Tooth extraction guide

Why teeth are extracted

Cleveland Clinic says providers prefer to save natural teeth, but extraction may be needed when fillings or crowns are not enough. Causes include a fractured tooth, advanced gum disease, an impacted tooth, crowded teeth, severe decay and dental trauma from an injury, which may need emergency extraction. ADA MouthHealthy says a tooth is removed mainly because of disease, injury or overcrowding.

How does a dentist pull a tooth?

Cleveland Clinic describes the steps.

• Local anesthesia numbs the tooth and the surrounding gum tissue.
• The dentist uses specialized instruments to loosen the tooth and remove it, and gum incisions or dividing the tooth into sections may be needed.
• The socket is cleaned and disinfected.
• A bone graft may be placed to help prevent jawbone loss.
• Stitches may be placed, though some patients do not need them.

Who does extractions?

Cleveland Clinic says general dentists do many extractions, oral and maxillofacial surgeons and periodontists also perform them, and complex cases are usually referred to specialists. Do endodontists pull teeth? Cleveland Clinic's endodontics page says endodontists extract teeth that are too damaged to save. Do orthodontists pull teeth? Healthline says aligning teeth may require removing teeth to make room, which is part of a braces plan, though the sources we read do not say who removes them.

How long it takes and sedation

A single extraction usually takes 30 to 60 minutes, according to Cleveland Clinic. Sedation options are discussed at the consultation, and sedation can help with dental anxiety. Tell your dentist about all medications, vitamins and supplements you take, since you may need to stop some beforehand. The sources we read do not address extraction during menstruation, so ask your dentist if it matters for you.

What a healing extraction site looks like

Cleveland Clinic says the socket heals from the bottom up: a blood clot forms first, then new tissue fills in, sometimes leaving a small indentation, and a whitish look on the clot is normal and does not mean infection. Complete jawbone healing takes several weeks, up to four months for a large tooth. Our dry socket guide explains how to tell a healing socket from a problem.

Recovery and aftercare

Cleveland Clinic says normal side effects include bleeding, bruising, discomfort (day three is usually the worst) and swelling, which typically resolve within a week, and that you can usually return to routine activities in 48 to 72 hours while avoiding strenuous exercise. ADA MouthHealthy advises avoiding smoking and vigorous rinsing, not drinking through a straw for 24 hours, following the diet your dentist recommends, rinsing gently if needed, brushing and flossing other teeth as usual but not cleaning the teeth right next to the site, and asking about pain medication.

Risks

Cleveland Clinic lists delayed healing, dry socket, infection, maxillary sinus damage and nerve injury as possible complications. Tell your dentist if you are worried, and follow the aftercare instructions.

Aftercare guides

Our guides on how long extraction pain lasts, how long to keep gauze in, mouthwash after extraction, when you can smoke or use a straw, and sleeping after wisdom teeth removal cover the details, and our wisdom teeth and dry socket guides cover those topics.

Questions to ask before an extraction

Written answers make the day and the recovery easier to plan.

• Is this a simple or surgical extraction, and who will do it?
• What anesthesia or sedation will I have, and what should I do about eating and driving?
• Will I need stitches, a bone graft or a replacement tooth later?
• What can I take for pain, and what should I avoid?
• Who do I call if something seems wrong, and what is the out-of-hours number?

Guides in this topic

Frequently asked questions