Tooth Extraction

An extraction is the removal of a tooth from its socket. The socket is a bone housing and the tooth is held in it by a ligament, so removal is a matter of widening the socket slightly and easing the tooth out along the line of its roots.

There are two forms. A simple extraction is used for a tooth that is fully visible and whose roots allow a straightforward lift. A surgical extraction is needed where the tooth is broken down to the gum, buried, impacted or awkwardly rooted; the gum is lifted, a small amount of bone may be removed, and the tooth is divided into pieces and taken out in sections.

Tell your dentist beforehand about blood-thinning medicines, bisphosphonates or other bone medicines, diabetes, heart valve problems, immune suppression and any radiotherapy to the jaw, since each of these changes how the extraction is planned. It is also worth discussing before the day what will fill the gap afterwards, because the options and their timing depend on what the socket looks like once the tooth is out.

Extraction is a day procedure done in the dental chair under local anaesthetic, and you leave within the hour.

An injection numbs the tooth, the bone and the gum, and takes a few minutes to take full effect. Your dentist tests it before starting. During the extraction you feel firm pressure and rocking and hear noise, and you should feel no sharpness.

For a simple extraction, an instrument is worked into the ligament space to loosen the tooth, and forceps then deliver it. This takes roughly ten to twenty minutes. For a surgical extraction, a flap of gum is raised, bone over the tooth may be trimmed with a drill under irrigation, the tooth is sectioned, and the pieces are removed; the flap is then closed with a few stitches, often dissolvable. This takes roughly 30 to 45 minutes.

Afterwards you bite on a gauze pack for 30 to 45 minutes to let a clot form, and your dentist checks the socket before you go.

Expect slight oozing for a few hours; the saliva will look bloodstained for the rest of the day and that is normal. Bite firmly on fresh gauze for another 30 minutes if it continues.

Swelling peaks on day two and settles by day four or five after a surgical extraction, and is minimal after a simple one. Use cold packs on the first day, then warm salt-water rinses from day two. Painkillers are needed for two to three days.

For the first 24 to 48 hours do not rinse forcefully, spit, use a straw, or smoke, since all of these dislodge the clot that the socket needs. Eat soft, cool food and chew on the other side. Most people go back to desk work the next day; take two to three days after a difficult surgical extraction. Stitches come out at about a week. The gum closes over in two to three weeks and the bone underneath fills in over several months, and replacement teeth are timed to that healing.