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Having a tooth removed

Having a tooth completely removed by a dentist can be done at one appointment or over a few sessions if more than one tooth needs to be taken out. You may choose to replace the missing tooth or it may be necessary to do so. Your dentist will explain all the options available to you. Keep in mind that your options may differ from what’s described here as personal dental care is designed to meet your individual needs.

About tooth extraction 

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). This is caused by bacteria building up on your teeth and damaging the bone that holds them in place. The teeth become loose and will need to be removed professionally.
  • Tooth decay. If a tooth is very decayed, its nerves and blood vessels can die, leading to a painful abscess.
  • A broken tooth. If it can't be repaired it will need to be removed
  • 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 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.

What are the alternatives? 

If you don't want to have your tooth taken out, sometimes alternative treatments are available. Painkillers or antibiotics may ease any pain and swelling, but these will just relieve your symptoms in the short term and won't get rid of the underlying problem. If you have crooked teeth, it's sometimes possible to have them corrected without extractions. An orthodontist (a dentist who specialises in straightening teeth) will be able to explain the treatment options available to you.

Preparing for a tooth extraction 

Your dentist will ask about your dental and medical history. It's important that you tell them about any medical conditions, allergies or recent operations. You should also tell your dentist if you use an inhaler or are taking any medicines, 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 to hospital and have the tooth removed under general anaesthetic, which 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. This completely blocks feeling from the area so you don’t feel any pain during the procedure, though you may feel some pressure in your mouth and hear some noise.

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. They will then move the tooth from side to side until it’s loose enough to be removed completely.

In more difficult and rarer cases, your dentist may not be able to reach the root of your tooth so small cuts will be made in your gum. If necessary your dentist can then drill away some of the bone so the root of the tooth 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’ve had your tooth removed under local anaesthesia, you’ll 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.

If you’ve had general anaesthesia or sedation, you’ll need to arrange for someone to drive you home. Try to have a friend or relative stay with you until the next day. Both sedation and general anaesthesia temporarily affect your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents until your dentist tells you it's safe to do so. This will be at least until the next day.

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 few hours after the extraction. This is because any blood clot that may have formed could be disturbed and the bleeding could start again. After the first few 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 as normal after the extraction but keep your toothbrush away from the healing wound for the first couple of days.

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 a common procedure 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.

Side effects

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, try over-the-counter painkillers such as paracetamol or ibuprofen. Always read the accompanying consumer medicines information leaflet and ask your pharmacist for advice.

Some slight bleeding is normal in 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

Contact your dentist immediately if you experience the following after the procedure:

  • Prolonged bleeding
  • Swelling
  • Severe pain
  • High temperature (fever)

These may be the signs 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’s 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 haven’t included statistics here. Ask your dentist to explain how these risks apply to you.

Further information 

Australian Dental Association

www.ada.org.au

Sources 

Chestnutt IG Gibson J. Churchill's pocketbook of clinical dentistry. 3rd ed. Elsevier. 2007.

Holt R Roberts G Scully C. Dental damage, sequelae, and prevention. BMJ. 2000; 320: 1717-1719.

Mitchell DA Mitchell L. Oxford handbook of clinical dentistry. 4th ed. Oxford University Press. 2007; 261.

Roberts G Scully C Shotts R. Dental emergencies. BMJ. 2000; 321: 559-562.

Last published: 30 July 2011

Disclaimer
This information has been developed and reviewed for Bupa by health professionals. To the best of their knowledge it is current and based on reputable sources of medical research. It should be used as a guide only and should not be relied upon as a substitute for professional medical or other health professional advice.

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