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Tooth Extraction: Things To Know

Updated: Jan 8

A tooth extraction is an irreversible surgical dental procedure that removes the entire tooth from the mouth. You will experience a lot of pressure, pushing, and pulling during the procedure but at least you'll be thoroughly numb for it. Don't forget that afterwards you still need to deal with the healing and also decide on a tooth replacement option.


Extraction socket with stitches
Extraction socket with stitches

Table of contents:


When is a tooth extraction needed?

Extractions are reserved as a last resort for when all other treatment options have failed or have a poor restorative prognosis. Believe it or not, your dentist would prefer to save your tooth and prevent it from being removed whenever possible. It is only when they no longer have an option that they have to do this procedure.


Conditions necessitating tooth removal:

  • Severe tooth decay. Untreated cavities will progress through the stages of tooth decay. If the decay starts to encompass more than 50% of the tooth, the restorative prognosis will start to decline.

  • Abscessed tooth. Severe infections may sometimes only be treated with an extraction.

  • Fractured tooth. A tooth that has broken down to the gum line cannot be saved.

  • Pulp inflammation. A tooth with severe irreversible pulpitis that is too costly to treat can be extracted.

  • Orthodontic reasons. Overcrowding may require teeth to be removed prior to putting on braces or Invisalign.

  • Severe gum disease. Untreated gingivitis will progress to periodontitis, which causes bone loss around the teeth. The teeth will start getting loose and fall out.

  • Trauma or accidents. Sports injuries or accidents can lead to tooth loss. If you need any convincing, take a look at how many teeth hockey players are missing.

  • Impacted teeth. In addition to the wisdom teeth, your regular teeth can be impacted as well. Both situations will require them to be removed, typically for hygienic purposes.

  • Financial reasons. There are times where a tooth can be saved with a root canal and a crown but due to financial constraints, the patient may opt for an extraction. Having a tooth pulled costs significantly less than saving it.


Who offers the treatment?

If you need a tooth extracted most dentists and some dental specialists would be able to do it for you. You can often find them at private dental practices, clinics, and hospitals.

  • General dentists

  • Oral maxillofacial surgeons

  • Periodontists (gum specialists)

  • Pediatric dentist (for baby teeth extractions only)


If you're having an emergency, it is unlikely for urgent care centers to have a dentist on staff. For emergency departments at the hospital in the middle of the night, only a select few are equipped to take out a tooth. Most of them aren't equipped to be able to do it.


 

What to expect for the procedure


Preparations prior to beginning treatment

There are a couple of items to go over with your dentist prior to the extraction. Depending on what you decide for these, it may change the course of treatment or require additional preparation.

  • Review medical history. Do you have a blood clotting disorder or are you taking any blood thinners? The former may require the procedure to be done at a hospital. The latter will require you to stop taking the blood thinners before getting the tooth pulled.

  • Premedication - do you have a health condition which requires antibiotic prophylaxis before dental work?

  • Sedation. If you're nervous or anxious, you may want to be sedated in addition to the local anesthesia for numbing.

  • Nitrous oxide. Also known as "laughing gas". You do not need a chaperone.

  • Oral conscious sedation. A prescription medication that you take by mouth about an hour prior to the procedure. It is usually one of the anxiolytics: diazepam, midazolam, triazolam, and lorazepam. You'll need a chaperone.

  • Intravenous (IV) sedation. You will be put to sleep via an IV line through the arm. you will definitely need a chaperone to take you home for this visit.

  • Replacement options. After the tooth gets extracted you will be missing a tooth. The question is what do you want to replace it with?

  • Tooth flipper. This is a temporary option to replace a missing tooth. You can think of it as a miniature partial denture that you can take in and out of your mouth at will.

  • Dental implant. This is a titanium screw that goes into the jaw and is the most favored way to replace your tooth. It is the most conservative treatment option however you may need a bone graft if you opt for it.

  • Dental bridge. Multiple crowns that are connected together. If you choose this option you will need to shave down the adjacent teeth. This is less conservative than an implant.


What happens during a tooth extraction

The entire tooth removal process can be explained in 7 simple steps and it should be painless. Despite your imagination, your dentist putting their knee on your chest for leverage is not one of the steps. If they need to do that then something is not going well with the procedure.

