Tooth Extraction

Tooth extraction is a dental surgical procedure in which a tooth is completely removed from its socket in the jawbone.

Each tooth is held in place by a ligament (a tough band of tissue) that connects it to the surrounding bone. During an extraction, the dentist loosens this ligament and the bone around the tooth, then lifts the tooth out. Simple extractions are done on teeth that are visible in the mouth. Surgical extractions are used when a tooth is broken at the gum line, has not fully come through the gum, or has curved roots that make removal more complex.

A dentist recommends tooth extraction when a tooth cannot be saved by other dental treatments such as fillings, root canal therapy (cleaning and sealing the inside of a tooth), or a crown (a cap placed over a damaged tooth).

• Severe tooth decay (cavities) that has destroyed most of the tooth structure
• Advanced gum disease (periodontitis) that has loosened the tooth from the bone
• A cracked or broken tooth that cannot be repaired
• An impacted wisdom tooth — one that is stuck under the gum or growing at an angle that causes pain, infection, or damage to nearby teeth
• A baby tooth that has not fallen out on its own and is blocking a permanent tooth from coming in
• Overcrowding — too many teeth for the jaw, often before orthodontic treatment (braces or aligners)
• A tooth that has become infected and the infection cannot be controlled with antibiotics or a root canal
• Preparation for radiation therapy to the head or neck area, which may require removing teeth in the treatment field

Extraction is not always the right choice. Dentists generally try to save natural teeth first. It may not be suitable in certain situations.

• Active, uncontrolled infection that has spread widely — the infection may need to be treated first
• Blood-thinning medications or clotting disorders that have not been assessed and managed before the procedure
• Recent heart procedures or certain heart conditions — the dentist and cardiologist (heart specialist) will coordinate care
• Bisphosphonate medications (used for bone conditions) taken over a long period — these can affect jawbone healing and require specialist assessment

Tooth extraction is a common procedure and serious complications are uncommon, but as with any surgical procedure, some risks exist.

• Pain and swelling around the extraction site for several days after the procedure
• Bleeding that lasts longer than expected — usually controlled by biting on gauze, but occasionally needs further treatment
• Dry socket (alveolar osteitis) — a painful condition where the blood clot that forms in the socket is lost or dissolves too early, leaving the bone exposed; more common after lower wisdom tooth removal
• Infection at the extraction site, which may require antibiotics
• Temporary or, rarely, lasting numbness or tingling of the lip, chin, or tongue if a nearby nerve is disturbed — this is more of a concern with lower wisdom teeth
• Damage to neighbouring teeth, fillings, or dental work during the procedure
• A small piece of tooth root left behind, which may need a follow-up procedure if it causes problems
• Sinus communication (an opening into the sinus cavity above upper back teeth) — usually heals on its own but sometimes needs repair
• Allergic reaction to the local anaesthetic (numbing injection) — rare

For a straightforward extraction done under local anaesthetic (a numbing injection), fasting is usually not required. However, if the dentist plans to use sedation (medication that makes you relaxed and drowsy) or general anaesthesia (medication that puts you fully to sleep), you will typically be asked not to eat or drink for several hours beforehand. Your dentist or the treating team will give you specific instructions.

Before the appointment, tell your dentist about all medications you take, including blood thinners, diabetes medications, and any supplements or herbal products. Some medications may need to be paused or adjusted by the prescribing doctor. Also mention any allergies, heart conditions, joint replacements, or previous reactions to anaesthetics. Smoking and alcohol can slow healing — most dentists advise stopping both for at least 24 to 48 hours before the procedure, and for longer afterwards.

Tests that are sometimes ordered before extraction include:

• Dental X-ray (periapical or panoramic) to see the full shape of the tooth roots and their relationship to nearby nerves and sinuses
• Blood tests to check clotting ability, especially if you take blood thinners or have a bleeding disorder
• A cone beam CT scan (a three-dimensional X-ray of the jaw) for complex impacted teeth — not always needed

On the day of the procedure, a typical sequence of steps is:

• 1. You are seated in the dental chair and your medical history is briefly reviewed.
• 2. The dentist injects local anaesthetic into the gum around the tooth. You will feel pressure but should not feel sharp pain. More anaesthetic can be given if needed.
• 3. For a simple extraction, the dentist uses an instrument called an elevator to loosen the tooth by rocking it gently within its socket.
• 4. Forceps (dental gripping tools) are then used to remove the tooth with a controlled back-and-forth motion.
• 5. For a surgical extraction — for example, an impacted wisdom tooth — the dentist or oral surgeon (a dentist who specialises in mouth surgery) may make a small cut in the gum, remove a small amount of bone if needed, and sometimes divide the tooth into sections to make removal easier.
• 6. Once the tooth is out, the socket is cleaned. Stitches (sutures) may be placed, especially after a surgical extraction. Many stitches dissolve on their own within one to two weeks.
• 7. Gauze is placed over the socket and you are asked to bite down gently to help a blood clot form.
• 8. The dentist gives you aftercare instructions before you leave.

Recovery from a simple extraction is usually quick — most people feel comfortable within a few days. A surgical extraction, especially of a wisdom tooth, may take one to two weeks for the gum to close and several weeks for the bone to fully remodel. Your dentist will tell you what to expect based on your specific situation.

• Bleeding: Some oozing in the first few hours is normal. Keep biting on gauze as directed. Avoid vigorous rinsing or spitting for the first 24 hours so the blood clot is not disturbed.
• Pain and swelling: Swelling often peaks around 48 to 72 hours after the procedure. A cold pack applied to the outside of the cheek in the first 24 hours can help reduce it.
• Eating and drinking: Stick to soft foods and cool or lukewarm drinks for the first few days. Avoid hard, crunchy, or very hot foods that could disturb the socket or cause pain.
• Smoking and alcohol: Both delay healing and increase the risk of dry socket and infection. Most dentists advise avoiding them for at least 72 hours, and ideally longer.
• Oral hygiene: Gentle tooth brushing can usually continue the day after, but avoid the extraction site for the first day or two. Gentle warm salt-water rinses are usually recommended after 24 hours to keep the area clean.
• Stitches: If non-dissolving stitches were placed, a follow-up appointment to remove them is usually scheduled within about a week.
• Activity: Strenuous physical activity in the first 24 to 48 hours can increase bleeding. Light activity is generally fine sooner.
• Warning signs to contact your dentist about: increasing pain after the third day (possible dry socket), fever, swelling that is spreading to the neck or face, difficulty opening the mouth, or persistent heavy bleeding.
• Tooth replacement: If the extracted tooth was a permanent adult tooth, your dentist will discuss options such as a dental implant, bridge, or removable partial denture to fill the gap — usually planned after the area has healed.