Tooth Extraction

WHY A TOOTH MAY NEED TO BE REMOVED

Decay that has gone too far. Where too little sound tooth remains to hold a filling or a crown, or where decay extends below the level of the bone, the tooth may not be restorable.

A tooth broken or cracked beyond repair. Particularly a vertical crack running down the root.

Advanced gum disease. When the bone supporting a tooth has been lost to the point where the tooth is loose and cannot be stabilised.

Infection that cannot be resolved. Where root canal treatment is not possible or has not worked, and surgery is not an option.

Wisdom teeth. Where they are impacted, repeatedly infected, decayed, or causing damage to the tooth in front.

Crowding, before orthodontic treatment. Occasionally a tooth is removed to create space so the remaining teeth can be aligned.

Baby teeth that will not come out on their own, or that are blocking an adult tooth coming through.

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THE TWO KINDS OF EXTRACTION

A simple extraction is used for a tooth that is fully visible in the mouth. The tooth is loosened in its socket with instruments and lifted out. It is done under local anaesthetic and is usually quick.

A surgical extraction is used where the tooth is not accessible in the usual way — a tooth that has broken at the gum line, a root left behind from an old extraction, or an impacted wisdom tooth still under the gum or bone. The gum is opened, a small amount of bone may be removed, and the tooth is sometimes divided into sections so that each piece can be removed through a smaller opening. Stitches are usually placed afterwards.

Dividing a tooth sounds more invasive than it is. It is generally the gentler approach, because it allows the tooth to come out without having to widen the socket.

 

WHAT HAPPENS DURING THE PROCEDURE

The area is numbed with local anaesthetic. You should feel pressure and movement, but not pain — and if you do feel anything sharp, more anaesthetic can be given.

Sedation or general anaesthesia may be used for complex surgical extractions, for several extractions at once, or for patients who are very anxious.

Afterwards, the socket is cleaned, any stitches are placed, and you are asked to bite on gauze to help a blood clot form. That clot is the beginning of healing and protecting it is the main aim of the first twenty-four hours.

 

HEALING, STEP BY STEP

The first 24 hours. A clot forms in the socket. Some oozing is normal. Swelling begins and usually peaks on the second or third day.

The first week. The gum begins to close over the socket. Discomfort steadily reduces. Any non-dissolving stitches are usually removed around a week afterwards.

The first month. The gum closes fully. The socket is still a hollow underneath, filling gradually.

Three to six months. Bone fills the socket. The ridge also changes shape during this period — it becomes somewhat narrower and lower than it was, which is normal and is worth knowing about if the tooth is going to be replaced later.

 

AFTERCARE

Your dentist will give you instructions specific to your case. Those below are the general principles.

On the day: bite firmly on the gauze for as long as you are told; do not rinse, spit forcefully or use a straw; avoid hot drinks, alcohol and exercise; rest with your head slightly raised.

Do not smoke. Smoking in the days after an extraction is the clearest avoidable risk factor for a painful complication called dry socket.

From the next day: gentle warm salt-water rinses, usually several times a day. Brush your other teeth normally and keep the socket clean but undisturbed.

Eating: soft food, cool or lukewarm, chewed on the other side.

Pain relief: ordinary painkillers are usually sufficient. Take advice on which, particularly if you take other medication.

Contact your dentist if: bleeding does not settle with pressure, pain increases rather than decreases after the third day, swelling worsens after day three, you develop a fever, or you cannot open your mouth properly.

 

DRY SOCKET

Dry socket is the most common complication after an extraction, particularly after lower wisdom teeth. It happens when the blood clot is lost from the socket too early, leaving the bone exposed.

It typically appears two to four days after the extraction as pain that is getting worse rather than better, often spreading towards the ear, with a bad taste or smell.

It is not an infection in the usual sense, and it is treatable: the socket is cleaned and a dressing placed, which usually relieves the pain quickly. Smoking, rinsing too vigorously too early, and using a straw are the recognised avoidable causes.

 

IF YOU TAKE MEDICATION OR HAVE A MEDICAL CONDITION

Some medication and some medical conditions affect how an extraction is planned, so your dentist needs to know about them beforehand.

Blood-thinning medication does not usually need to be stopped for a routine extraction, and stopping it carries its own risks — but your dentist needs to know you are taking it, and may want a recent blood test result.

Medication for osteoporosis or used in cancer treatment, particularly bisphosphonates and denosumab, affects how the jawbone heals after an extraction and must be disclosed, including if you took it in the past.

Diabetes, heart conditions, immune conditions and previous radiotherapy to the jaws all affect planning.

Bring a full list of your medication to your appointment, including anything you buy without a prescription.

 

REPLACING THE TOOTH

Not every extracted tooth needs replacing — a wisdom tooth, for example, generally does not. But where a tooth in the visible or chewing part of the mouth is removed, it is worth discussing replacement at the time rather than later, because the bone and the neighbouring teeth both change once a gap has been there for a while.

The options are an implant, a bridge or a denture, and there is also a procedure called socket preservation, where graft material is placed into the socket at the time of the extraction to limit the shrinkage that follows.

 

QUESTIONS PATIENTS ASK

Does it hurt? Not during the procedure, which is done under anaesthetic. You will feel pressure and movement. Afterwards, discomfort is usually manageable with ordinary painkillers and improves day by day.

 

How long does it take? A simple extraction is often a matter of minutes. A surgical extraction takes longer.

 

Can several teeth be removed at once? Yes, and it is often sensible to do so rather than repeating the recovery several times. How many is appropriate at one appointment depends on the case.

 

When can I eat normally again? Most people return to normal food within a few days to a week, starting soft and progressing as comfort allows.

 

When can I fly? Ask your dentist before booking, particularly after a surgical extraction.

 

Will I have a gap while it heals? Where appearance matters, a temporary replacement can usually be arranged.

 

What if I am very nervous? Sedation and general anaesthesia are both options for extractions, and this is worth raising before the appointment rather than on the day.

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