  1. Obtain consent. Read and sign consent forms. Last call for questions.

  2. Administer local anesthesia. Numbing gel applied first followed by lidocaine.

  3. Release PDL fibers. Sever the periodontal ligament fibers with a periosteal elevator.

  4. Elevate the tooth. Luxate and loosen the tooth with a dental instrument called a dental elevator.

  5. Deliver tooth with forceps. Grab the tooth with forceps and gentle remove it from the mouth.

  6. Curette socket. Clean out the inside of the socket by scraping the walls. This step removes any remaining abscesses and infections.

  7. Irrigate socket. Flush out the extraction hole to remove residual debris.


forcep techniques for tooth extraction
Credit: Anuj Jain

Surgical extraction

Difficult cases will require a surgical extraction in lieu of a routine one. Taking it out surgically typically involves cutting back the gums, drilling away bone, and sectioning the tooth into pieces.


Tooth extraction socket
Tooth extraction socket

Situations which require surgical removal:

  • Tooth breaks mid-procedure. Especially if the tooth gets broken down to the gum line you will be forced to undergo surgical removal. There is no tooth to grab at that point.

  • Tooth is not budging. Usually if after 5-10 minutes of elevation and there is no tooth movement at all, it is time to start drilling.

  • It is impacted. Impacted teeth automatically require flapping back the gums and drilling away the bone along with the tooth.


Afterwards you will most likely need stitches and antibiotics. The amount of sutures you need will depend on the size and complexity of the surgical site.


What happens after the tooth is removed

Immediately after the tooth is removed you can't just leave yet. There are a few things to do and items to go over prior to you going home.

  • Stitches. Not all tooth extractions require stitches but your dentist will decide if they are necessary. Some stitches dissolve on their own while others will require removal.

  • Stop the bleeding. The most effective way to stop the bleeding from the extraction hole is by using gauze. Bite down on the gauze with firm pressure and follow the instructions.

  • Post-operative instructions. Your dentist will review with you the dos and don'ts after a tooth extraction. You may not remember everything they tell you so they'll give you a written set of instructions as well.

  • Prescriptions. Last but not least you should be getting some pain medication and perhaps some antibiotics as well. The latter may not always be necessary so don't be surprised if you don't get any antibiotics after an extraction.


 

Risks and Benefits


Advantages for removing the tooth

Despite the procedure not being everyone's favorite option, it does come with a few benefits.

  • Instant pain relief. A raging toothache can cause extreme tooth pain that feels almost unbearable at times. The instant the tooth gets pulled out, you'll experience a breath of relief like a heavy burden has been lifted off of you.

  • Less costly alternative to root canals. Tooth nerve pain can even bring anesthesiologists down to their knees despite being the expert at pain management. If you can't afford a root canal because you don't have insurance, the only alternative left to alleviate the pain is by removing it.

  • Cures dental abscesses. Pulling a tooth out is one of the few ways to treat an abscessed tooth.


Potential complications

The vast majority of treatments are completed and heal without a hitch but sometimes complications do arise. Here is a list of potential ones you may experience:

  • Post-operative infection. The socket can always get infected during the healing process if you don't take care of it. You must do your very best to keep it as clean as possible.

  • Pop off adjacent crowns. If you have teeth with crowns that are next to the tooth to be extracted, sometimes they may come off during the procedure. If that happens your dentist will need to glue it back on. We've had this happen to us quite a few times which is why we tend to proceed more cautiously during the procedure when we see crowns.

  • Dry socket. A dry socket is an incredibly painful condition where the blood clot does not form. The cause is still not completely understood but smoking does increase the incidence. Thus, please do not smoke while you're recovering from the procedure.

  • Nerve injury. Injuring/damaging the nerve is more commonly associated with removal of impacted lower wisdom teeth. However it is still possible with certain other teeth as well. It is quite rare though.

  • Retained root tip. A piece of the root tip may get left behind.

  • Maxillary sinus perforation. Taking out upper molars always comes with the risk of puncturing through the Schneiderian membrane which leaves the sinus exposed. The root tips of the upper molars can be in close proximity to it.

  • Delayed healing. Slow healing is most commonly found in those with pre-existing health conditions. There are times where you may have undiagnosed disorders and you don't find out until after you get your tooth taken out.

  • Canker sores. The immense psychological stress of having to take out a tooth may induce the appearance of canker sores.

  • Trismus. Difficulty opening your mouth. The amount you can open may be limited.

  • Death. Incredibly rare but death is always a potential adverse outcome with any surgical procedure.

