Tooth extraction, in its simplest form, refers to removing a tooth from its socket in the jawbone. This procedure is often necessary when a tooth is damaged beyond repair, posing potential health risks, or when there is a need to create space for orthodontic treatment such as braces or Invisalign.
Why would a tooth need to be removed?
A good dentist will always do their best to save a tooth; however, sometimes, removing a tooth may be the best (or only) option for you. Below are some reasons why a dentist may suggest extracting a tooth.
Severe Decay: If tooth decay reaches the pulp—the centre of the tooth containing nerves and blood vessels—it can lead to infections that sometimes cannot be corrected with a root canal treatment.
Lack of healthy tooth structure: If a tooth has a large cavity which is too deep below your gumline or leaves not enough healthy tooth structure to support a filling or crown, the tooth will need to be removed and replaced.
Gum Disease: An extraction may be necessary if gum disease causes the structures around the teeth to become loose or unstable.
Impacted Teeth: Wisdom teeth, or third molars, often become impacted because they don't have enough room to emerge or grow normally. This can lead to pain, swelling and infection. Impacted wisdom teeth can also trap food and plaque, causing decay in the tooth in front of them.
Orthodontic Treatment: For patients getting braces or undergoing other orthodontic procedures like Invisalign, an extraction can help make room for teeth to be aligned properly.
Fractured Teeth: Trauma or injury can cause irreparable damage to the tooth structure, warranting extraction.
Other Medical Reasons: Sometimes, teeth are extracted as a precaution for patients undergoing chemotherapy, organ transplantation, or other treatments that can weaken the immune system.
The process of removing a tooth
A dental extraction is a routine process and nothing to be too concerned about. Below we will go over the process of removing a tooth and share some tips to make sure the process goes smoothly for you.
Before the appointment
Make sure you’ve had a light meal.
We want to make sure your body is nourished and hydrated to combat any potential feelings of dizziness or faintness. Let the dentist know if you haven’t eaten, and they may offer you a sugar tablet to take before you start your appointment.
Block off the rest of your day.
After your appointment, you’ll be numb, slightly swollen and may experience some aching from the area. Don’t plan any strenuous activities like exercise after the appointment. You can still go back to work or school but make sure you take it easy. For this reason, we would advise not cycling to or from the appointment.
During the appointment
Make sure you know what’s happening that day, and if you’re not sure, then ask your dentist.
It’s okay to be nervous; your dentist will have seen nervous patients before (it’s pretty common) so just let them know and they will be able to help put you at ease. Rest assured, tooth extractions are typically a very straightforward process.
Numbing the tooth (local anaesthetic)
Your dentist will apply some anaesthetic with a few tiny injections to make the tooth and gums in the area go numb. Once the anaesthetic kicks in, you shouldn’t feel any pain. Before beginning the procedure, your dentist will test the area with a sharp probe to ensure you can’t feel any pain.
You shouldn’t feel any pain (sharpness), but you will feel a lot of pressure (pushing). That is entirely normal. Keep still, put your hand up, and let the dentist know straight away if you feel pain! Your dentist will then be able to apply any additional anaesthetic if needed.
The removal procedure
Your dentist loosens the tooth using various instruments (this is why you feel the pushing) then takes the tooth out using forceps.
Most extractions are straightforward, and the actual process of the extraction can take as little as 5-10 minutes.
When your tooth is coming out, you may hear some cracking and crunching noises, it doesn’t sound nice, but it’s completely normal and expected. So don’t worry!
Some teeth can be more difficult (molars, including wisdom teeth in particular) and may come out in several pieces. Your dentist may split the tooth with a special drill and remove each root individually. Although this doesn’t sound nice, it makes taking the tooth out more straightforward.
Remember, you should not feel any pain throughout this whole process. If you do, let your dentist know!
Once the tooth is removed, your dentist will ask you to bite down on some sterile gauze and apply some pressure on the area to make sure the hole stops bleeding before you go home.
Most extractions don’t require stitches, but after surgical extractions or removing bigger teeth, a stitch may be needed to close the hole that is left.
Surgical extractions
When removing impacted, heavily broken down or large teeth, your dentist may cut your gum first and remove a small amount of bone around the tooth to allow it to come out easily. This is known as a ‘surgical extraction’ and your dentist will tell you if they are planning this at the start of the procedure.
Failed extractions
Sometimes, if the tooth breaks and your dentist cannot get the entire root of the tooth out, there are two options. If the piece of root is tiny, they may want to leave it where it is, and your body will heal around it. A lot of the time, this piece of root doesn’t cause any further problems.
If the root is too big to leave, your dentist may need to stop the extraction and refer you to an oral surgeon with specialist equipment and skills to remove this piece of root for you.
After the appointment
Go home, put your feet up and relax! It’s all over.
Follow the instructions below to make sure you heal well after the extraction.
