Tooth Extractions: Complete Guide

Tooth Extractions: Complete Guide

A tooth extraction is an irreversible dental procedure in which a tooth is removed from its socket in the jaw bone. This may be done to relieve dental pain, overcrowding of teeth, or for preventive reasons such as potential decay or gum disease. This article will give an overview of tooth extractions, what to expect before and after, potential risks and complications, and tips for a speedy recovery.

What is a Tooth Extraction?

Tooth extractions are seen by dentists as a “last resort” treatment option when a tooth cannot be saved by other forms of treatment, such as fillings, root canals, crowns, or bridges. The procedure is performed under local anesthesia and usually takes between 10-20 minutes, depending on the complexity of the extraction. In general, a tooth extraction will be recommended by a dentist if:

  • Severe Tooth Decay: If a cavity is not treated, the decay will continue to progress throughout the entirety of a tooth. As a general rule of thumb (although it may still be possible), when 50% or more of the tooth is gone, it may not be restorable.
  • Abscessed Tooth: In some cases, severe infections may need to be treated with a tooth extraction. However, there are other options.
  • Fractured Tooth: As a general rule of thumb (although it may still be possible to receive a filling), if a tooth is broken down to the gum line, it cannot be saved.
  • Overcrowding: Overcrowding of teeth (having a jaw that is too small to accommodate all your teeth) may require teeth to be removed before braces or Invisalign can be placed.
  • Severe Gum Disease: Advanced gum disease, known as periodontitis, can cause bone loss around the teeth resulting in loose teeth that may require extraction.
  • Impacted Teeth: Wisdom teeth or any other teeth can become impacted, which is when they do not fully come into the mouth. If this is the case, it can be difficult for patients to keep them clean which often results in the repeated buildup of bacteria. These teeth may need to be removed for hygiene purposes.
  • Financial Reasons: Unfortunately, the cost of tooth extractions often makes them an attractive choice to patients in situations where they are not the healthiest course of action. In situations where root canals and crowns can save a tooth, extraction may be chosen due to financial constraints.

What to Expect During a Tooth Extraction

Before the Procedure

Prior to the tooth extraction procedure, you will need to take X-rays as well as discuss some details about your health history and procedure preferences. This information will inform their decision-making and how the procedure will be performed. Common things to review include:

  • Medical History: Your dentist will want to know about any medical conditions you may have and if you take any medications that could interfere with the procedure. Blood Thinners, for example, can make it difficult to stop bleeding after the extraction and may require you to do the procedure in a hospital setting.
  • Anesthesia Preferences: Your dentist will discuss your anesthesia and sedation options and the best for your situation. These include nitrous oxide (laughing gas), oral or intravenous sedation. In general, tooth extractions can be done without anesthesia and are only usually recommended for nervous and anxious patients.
  • X-Rays: You will need to have X-rays taken of the area to get a better idea of the anatomy before proceeding with the extraction. Each extraction process is unique from the rest, and being able to visualize the tooth in the jawbone will help make the procedure as quick and painless as possible.
  • Discuss Replacement Options: You will also need to decide what replacement option you want for the extracted tooth, such as a tooth flipper, dental implant, dental crown, or dental bridge.

During the Procedure

The tooth extraction process is a relatively painless procedure that dentists perform. The general steps that a dentist will perform include:

  1. Confirm Consent: The dentist will confirm that you understand the risks and procedure and agree to it before continuing.
  2. Administer Local Anesthesia: The dentist will numb the area around the tooth with a numbing gel, followed by a local anesthetic. This will make sure that you do not feel anything during the procedure.
  3. Lossen the Tooth: To loosen the tooth, the dentist will use an instrument called a dental elevator to detach the periodontal ligament fibres that hold your tooth in place. This will be done through slow, firm, and consistent pressure.
  4. Elevate the Tooth: Once the tooth is loose, the dentist will use a variety of different tools, including dental forceps and dental elevators, to slowly make space for the tooth to come out of the jaw bone. This will once again be done through slow, firm, and consistent pressure.
  5. Surgical Removal (Optional): Depending on the complexity of the extraction, the dentist may need to perform a minor surgical procedure. This can involve making small incisions into the gum tissue, drilling through bone, or cutting your tooth into many different pieces. These procedures will be done if your tooth refuses to move, is impacted (stuck in the bone), or breaks during the procedure.
  6. Deliver the Tooth: Once the tooth is successfully extracted, the dentist will use forceps to deliver it out of your mouth.
  7. Clean out the Socket: The dentist will then clean the socket and make sure that no pieces of the tooth or bone are left inside the mouth. They will also scrape along the walls of your bone to ensure that there isn’t any abscesses or infections left over.
  8. Suture (Optional): Depending on the complexity of the extraction, your dentist may need to stitch up the area. This is done to help promote healing and reduce bleeding. In general, if cuts were made in your gums during the procedure, suturing will be done afterwards.
  9. Place Gauze: Once the procedure is complete, the dentist will place a gauze pad over the extraction site to help control any bleeding and encourage healing. You will be instructed to keep the gauze in your mouth for the first few hours after surgery.