  • Bruising. Excessive bleeding can cause blood to pool and result in a bruise.


Expected side effects

Having a tooth taken out is a surgical procedure so some side effects are to be expected. Definitely not a walk in the park which is why you need to be fully aware of what it entails.

  • Bleeding. The procedure separates the tooth from your jaw bone. It would be unusual for you to have no bleeding at all. Imagine another body part getting removed.

  • Swelling. There should be some swelling with your gums, mouth and even the face. It is due to these reasons that a cold compress or an ice pack comes in handy.

  • Discomfort. We highly recommend taking the pain medication for at least the next 3 days. After that you can take it as needed if you have high pain tolerance. The pain should last for about a week or so.

  • Compromised chewing. You should try to chew more on the opposite side while the side with the extracted tooth is healing. This is to avoid discomfort and also to minimize food getting stuck in the hole.


 

Recovery


How long does it take to recover from a tooth extraction?

For a single tooth extraction you only need a day or two at most to recover from it and return to your usual activities. There will be residual discomfort and tenderness over the next 7 days but it should improve with each passing day.


Recovery timeline:

  • First Day. You should spend your time to rest and recover. Please abstain from all activities that are remotely strenuous such as exercise or physical labor.

  • Second Day. Most people can resume daily activities such as going to work. Although if you need an extra day to recover that is okay as well.

  • After a week. The vast majority should be fully functional at this point.

  • After the 3rd or 4th week. This is when the gums heal over and the extraction hole closes. You should've notice the hole getting smaller after each day.

  • After 3 months. Even after the hole closes the bone underneath will require several more weeks before it completely heals. However this second part of bone healing is not something you'd be able to see or even notice.


Note: If you get more than one tooth taken out, the recovery timeline will be impacted. We would add an extra day or two for each of the recovery phases.


When to return to work

You may return to work the next day if your job does not require heavy physical labor such as desk jobs or etc. Just remember to take things slowly and don't push yourself too hard as you're still healing. However if you feel like you need an extra day off then by all means take it since everyone is different.


If your job has a very physical component for it then we would advise you to return to work after two days of rest. Typically if you're in one of the construction sectors where you feel like you're huffing and puffing throughout the day. You should take an extra day of rest!


When can I exercise again?

You should abstain from exercising and working out for two days after having a tooth removed. Here are examples of what we mean:

  • Cardio

  • Heavy weightlifting

  • Anything that will get your your heart rate up.


However if you're an athlete and you need to train, you should still refrain from all strenuous exercises on the first day. You can slowly ease back into it the next day. However we would stick to lighter and less strenuous exercises. Rehab and prehab exercises would work better since they don't get your heart pumping. You probably don't do enough of those anyway!


Tooth extraction aftercare

Follow these extraction aftercare tips to maximize your healing. Delayed recovery may occur if you do not abide by these recommendations.

  • Take prescribed medications. If you were given antibiotics, make sure you finish the entire course of it. Also be sure to take your pain medication to alleviate the discomfort. Use the chlorhexidine rinse if you were prescribed it, it can reduce chances of dry socket.

  • Bite on gauze. You should be biting firmly onto the gauze for about 3 hours to stop the bleeding. Switch out to a new one every 30 minutes.

  • No smoking. Smoking can increase the chances of getting a dry socket. Please abstain for 3-7 days but quitting would be even better for your health.

  • Cold compress. Using an ice pack can help reduce the swelling. Alternate with 10-20 minutes on and 10-20 minutes off. Too much at once can give you frost bite.

  • No rinsing, no spitting, no drinking through a straw. All of these activities create a lot of pressure in the mouth which may dislodge the blood clot. If that happens you will have persistent bleeding from the socket.

  • Rinse with salt water. After 24 hours or the next day, you should start rinsing with salt water after every meal. Swish vigorously because it can help get out food that may be stuck in the extraction hole.

  • Rest for 24 hours. The first day is meant for rest so hopefully you picked out some good movies to watch after your procedure.

  • Eat soft foods. It'll be sore and tender to eat right after but it is important to get in nutritious food to speed up your healing.

  • Avoid strenuous activity for 48 hours. Definitely no heavy exercising for the first two days as it may induce bleeding. It is counter productive for stopping the bleeding if your heart is racing.


Nutrition during recovery

Let's be honest, the tooth removal process can be quite traumatic physically and emotionally. You may not be in the mood to eat very much afterwards but nutrition is important for your recovery. We will review the dos and don'ts in regards to your diet after a tooth extraction.