Take some painkillers - the area may ache once the anaesthetic has worn off, so take some over the counter painkillers before it does (whatever you would typically take for a headache). It’s normal for some pain to last 3-4 days.
Wait for the feeling in the area to come back before eating. You don’t want to end up accidentally biting your lip or cheeks (ouch!)
Don’t rinse your mouth or spit for 24 hours - This is VERY important. Agitating the area can cause it to bleed and lead to a dry socket (explained below). Leave the site alone.
If you notice active bleeding, wrap some gauze or tissue into a ball and bite hard on it for 10 minutes or until it stops bleeding.
Avoid exercise for the rest of the day.
Avoid hot drinks like tea and coffee for the rest of the day.
Do not smoke for 48 hours - smoking increases the risk of dry socket, reduces blood flow and delays healing.
Clean the area by rinsing with warm salt water rinses after the initial 24 hours. Do this three times a day for three days.
When to contact your dentist
Some pain, oozing, and swelling are expected after an extraction, which can last 3-5 days. You should contact your dentist if:
You are experiencing severe pain that can’t be managed with painkillers.
The extraction site is bleeding, and you can not get it to stop.
It’s been five days, and the swelling has not reduced.
There is severe swelling limiting how far you can open your mouth or your ability to swallow or speak.
If the swelling is limiting your ability to breathe correctly, call the emergency services (999 in the UK) immediately.
Risks/complications of taking teeth out
Though highly unlikely, as with any other medical procedure, complications can arise. Remember, your dentist will be well prepared for any of these eventualities, so will be able to guide you through what to do to address the problem.
Dry Socket
If the extraction site doesn’t seal over properly, the jaw bone becomes exposed, which is called a ‘dry socket’. This can be extremely painful but luckily is quite simple to resolve. You’ll need to see your dentist, who will clean the extraction area and pack the site with a particular material to seal the extraction site again and help alleviate the pain.
Infections
Rarely, the extraction site can get infected. Signs of infection include swelling, raised lymph nodes, pus coming from the area, pain and fever. Contact your dentist if you think the site is infected. Most small infections will clear on their own but your dentist may wish to provide you with some antibiotics if they believe the infection is spreading.
Lower wisdom teeth and your jaw’s nerve
Your lower wisdom teeth (the molars at the very back) sometimes sit very close to a nerve that runs along your jaw. This nerve supplies sensation to your lip, chin, teeth and tongue. There is a small risk that your nerve can be irritated or bruised when removing wisdom teeth. This means you may lose the sensation of the areas mentioned above and some altered taste. Most of the time, this is temporary, and your sensation comes back, but sometimes it can be permanent.
Your dentist will tell you about the likelihood of this happening before taking your tooth out.
Upper molar teeth and the sinus
Your upper molar teeth can sit close to the floor of your sinuses. Sometimes, a tiny hole can develop between your sinus and your mouth when taking these teeth out. Most of the time, this hole closes over naturally. Still, sometimes your dentist may need to carry out a minor surgical procedure to close this hole (they will probably want to refer you to an oral surgeon to carry this out).
Your dentist will check for this after the extraction to ensure this hasn’t happened. If it does, they will let you know how to proceed.
Sometimes the hole between the mouth and sinus can be difficult to detect. Symptoms may not occur straight away (such as a small amount of fluid coming from the mouth through the nose or sinusitis-type symptoms). If this is the case, you should book a review appointment with your dentist and may need a future referral to an oral surgeon.
Managing the Gap After a Tooth Extraction
Once a tooth has been extracted, it leaves behind a gap that can impact aesthetics and the health and function of the surrounding teeth and jaw. Managing this gap effectively is essential for maintaining optimal dental health. Here's what you should know:
Potential Issues with leaving a gap in your dental arch
Teeth Shifting: Adjacent teeth can drift into the vacant space, leading to misalignment.
Bite Problems: The opposing tooth in the opposite jaw might grow longer due to the lack of counter-pressure (a phenomenon called super eruption).
Bone Loss: Over time, the jawbone in the extraction area can recede, weakening the foundations of the teeth either side of the gap
Aesthetic Concerns: A missing tooth, especially in the front, can affect your smile and self-confidence.
Functionality: It may become harder to chew food or pronounce certain words.
Options for Managing a gap in your teeth
Dental Implants: These are titanium posts surgically placed into the jawbone, providing a stable foundation for a replacement crown. They function and look like natural teeth. Read more about implants here.
Dental Bridge: This involves creating a 'bridge' between two adjacent teeth, using them to support a false tooth in the middle. Read more about dental bridges here.
Partial Dentures: Removable replacements for missing teeth, partial dentures can be taken out and put back into the mouth with ease.
Orthodontic Treatment: In cases where the gap isn't filled immediately, braces or aligners can correct the alignment issues resulting from shifting teeth.
Bone Grafting: A bone graft can provide the necessary support structure for future treatments like implants if there's significant bone loss in the jaw after an extraction. You can read more about bone grafting here.
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