While having a tooth pulled permanently is not an ideal situation, sometimes an extraction is necessary to preserve or improve dental health. 

Dentists and oral surgeons perform tooth extractions for a number of reasons. For many patients, wisdom teeth removal is the first extraction experience. Other circumstances potentially requiring tooth extraction include deep decay or damage, severe infection, and orthodontic treatment. 

Patients often face fear or anxiety when preparing for a tooth extraction, but the process is a relatively standard, commonly performed dental procedure. The following in-depth guide will discuss what to expect from a tooth extraction. 

Preparing for a Tooth Extraction Procedure

The process of a tooth extraction starts with a visit to the dentist, where the practitioner will evaluate the issues presented and develop an appropriate plan of action. Once an extraction is deemed necessary, it is important to understand what to expect during a tooth extraction in order to properly prepare for the experience and aftercare. 

Before the procedure, the dentist or oral surgeon will assess the patient’s complete medical and dental history, including all medical conditions and any medications, vitamins, or supplements taken. While tooth extraction is an overall safe procedure, the process can allow harmful bacteria to enter the bloodstream. Patients with an elevated risk of developing severe infection may need to take antibiotics before and after the extraction. 

Common Reasons for a Tooth Extraction 

Although permanent teeth are expected to last a lifetime, there are many circumstances in which a tooth extraction is inevitable: 

• Tooth Decay: A tooth is susceptible to extreme, irreversible decay when an untreated cavity progresses through it, affecting the root and underlying nerve. If the resulting damage is too severe to repair, an extraction may be required.
• Trauma or Injury: Traumatic dental injuries often occur as a result of an accident or sports injury. Fracture of the root may render a tooth unable to be restored by dental work, necessitating a broken tooth extraction procedure.
• Infection: Infection can develop when decay or damage extends to the center of the tooth, allowing bacteria to enter the pulp, where connective tissues, blood vessels, and nerves are located. If the infection is so severe it cannot be cured by antibiotics or root canal therapy, tooth extraction may be necessary to prevent it from spreading to other parts of the body.
• A Crowded Mouth: Tooth removal is sometimes needed to prepare the mouth for dental braces. If tooth size is contributing to misalignment, or if there is not enough space for a tooth to break through the gum line, extraction can aid the orthodontic process. 
• Wisdom Teeth: Third molars, commonly known as wisdom teeth, are the final adult teeth to enter the mouth. Impacted wisdom teeth occur when there is not enough space to emerge correctly and can result in pain or damage to the surrounding teeth. Impacted wisdom teeth are often extracted to prevent further complications. 

How is a Tooth Extracted? 

Tooth extraction is an outpatient procedure performed by a dentist or oral surgeon. During a tooth extraction, the entire tooth is permanently removed from the gum socket. The correct method of extraction is case-specific and dependent on several factors, including the tooth’s shape, size, position, and location. An x-ray image is used to properly assess these factors and assist the dentist in determining the best course for removing the affected tooth.

Most tooth extractions fall into two categories – simple and surgical.

1. Simple Tooth Extractions

A simple extraction involves removing a tooth visible above the gums. Simple extractions are relatively easy procedures commonly performed by general dentists. After thoroughly numbing the surrounding area, the dentist uses a tool called an elevator to loosen the tooth from its socket. Once the tooth is sufficiently loosened, dental forceps are used to grasp the tooth and complete the extraction.

2. Surgical Tooth Extractions

A surgical extraction is a more complex procedure that may involve removal of gum tissue, bone, or both. Surgical extractions are required for teeth not easily accessible or immediately visible in the mouth. In some cases, teeth have broken off at the gum line, and other times, the tooth has not yet erupted through the gums – as is the case with most wisdom tooth removal procedures. During a surgical extraction, a small incision is cut into the soft tissue to allow access to the underlying tooth.

Is a Tooth Extraction Painful?

Tooth extraction can be uncomfortable, but anesthesia is typically used to eliminate pain during the procedure. One or more types of anesthesia may be administered based on the patient’s comfort level, pain tolerance, and the expected complexity of the extraction. 

Local Anesthesia 

When performing simple extractions, local anesthesia is usually sufficient. The practitioner will apply a topical numbing agent to the gums before injecting anesthetic near the extraction site. The patient may feel movement or pressure during the procedure, but should not experience pain or sharpness.

Sedation Anesthesia

For complicated extractions or patients suffering from dental anxiety, sedation anesthesia is used to manage discomfort more effectively. Nitrous oxide (or laughing gas) can aid relaxation while the patient remains awake. Conscious sedation may also be available in pill or tablet form. For a deeper sedation, the dentist or oral surgeon can administer sedation medication through an intravenous (IV) line. This form of anesthesia suppresses consciousness, and the patient will have limited memory of the procedure. 

