Tooth Extraction

By: Maria Trimarchi

Cracked teeth are often extracted to prevent infection in the root canal.
Cracked teeth are often extracted to prevent infection in the root canal.
©iStockphoto.com/choicegraphx

While teeth whitening may be the most requested cosmetic dental procedure in America, flashing a smile of pearly whites takes more than just bleach -- good oral hygiene is key to a healthy mouth.

Who among us, though, hasn't suffered a cavity? As it turns out, most of us have. Ninety-two percent of American adults ages 20 to 64 have had at least one cavity in their permanent teeth [source: NIDCR]. That's a lot of dental fillings. Left untreated, even just a small spot of decay can turn ugly. Sometimes, damage and decay is severe enough that it can't be repaired with a filling, crown, root canal or other restorative treatment, and then extraction comes into the picture. When a tooth is extracted, it's permanently removed from the mouth. Teeth that are infected are also recommended for removal -- while oral antibiotics will clear a bacterial infection that has spread to the jaw, those antibiotics can't take the fight inside of a tooth where the infected nerve is. Removing the tooth removes the decay and infection, preventing the spread of infection and inflammation to other areas of the mouth and body.

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Teeth that are loose or that no longer have surrounding supportive bone and soft tissue are also common candidates for extraction, as are impacted wisdom teeth. When wisdom teeth -- our third molars -- don't have enough room, they can become impacted, which means they're stuck in the jaw and can't erupt. Wisdom teeth may also sometimes only partially erupt, usually because of crowding in the mouth as well. Impacted wisdom teeth may cause pain, swelling and other complications if not removed.

Tooth extractions are also sometimes performed on an elective basis. For example, extractions are sometimes done in preparation for other dental procedures or orthodontic treatments such as braces. Cancer patients and organ-transplant patients have an increased risk of developing infections and may have teeth extracted before or after treatment if those teeth pose a risk for or develop infection during treatment or recovery.

And sometimes, it just comes down to individual anatomy: Some people just have too many teeth for the size of their mouth, and teeth are extracted to ease crowding.

Now you know many of the reasons why a tooth may need to be removed, but did you know there is more than one type of extraction? Let's dive more deeply into extraction, from prep to procedures.

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Tooth Extraction Procedure

Let's learn a few basics about our teeth before we start talking about pulling them out of our mouths. The crown of the tooth is the part you can see in your mouth, above the gum line, while the root of the tooth is hidden below the gum line. The roots are embedded in a socket (a hole) in the jaw bone, along with connective tissues that keep the tooth set firmly in the bone.

Before the procedure, your dentist will perform an oral exam and take X-rays of the tooth (or teeth) to be extracted and the surrounding area to see what's going on below the gum line.

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With the prep done, it's time to extract. There are two types of tooth extraction procedures, a simple type and a surgical type.

If you can see the tooth in your mouth then its removal is a simple extraction. If you can't see the tooth in your mouth because it hasn't erupted, is impacted or it has broken at or below the gum line, then its removal is a surgical extraction. There are more than 10 million teeth surgically removed from American mouths every year [source: Boyd].

Let's talk about the simple extractions first.

Simple extractions are usually managed by your dentist and done with local anesthesia. In a simple extraction a tooth is removed with an elevator and a pair of forceps. In this instance an elevator is a special tool used to separate the root of the tooth from its socket, loosening it in the bone. The forceps, also used to loosen the tooth, are used to yank the tooth by its crown. There may or may not be a few stitches to close up the extraction.

Surgical extractions are a little more complicated because they entail removing tooth from bone. These extractions are most commonly performed by oral and maxillofacial surgeons, and patients are given either local or general anesthesia depending on the individual circumstance. Unlike in a simple extraction where the dentist is able to grab the crown of the tooth with forceps, in a surgical extraction, the gum is cut open for access to the tooth. With access below the gum line, the surgeon removes the tooth, sometimes in fragments, from the jaw bone, and stitches the wound closed.

Immediately after a tooth is pulled, your dentist will pack the wound with gauze and ask you to bite down -- this pressure will help speed the formation of a blood clot in the socket, needed for a healthy, uneventful healing.

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Tooth Extraction Healing

During the first 24 hours after the extraction, patients can expect a little bleeding to continue, at least for a few hours after the surgery. There will likely be swelling and mild to moderate pain as well. The level of pain is determined by the number of teeth extracted, the type(s) of extraction and location(s), if there is any co-existing infection and by the patient's personal pain tolerance.

If the pain begins to worsen rather than improve after the first two to three days, it may be due to a complication known as dry socket.

