Advice for patients requiring a dental extraction

Tooth extraction involves having one or more teeth completely removed from your mouth by a dentist. This can be done at one appointment or over a few sessions (if more than one tooth needs to be taken out). You may or may not want, or need to have the teeth replaced. Your dentist will explain all the options available to you.

There are a number of reasons why your teeth may need to be extracted. Some of the most common reasons include:

  • severe gum disease (periodontal disease) – when bacteria build up on your teeth and damage the bone that holds them in place, the teeth may become loose
  • tooth decay – if a tooth is very rotten, its nerves and blood vessels can die, leading to a painful abscess
  • a broken tooth that can’t be repaired
  • crowded teeth – if you have a small jaw or lost your milk (baby) teeth early, your teeth may be crooked and you may need to have one or more removed so that the rest can be straightened
  • wisdom tooth problems – if there isn’t enough space in your mouth for your wisdom teeth they may become impacted (stuck behind the tooth in front) and need to be removed

Preparing for a tooth extraction

Your dentist will ask about your dental and medical history. It’s important that you mention any medical conditions, allergies or recent operations. You should also tell your dentist if you use an inhaler or are taking any medication, including the contraceptive pill or over-the-counter medicines such as aspirin.

If you’re particularly anxious about having treatment, your dentist may give you a sedative – this relieves anxiety and causes temporary relaxation without putting you to sleep. In certain situations, you may need to go into hospital and have treatment under general anaesthetic. This means you will be asleep and feel no pain while your tooth is being removed.

What happens during a tooth extraction?

So that you don’t feel any pain during or immediately after the procedure, your dentist will give an injection of local anaesthetic into your mouth, which completely blocks feeling from the area.

After the anaesthetic has taken effect, your dentist will widen the socket (the area your tooth sits in) using a tool called an elevator or a pair of special forceps. He or she will then move the tooth from side to side until it is loose enough to be removed completely.

During the procedure you will feel some pressure in your mouth and hear some noise. You should not feel any pain.

In more difficult and rarer cases, your dentist may not be able to reach the root of your tooth so he or she will make small cuts in your gum. If necessary he or she can then drill away some of the bone so the tooth root can be removed.

What to expect afterwards

There will be some bleeding and your dentist may put in stitches. After the extraction, you will be given a piece of soft padding to bite on to stop the bleeding.

If you have had your tooth removed under local anaesthesia, you will need to stay at the dental surgery until the bleeding is controlled. This will probably take about 10 to 15 minutes. You may need pain relief to help with any discomfort as the anaesthetic wears off.

Wait until the local anaesthetic has worn off before having hot food or drinks – you might burn your mouth or chew the inside of your cheek while it’s still numb. Once you regain some feeling, stick to lukewarm, soft food and try not to chew in the part of your mouth where the tooth has been removed. Try not to drink alcohol or smoke for the first 24 hours after the extraction – this may cause further bleeding.

It’s best not to rinse out your mouth or do any exercise for the first 24 hours after the extraction. This is because any blood clot that may have formed could be disturbed and the bleeding could start again. After 12 hours it can be helpful to rinse out your mouth with salt water (half a teaspoon of salt in a glass of warm water) a few times a day.

Recovering from a tooth extraction

It’s important to keep your mouth as clean as possible so continue brushing your teeth after the extraction.

If you had stitches during the procedure, you may need to go back to your dentist to have them removed. Otherwise you probably won’t need a follow-up appointment.

What are the risks?

Tooth extraction is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful treatment.

You may have some discomfort and swelling for a few days afterwards, and your jaw may feel a little stiff. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. We have found the most effective pain relief can be gained by using paracetamol followed 2 hours later by ibuprofen this again can be repeated every 2 hours. This will give continuous pain relief.

It’s normal for you to notice some slight bleeding for the first couple of days after having a tooth removed. Rinse the excess out of your mouth and then bite down on a clean pad of material such as a handkerchief. If the bleeding doesn’t stop within 15 to 30 minutes, contact your dentist for advice.

Complications

This is when problems occur during or after the procedure. Most people aren’t affected.

Contact your dentist immediately if you experience:

  • prolonged bleeding
  • swelling
  • severe pain
  • high temperature (fever)

These may be the sign of an infection or other complications.

One of the most common problems that can occur after tooth extraction is called a dry socket. This is when there is no blood clot so the tooth socket doesn’t heal as quickly as expected. This usually happens within two to four days after the extraction and is extremely painful. Go back to your dentist who will rinse the area, put a dressing on it and may give you antibiotics. Dry socket is more common after extraction of lower molar teeth, if you’re taking the contraceptive pill or if you smoke.

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your dentist to explain how these risks apply to you.