Foods to avoid

  • Require a lot of chewing. This includes baguettes or anything that is chewy like steak.

  • Small particle sized. Seeds, nuts, granola, chia seeds can easily get stuck in the extraction socket.

  • Hard foods. Avoid popcorn, crab legs, and anything hard because they require a lot of chewing force. Your jaw will be sore and tired from the procedure.


What can I eat?

Choose foods that are softer and easier to eat for the next 2-3 days. After that you can slowly reintroduce harder foods but go slowly to see what you can tolerate.

  • Yogurt

  • Mashed potatoes

  • Scrambled eggs

  • Avocados

  • Soft pasta

  • Soups

  • Apple sauce

  • Blended up food


What can I drink?

Please try to drink liquids that are nutritious and avoid the ones that aren't. Be sure to drink plenty of water to stay hydrated.


What you can drink:

  • Water

  • Smoothies

  • Soup


Drinks to avoid:


When can I resume brushing?

You may be excused from brushing on the night of having your tooth taken out. However you are expected to resume brushing and flossing in the morning after the procedure.


It may be a little sore and tender so you should do it gently around the surgical site. Keeping your mouth clean after the procedure is paramount to preventing infections and expediting healing. You do not want to end up with any complications because you did not keep it clean!


 

Cost


Tooth extraction with insurance

Most dental insurances will cover tooth extractions at about 80% which means your copay will be 20% of the total cost. However you should be aware that each plan is different so be sure to read the fine print of your contract.


We've seen some fortunate insurances which cover it at 100% and also some unfortunate ones that cover 50% or less. It all depends on the insurance that you signed up for.


Tooth extraction without insurance

The average cost of a tooth extraction without insurance is $210.40 and that is according to a national survey by the ADA. It may be higher or lower depending on the cost of living in your area.


However you should be aware that is the cost for a routine tooth removal. If the procedure becomes more complicated such as your dentist needing to drill away bone, it becomes a surgical one. The average cost of a surgical extraction without insurance is $325.38 and that is according to the ADA.


 

When to seek medical help

Most tooth extractions should heal uneventfully which is a good thing. However there are certain signs which you should look out for that may indicate a complication has occurred. You should call your dentist if you notice any of these.

  • Bleeding is not improving. You want to look for a trend in this case. If it looks like it is bleeding less every hour then you're on the right track. If there is no change at all then you've a complication.

  • Worsening pain after 3 days. Pain typically peaks after 48-72 hours of the procedure. If the pain is getting worse after that time, you most likely have a dry socket.

  • Sharp bone sticking out of the gums. If you start feeling something sharp coming out of your gums after 5-7 days, you may have a bony spicule. This will need to be smoothed down by your dentist or removed. Despite what you may think, it is not a leftover piece of your tooth!


Last but not least, most stitches are meant to dissolve. If you had them placed and they feel loose, it is usually okay. They're supposed to loosen up and get absorbed by the body after 10-14 days anyway. The only exception is if you had a bone graft placed. Those stitches are not meant to dissolve.


Aside from those instances above, the healing should go without a hitch. Most of the time, a follow up appointment isn't necessary. Although your dentist may give you one if the treatment was more complicated than usual. Please follow their instructions carefully!


That should cover most of things you should know about tooth extractions as per our dentists in Long island City.

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About the author: Dr David Chen, DDS

Hello, I'm Dr Chen and I'm an actively practicing dentist in Long Island City, NY. I graduated from Columbia University College of Dental Medicine in 2016 but prior to going to dental school I was already working in the dental field. It's been more than a decade since I first got to know dentistry and let me tell you, time flies by quickly. Since then I've developed a fondness for writing, which is how this all got started!

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Medical Disclaimer:

This blog is purely meant for information purposes and should not be used as medical advice. Each situation in your mouth is unique and complex. It is not possible to give advice nor diagnose any oral conditions based on text nor virtual consultations. The best thing to do is to go in person to see your dentist for an examination and consultation so that you can receive the best care possible.

The purpose of all of this oral health information is to encourage you to see your dentist and to inform you of what you may expect during your visit. Due to the unfortunate nature of dentistry, there isn't really any true home remedies that will get rid of dental problems. Roughly 99.99% of them require in-person intervention by a healthcare professional.

Hint: That is the reason why you can't eliminate seeing dentists in your life!

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