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After a tooth is extracted, a blood clot begins to form in the now-empty socket. It's important to avoid rinsing, spitting and sucking -- and that includes smoking -- after a tooth extraction, because those activities can disrupt the formation of that blood clot or dislodge it from the socket. If the clot becomes damaged or dislodged, it exposes the nerves and bone underneath to everything in the mouth, from the air we breathe and our saliva to debris from the foods we eat. Dry socket is a severely painful condition, and is commonly treated with antibiotics and wound cleaning. Take a sigh of relief: The condition affects a small number of tooth extraction patients -- only an estimated 2 to 5 percent of patients who have a tooth extracted develop dry socket [source: Mayo Clinic].

Wondering when the hole in your mouth will close? If there are no complications, new gum tissue will close the hole in about one to two weeks, and both soft tissues and bone will continue to heal during the following month.

Most patients will find that the recovery period for an uncomplicated tooth extraction is only a few days, but it's important to remember that although the bleeding and swelling have ended, the wound needs several weeks to completely heal. Good tooth extraction aftercare can help make the healing process smooth and uncomplicated. Let's look at what type of care is needed in the first 24 hours after surgery through until the stitches come out.

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Tooth Extraction Aftercare

If you're like us, your first question about aftercare will likely be about pain management. During the first 24 hours after tooth extraction surgery, most patients take painkillers, either prescribed by the dentist or oral surgeon or over-the-counter anti-inflammatory medications such as ibuprofen. Applying a cold compress or cold pack to the face or jaw will help constrict blood vessels, preventing and reducing swelling as well as reducing pain.

And what about eating and drinking? Tooth extraction is no cause for fasting during the first 24 hours, but stick to a liquid diet while your mouth is still numb so you don't accidentally bump the wound. Once the feeling is back in your mouth, unless otherwise instructed by your dentist or oral surgeon, it's OK to eat soft foods such as puddings, oatmeal and mashed potatoes, and liquids during the first few days after the procedure. After that, it's fine to return to solid foods.

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After the first 24 hours pass, most patients continue to take pain relievers, but typically after the first three days or so there is no longer a need for any prescription painkillers. Over-the-counter anti-inflammatory medications such as ibuprofen can control pain and lingering swelling for several days after the extraction.

Rinsing with warm salty water may also help to reduce pain and swelling, but to avoid disrupting the formation of the blood clot, wait to do so until after the first 24 pass, then rinse gently several times a day. It's also OK to brush and floss your teeth as well, but be extra careful to avoid the area of the tooth extraction as well as any stitches. While some extractions require stitches, some do not, and while some stitches dissolve as the wound heals, over one to two weeks, others will need to be removed at a follow-up visit to the dentist.

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Lots More Information

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More Great Links

  • American Association of Endodontists. "Endodontic Facts." (Nov. 11. 2011) http://www.aae.org/News_Room/Endodontic_Facts.aspx
  • Beth Israel Deaconess Medical Center. "Tooth Extraction." 2010. (Nov. 11, 2011) http://www.bidmc.org/YourHealth/MedicalProcedures.aspx?ChunkID=14873
  • Boyd, Jane. "Bone Implants Could Speed Healing after Tooth Removal." Sallyport. Vol. 61, no. 2. 2004. (Nov. 11, 2011) http://www.rice.edu/sallyport/2004/winter2/sallyport/bone.html
  • Colgate Oral and Dental Health Resource Center. "Tooth Extraction." (Nov. 11, 2011) http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Checkups-and-Dental-Procedures/Tooth-Removal-Extraction/article/Tooth-Extraction.cvsp
  • Colgate Oral and Dental Health Resource Center. "Tooth Whitening." (Nov. 11, 2011) http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Cosmetic-Dentistry/Tooth-Whitening/Tooth-Whitening-Basics/article/Tooth-Whitening.cvsp
  • Mayo Clinic. "Dry Socket." 2010. http://www.mayoclinic.com/health/dry-socket/DS00778
  • National Institute of Dental and Craniofacial Research. "Dental Caries (Tooth Decay) in Adults (Age 20 to 64). 2011. (Nov. 11, 2011) http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/DentalCariesAdults20to64.htm
  • North Sound Oral Surgery. "Wisdom Teeth & Other Extractions." (Nov. 11, 2011) http://www.northsoundoralsurgery.com/faq-and-helpful-hints/faqs.html#wisdom
  • Steiner, GG; Francis, W.; Burrell, R.; Steiner, DM; and R. Macias. "The healing socket and socket regeneration." Compendium of Continuing Education in Dentistry. Vol. 29, no. 2. Pages 114-116, 118, 120-124. 2008. (Nov. 11, 2011) http://www.ncbi.nlm.nih.gov/pubmed/18429427
  • WebMD. "Dental Implants." 2009. (Nov. 11. 2011) http://www.webmd.com/oral-health/dental-implants
  • WebMD. "Tooth Extraction." 2011. (Nov. 11, 2011) http://www.webmd.com/oral-health/tooth-extraction