Tooth Removal (Extraction)

What is tooth removal?

Tooth removal, or extraction, is when a dentist or oral surgeon takes a tooth out of its socket in the jawbone. It can be done as a simple procedure under local anaesthetic, or as a slightly more involved surgical procedure if the tooth is harder to reach.

What conditions does it treat?

Your dentist may recommend removing a tooth for a number of reasons, including:

• severe tooth decay or damage that's too extensive to repair with a filling or crown
• advanced gum disease that has loosened or damaged the tooth
• a broken or fractured tooth, often from an injury
• an impacted tooth, most commonly a wisdom tooth, that's stuck under the gum and causing pain, infection or cysts
• overcrowded teeth, sometimes removed to make space for orthodontic treatment such as braces
• a severe infection or abscess that hasn't been resolved by antibiotics or root canal treatment.

Dentists prefer to save a natural tooth wherever possible, so extraction is usually considered once other treatments aren't enough.

What are the benefits of having a tooth removed?

Removing a damaged or infected tooth reduces the harmful bacteria that can spread to other teeth and gums, giving you the best chance of long-term oral health. It can also ease dental pain almost immediately, especially if the tooth was badly broken or infected.

Where a tooth is removed to prevent the spread of infection, or to relieve overcrowding before orthodontic treatment, it can also protect the health and alignment of the teeth around it.

Are there different types of surgical approaches?

A simple extraction is used for a tooth that's visible in the mouth. After numbing the area, your dentist loosens the tooth with an instrument called an elevator, then uses forceps to gently rock it from side to side until it comes free.

A surgical extraction is needed when a tooth can't be easily reached, for example if it's broken below the gum line or hasn't fully come through. This involves a small cut in the gum, and sometimes removing a little surrounding bone or dividing the tooth into sections, to remove it safely.

What happens before the operation?

Before your extraction, you'll have a consultation where you can discuss the procedure, ask questions, and agree on the type of anaesthetic that suits you best.

• Tell your dentist your full medical history, including any heart or liver conditions, a weakened immune system, or artificial joints, and every medicine, vitamin or supplement you take
• Follow any instructions about stopping certain medicines beforehand
• If you're having sedation or a general anaesthetic, arrange for a responsible adult to bring you, stay with you, and take you home afterwards
• You may be prescribed antibiotics in advance if you're at higher risk of infection, though this isn't routine for every extraction.

What happens during the procedure?

Removing a single tooth usually takes between 30 and 60 minutes, longer if you need more than one tooth removed or the case is more complex. In general, it follows these steps:

1. You're given a local anaesthetic injection to numb the tooth and surrounding gum. Sedation or a general anaesthetic may be used instead for more complex procedures.
2. Your dentist loosens the tooth using an instrument called an elevator.
3. Using forceps, your dentist gently rocks the tooth from side to side to widen the socket, then lifts it out.
4. If the tooth is hard to access, for example if it's broken or hasn't fully come through the gum, a small cut may be made in the gum, some bone may be removed, and the tooth may be divided into pieces to remove it.
5. Your dentist cleans and checks the socket, and may place one or more stitches, often a dissolvable type.
6. A gauze pad is placed over the socket and you're asked to bite down firmly, which helps a blood clot form and stops the bleeding.

What does recovery look like?

Most people go home the same day. If you had local anaesthetic only, you can usually drive and return to routine activities straight away. If you had sedation or a general anaesthetic, you'll need someone to take you home and stay with you, and you shouldn't drive, work, or drink alcohol for 24 hours.

For the first 24 hours, avoid rinsing or spitting forcefully, hot food and drinks, alcohol, smoking, and drinking through a straw. All of these can dislodge the blood clot in the socket and lead to a painful complication called dry socket. Biting firmly on the gauze provided, resting, and applying an ice pack to your cheek for 10 to 20 minutes at a time help control bleeding and swelling early on.

From the next day, gently rinse with warm salt water after meals, stick to soft foods, and resume brushing and flossing your other teeth as normal, taking care around the extraction site. Pain is often at its worst around day three, so keep taking pain relief regularly rather than waiting for pain to build up.

Most people feel back to normal within 1 to 2 weeks and can return to work or school within a day or two, longer for manual jobs. The underlying bone takes several weeks longer to heal fully, and for a large tooth such as a molar, complete healing can take up to around 4 months.

What are the risks and complications?

Tooth removal is a common and generally safe procedure, but as with any surgery there are risks to be aware of, including:

• bleeding, both during the procedure and for a few days afterwards
• dry socket, a painful condition where the blood clot is lost too early, most common a few days after removing a lower wisdom tooth
• infection at the extraction site
• nerve damage, particularly with lower wisdom teeth, which can cause temporary or, rarely, permanent numbness or altered sensation in the lip, chin or tongue
• damage to neighbouring teeth, fillings or crowns
• restricted mouth opening (trismus), which usually improves gradually over about a week
• for upper back teeth, an occasional small connection between the mouth and the sinus above, which may need extra treatment to heal
• swelling and bruising around the jaw and cheek.