Recovery and Aftercare

  1. Just like any surgery, it is normal to experience some discomfort, swelling, and bleeding after tooth extraction. The typical recovery process for wisdom teeth removal will be as follows:
  2. First Day: You may experience some swelling and discomfort. In most cases, the swelling should go away within a few days. Take ibuprofen or acetaminophen, or apply an ice pack with any pain or discomfort. Refrain from all strenuous activities.
  3. First Few Days: Swelling may increase over the first couple of days after surgery. However, most people tend to be able to resume normal activities, such as going to school or work, at this point. Some people may opt to eat softer foods and soups so that they do not irritate the surgical area, however, it depends from person to person. Additionally, be careful not to injure the area when brushing your teeth, and to not rinse your mouth vigorously.
  4. One Week: At this point, the swelling should begin to subside. You may still experience discomfort and pain, so take ibuprofen or acetaminophen as needed. Most people will be able to eat regular food and brush and floss normally.
  5. One Month: Your gums heal approximately 1 millimetre per day. At this point, the gum should be completing healing over the extraction site.
  6. Three Months: Your bone should be finishing healing and growing to fill in the void left by the extracted tooth. The healing of the bone will not be noticeable for the most part.

To aid in the healing process, it is important to follow any aftercare instructions that your dentist has given you. This includes following these steps for the first few days:

  • Refraining from smoking
  • Not drinking from straws
  • Avoiding biting overly hard and crunchy foods in the extraction area
  • Not brushing vigorously over the extraction area
  • Refraining from rinsing vigorously (let water flow over the area instead)
  • Do not undergo extreme physical exercise
  • Take any prescribed medication

Next Steps

After the tooth extraction and recovery period, you may need to consider further dental treatments such as dental implants or bridges to replace the missing tooth. If no action is taken after an extraction, the teeth around the extraction area may start to move, leading to problems with your bite. Additionally, bone loss may occur in the area of the extracted tooth. This will take away from the support of the adjacent teeth. However, since this will take months, if not years, to occur, they do not need to be done right away.

Your dentist will guide you on the best option and schedule any necessary follow-up appointments.

Alternatives to Dental Extractions

In some cases, a dental extraction may not be necessary. Alternatives to tooth extraction include:

  • Root Canal: This is when the dentist will open and clean out the inside of your tooth. The root canal procedure is used when there are severe cases of infection or decay that cannot be treated with fillings or other treatments.
  • Gum Surgery: In some cases, gum surgery may be an option instead of an extraction. Depending on the complexity of your case, this can involve cutting away excess tissue around the tooth in order to access it more easily for filling or cleaning.
  • Tooth Fillings: Tooth fillings are one of the most common alternatives to extractions. They are used to repair cavities and prevent further decay from occurring.
  • Dental Crowns: Dental crowns are used to cover damaged or decayed teeth in order to reinforce and protect them from further damage. This is an option if the tooth is still usable and can be saved.
  • Dental Bridges: Dental bridges are used to replace missing teeth by filling in the gap and connecting two healthy, adjacent teeth.

Risks and Complications

While tooth extractions are usually safe, there can be some risks involved. Possible risks and complications include:

Normal Complications

  • Bleeding: It is normal to experience bleeding for a few days after a tooth extraction procedure. The tooth is separated from the jawbone during the surgery, which causes some irritation to the surrounding tissue. It is important to follow your dentist’s instructions for managing bleeding and contact them if bleeding is excessive.
  • Swelling: Swelling of the gums, mouth, and face is normal after tooth extraction. To alleviate swelling, you can apply a cold compress or an ice pack to the affected area.
  • Discomfort: Some degree of discomfort and pain is normal after tooth extraction. Pain can be managed with pain medication prescribed by your dentist. Typically, pain should subside within a week.
  • Difficulty Chewing: With an open hole present in the area where your tooth is, it is normal to experience difficulty chewing for the first week after surgery. It is best to avoid chewing on the side of the mouth where the tooth was extracted to minimize discomfort and prevent food from getting stuck in the hole.

Abnormal Complications

  • Infection: While rare, the extraction site can become infected during the healing process. Keeping the area clean and following your dentist’s instructions for aftercare are essential in preventing infection.
  • Dry Socket: A dry socket is a painful condition that can occur when the blood clot at the extraction site fails to form properly or falls out of the mouth. Smoking can increase the risk of developing dry socket, so it is crucial to avoid smoking during the recovery period.
  • Nerve Injury: Nerve injury is rare but can occur during the extraction of impacted lower wisdom teeth or certain other teeth. This is because the inferior alveolar nerve runs near the roots of your teeth. This can cause partial or full numbness in certain areas of the mouth.
  • Maxillary Sinus Perforation: Extraction of upper molars comes with the risk of accidentally creating an opening to your maxillary sinus, a hollow cavity located in the upper jawbone. This can cause infection, pain, and other complications if not treated properly.
  • Canker sores: The stress of having a tooth extracted can sometimes induce the appearance of canker sores.
  • Trismus: Difficulty opening the mouth can occur following a tooth extraction procedure. The amount you can open your mouth may be limited, but this is typically a temporary condition.


Tooth extraction is a common dental procedure used to remove seriously damaged or decayed teeth. While it is generally safe, there are some risks and complications that may occur. Proper aftercare and following your dentist’s instructions can help minimize these risks and ensure a successful recovery.


The contents of this website, such as text, graphics, images, and other material are for informational purposes only and are not intended to be substituted for professional medical advice, diagnosis, or treatment. Nothing on this website constitutes the practice of medicine, law or any other regulated profession.

No two mouths are the same, and each oral situation is unique. As such, it isn’t possible to give comprehensive advice or diagnose oral conditions based on articles alone. The best way to ensure you’re getting the best dental care possible is to visit a dentist in person for an examination and consultation.


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