Definition

A tooth extraction is a procedure to remove a tooth from the gum socket. It is usually done by a general dentist, an oral surgeon, or a periodontist.

Alternative Names

Pulling a tooth; Tooth removal

Description

The procedure will take place in the dental office or hospital dental clinic. It may involve removing one or more teeth. You may be asked to take antibiotics before the procedure.

• You will get a local anesthetic to numb the area around the tooth so you do not feel pain.
• Your dentist may loosen the tooth in the gum using a tooth removal instrument called an elevator.
• Your dentist will then place forceps around the tooth and pull the tooth out from the gum.

If you need a more complex tooth extraction:

• You may be given sedation so you are relaxed and asleep, as well as an anesthetic so you are pain-free.
• The surgeon may need to remove several teeth using the methods above.
• For an impacted tooth, the surgeon may have to cut a flap of gum tissue and remove some surrounding bone. The tooth will be removed with forceps. If it is hard to remove, the tooth may be sectioned (broken) into pieces.

After your tooth is removed:

• Your dentist will clean out the gum socket and smooth out the bone that is left.
• The gum may need to be closed with one or more stitches, also called sutures.
• You will be asked to bite down on a damp piece of gauze to stop the bleeding.

Why the Procedure Is Performed

There are several reasons people have a tooth pulled:

• A deep infection in a tooth (abscess)
• Overcrowded or poorly positioned teeth
• Gum disease that loosens or damages teeth
• Tooth injury from trauma
• Impacted teeth that are causing problems, such as wisdom teeth (third molars)

Risks

While uncommon, certain problems may occur:

• The blood clot in the socket falls out days after the extraction (this is known as dry socket)
• Infection
• Nerve damage
• Fractures caused by instruments 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 relief of pain
• Reaction to local anesthesia or other medicines given during or after the procedure
• Slow healing of wounds

Before the Procedure

Tell your dentist about any medicines you take, including over-the-counter medicines, and about 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 prone to infection. These may include:

• Heart disease
• Liver disease
• Weakened immune system
• Recent surgery, including heart surgery and bone and joint procedures that involve metal hardware

After the Procedure

You may go home shortly after the procedure.

• You will have gauze in your mouth to stop the bleeding. This will also help a blood clot to form. The clot fills the socket as the bone grows back in.
• Your lips and cheek may be numb, but this will wear off in a few hours.
• You may be given an ice pack for your cheek area to help keep swelling down.
• As the numbing medicine wears off, you may begin to feel pain. Your dentist will recommend pain relievers, such as ibuprofen (Motrin, Advil). Or, you may be given a prescription for pain medicine.

To help with healing:

• Take any antibiotics or other medicines as prescribed.
• 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 a cold pack. Do not place ice directly on the skin.
• Avoid doing too much physical activity for the first couple of days.
• Do not smoke or use tobacco.

When eating or drinking:

• Chew on the other side of your mouth.
• Eat soft foods such as yogurt, mashed potatoes, soup, avocado, 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 disturb 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 your surgery.
• Avoid the area near the open socket for at least 3 days. Avoid touching it with your tongue.
• You may rinse and spit starting about 3 days after surgery. Your dentist may ask you to gently wash out the socket with a syringe filled with water and salt.
• The stitches may loosen (this is normal) and will dissolve on their own.

Follow up:

• Follow up with your dentist as directed.
• See your dentist for regular cleanings.

Outlook (Prognosis)

Everyone heals at a different rate. It will take 1 to 2 weeks for the socket to heal. Affected bone and other tissue may take a bit longer to heal. Some people may have changes to the bone 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 out (dry socket) days after the extraction, causing pain
• Rash or hives
• Cough, shortness of breath, or chest pain
• Trouble swallowing
• Other new symptoms

References

Hall KP, Klene CA. Routine extraction of teeth. In: Kademani D, Tiwana PS, eds. Atlas of Oral and Maxillofacial Surgery. St Louis, MO: Elsevier Saunders; 2016:chap 10.

Hupp JR. Principles of routine exodontia. In: Hupp JR, Ellis E, Tucker MR, eds. Contemporary Oral and Maxillofacial Surgery. 7th ed. Philadelphia, PA: Elsevier; 2019:chap 8.

Melnick PR, Takei HH. Preparation of the periodotium 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:chap 69.