Modern Oral and Maxillofacial Surgery. 7th ed.Philadelphia, PA: Elsevier; 2019: chapter 8.
Melnick PR, Takei HH. Period preparation for restorative dentistry. In: Newman MG, Takei HH, Klokkevold PR, Carranza FA, eds. Newman and Carranza’s Clinical Periodontology. 13th ed Philadelphia, PA: Elsevier; 2019: chapter 69.
