Tooth Extraction

Tooth extraction, also known as exodontia, is the process of pulling out a tooth from its socket in the bone. For the good of your dental health, your dentist may recommend a tooth extraction if the tooth is broken or damaged by decay and cannot be saved with a filling, crown, or other dental treatment. In an emergent situation, a dentist will pull a tooth usually as a result of severe tooth pain that worsens with chewing, swollen gums, or jaw pain.

When else is a tooth extraction required?

Your dentist may also recommend a tooth extraction under the following circumstances:

Compromised immune system.  If your immune system is compromised (after receiving chemotherapy or having an organ transplant), the risk of infection in a particular tooth may be reason enough to pull the tooth.

Crowding.  If your teeth are crowded, sound teeth may be extracted to create space so the rest of the teeth can be straightened.  Similarly, if a tooth cannot break through the gum (erupt) because there is no room in the mouth for it, your dentist may recommend pulling it. This crowding may be due to a malposed tooth or supernumerary teeth (hyperdontia). A malposed tooth is one that has grown in a faulty position whereas supernumerary teeth refer to a condition where there are more teeth present in the oral cavity than the normal number.

Impacted tooth/infection. An impacted tooth, such as a wisdom tooth (the third and final set of molars that most people get in their late teens or early twenties), sometimes gets stuck and is unable to grow normally in the mouth. This may cause recurrent infections of the gum tissue around wisdom teeth (pericoronitis).

Periodontitis/Gum Disease.  People with unhealthy gums that start receding and forming pockets are at risk for bacterial growth.  Bacteria can seep inside the gums and cause an infection. This can lead to decay of gums and even the tooth. The gums can become so weak that the base for tooth attachment can become fragile and the tooth can fall out or must be pulled.

Trauma.  If a patient has been involved in an accident and fractures their jaw and teeth are involved directly in the line of fracture, it is advised to extract the tooth.

Traumatic avulsion of a tooth is the complete displacement of the tooth from its socket due to the fracture of the alveolar bone, while intrusion is displacement of the tooth into the alveolar bone. These conditions may require an extraction. 

How does tooth decay damage a tooth?

Tooth decay can damage a tooth when it extends to the pulp (the center of the tooth containing nerves and blood vessels). When this happens, bacteria in the mouth can enter the pulp and cause an infection. Usually, this can be corrected with root canal therapy, but when an infection is so bad that not even antibiotic treatment can cure it, your dentist will have to pull your tooth to prevent the spread of infection.

Are there any risks associated with a tooth extraction?

Although tooth extraction is a safe procedure, patients with certain medical conditions are at higher risk for developing a severe infection, because the procedure can allow harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. It is, therefore, important for you to go over your medical and dental history (as well as any medications or supplements you might be taking) with your dentist before you have a tooth extraction. You should also let your dentist know if you have any of the following medical conditions:

  • Artificial heart valves
  • Damaged heart valves
  • Congenital heart defect (CHD)
  • Impaired immune system
  • Liver disease (cirrhosis)
  • Artificial joint replacement (hip, knee, shoulder)
  • History of bacterial endocarditis
  • Rheumatic heart disease
  • Diabetes
  • Pregnancy (When a woman is pregnant, they are immunocompromised. Tooth extraction can lead to infection or even trauma.)
  • Toxic goiter
  • Nephritis

If you have any of these conditions, your dentist may have you take antibiotics before and after the extraction to lower your risk of infection.

What happens during a tooth extraction?

A tooth extraction procedure starts with a local or general anesthetic to numb the affected area where the tooth will be removed. For a simple extraction where the tooth can be seen in the mouth, your dentist will loosen the tooth with an instrument called an elevator, and will then remove it with forceps. If you have a broken or impacted tooth, an oral surgeon will need to do a surgical extraction, cutting away gum and bone tissue that covers the tooth, and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place.

Once the tooth has been removed, a blood clot forms in the socket. Gauze is then packed into the socket, and the patient is instructed to bite down on the gauze to help stop the bleeding. In some instances, stitches may be required to stop the bleeding.

Are there any complications that can develop after a tooth extraction?

Dry socket is a painful dental condition that sometimes happens after you have a permanent tooth removed. After the procedure, the blood clot in the socket fails to develop or it dislodges or dissolves before the wound has healed. If this happens, underlying bone and nerves are exposed resulting in intense pain.

What are the signs of a dry socket?

Patients can get dry socket within 2 to 4 days after tooth extraction. The signs and symptoms of a dry socket may include:

  • Severe pain within a few days after tooth extraction.
  • Partial or total loss of the blood clot at the tooth extraction site.
  • Visible bone in the socket.
  • Unpleasant taste in your mouth.
  • Bad breath or foul odor coming from your mouth.

If you think you have developed a dry socket, call our office to schedule an emergency follow-up appointment. Your dentist will likely place a sedative dressing over the socket for a few days to protect it as a new clot forms.

What are the side effects of tooth extraction?

After tooth extraction, the area from where the tooth has been extracted will remain sore or even hurt. Pain can also radiate to other portions of the mouth like adjacent teeth, gums, and even the face. This type of pain is known as referred pain. Referred pain is the pain that is felt at a place other than the actual injured area.

Surgical insult to the tissues, both hard and soft, surrounding a tooth, may cause moderate swelling.

Bruising may also occur and may take weeks to disappear completely.  Bruising is more common in older people or people on aspirin or steroid therapy. 

How long does it take for the extraction site to heal?

The soft tissue within the extraction site usually takes  3-4 weeks to heal fully.

What can you expect after tooth extraction?

After tooth extraction, your dentist will provide you with aftercare instructions that may include:

  • Take painkillers and analgesics for pain relief.
  • Keep gauze pads in place for up to 3-4 hours after the extraction.  If they become blood-soaked, change the pads and bite into them to absorb any remaining blood from the extraction.
  • Apply an ice bag to the affected area immediately after the procedure to reduce swelling.
  • Rest for at least a day after the procedure and avoid strenuous activity for 24 hours.
  • Avoid rinsing or spitting forcefully for 24 hours after the extraction to avoid dislodging the clot that forms in the socket.
  • Rinse your mouth with a solution made of a 1/2 teaspoon of salt and 8 ounces of warm water after 24 hours. The saline solution has antiseptic properties to prevent the gums from developing an infection.
  • Avoid hard or extra chewy foods, giving your mouth time to relax and heal.
  • Avoid drinking from a straw for the first 24 hours.
  • Refrain from smoking, as it can inhibit healing.
  • Eat soft foods, such as bananas, custard, soup, pudding, yogurt, or applesauce the day after the extraction. Gradually add solid foods to your diet as the extraction site heals.
  • Prop your head with pillows when lying down, as lying flat may prolong bleeding.
  • Brush and floss your teeth, and brush your tongue, while avoiding the site of extraction.
  • Avoid talking to give the extraction site time to heal.  Talking moves the mandible, which may prolong bleeding.

If you are having a dental emergency, call Burlingame Dental Arts at (503) 218-4285 to schedule an appointment.