General Anesthesia 

This method of anesthesia is only offered in special circumstances. Under general anesthesia, total loss of consciousness is achieved by administering inhaled or IV medications, and vital signs are closely monitored. The patient will not feel pain or have any memory of the procedure. 

How Long Does Pain Last After Tooth Extraction?

It is normal to experience some pain as the anesthesia wears off. Swelling and residual bleeding should be expected for 12-24 hours following the procedure. While all patients heal at different speeds, tenderness or discomfort should decrease after 3 days. Fatigue after tooth extraction is also common.

Post-operative pain is frequently felt at the extraction site, as well as in the face, head, or neck. The dentist or oral surgeon may recommend an over-the-counter pain reliever to manage soreness. If the extraction was complex or required surgery of the gums and bone, a more powerful pain medication may be prescribed. If the pain is extreme or persists beyond a few days, a follow-up appointment should be arranged to ensure there are no complications. 

Tooth Extraction Recovery

Knowing what to expect after a tooth extraction procedure can help the patient avoid painful infections, speed up the healing process, and ease worries. A thorough understanding of the healing timeline, stages of healing, and proper aftercare are essential for a smooth recovery.

1. Tooth Extraction Healing Time

How long does it take to recover from a tooth extraction? Recovery time varies from patient to patient, but within a few weeks, the process of healing is usually complete. For a simple extraction, the recovery time is brief. More complicated surgical procedures, like wisdom teeth removal, can affect how long it takes the hole to close after tooth extraction.

2. Tooth Extraction Healing Stages

Throughout the healing process, many changes will occur at the extraction site. Recognizing what tooth extraction should look like when healing will help the patient better understand the stages of recovery.

In the first 24 hours, a blood clot will form in the socket to stop the bleeding. Care should be taken to avoid dislodging it, as this clot plays a fundamental role in healing. 

Within a few days, the body begins to develop granulation tissue to close the wound. This tissue can appear pale in color and consists of collagen, white blood cells, and blood vessels.

After a couple weeks, the surface wound should be almost or completely closed. New bone and gum tissue will continue to grow into the space the tooth root once occupied. Over time, a missing tooth can cause the remaining teeth to shift, affecting the patient’s bite. Replacing the extracted tooth or teeth with an implant, fixed bridge, or denture is often advised for that reason.

3. Tooth Extraction Aftercare

Proper tooth extraction aftercare is vital to minimizing discomfort and avoiding complications. The dentist or surgeon will often print out their personalized post-surgery guidelines for the patient to reference. Taking the recommended medicine as directed supports pain management for a more comfortable healing process. 

Although infection after extraction is rare, the patient should be aware of the potential warning signs, including:

• Foul Breath
• Bitter, unpleasant taste in the mouth
• Fever
• Extreme tooth sensitivity
• Swollen glands in the neck 

Post-Operative Tips: Do’s and Don’ts

While specific instructions will vary based on the complexity of the procedure and the dentist’s preferences, there are many beneficial self-care practices the patient can follow:

• • DO: Rest and Relax. Exercise and over-exertion should be avoided, especially for the first 24 hours. Taking time to rest gives the body the ammunition it needs to recover quickly.
  • DON’T: Use a Straw. Drinking through a straw involves a sucking motion that can dislodge the blood clot. Beverages should be sipped slowly and gently.
  • DO: Stick to Liquid and Soft Foods. Foods that are chewy, crunchy, or spicy can irritate the extraction site. Soft or liquid foods are preferred, and anything too hot or cold should be avoided for at least 24 hours.
  • DON’T: Brush or Floss. It is important to avoid disturbing the extraction site until advised safe to do so. Brushing, flossing, or using mouthwash too soon can irritate the area and impair healing. Instead, the mouth should be gently rinsed with warm water after eating or drinking.
  • DO: Ice the Area. If swelling is present, ice can be applied to the affected side of the face in 15-minute intervals – 15 minutes on, 15 minutes off. The process is repeated for 1-2 hours.

• DON’T: Smoke. Smoking should be avoided for at least 48 hours. Smoke can affect the blood clot and increase the risk of developing complications. 

Managing Expectations

Facing a tooth extraction can be a worrisome, daunting experience, and while these feelings are normal, understanding what to expect before, during, and after the procedure will provide a great deal of reassurance. Managing expectations for the extraction, healing process, and aftercare ensures proper preparation and a smooth, speedy recovery.

USHA-WB7-1221