Removing a tooth
Tooth Extraction
Taking out a tooth that cannot be saved, or that has to go for the sake of the rest of the mouth, and looking after the socket afterwards.
When a tooth comes out
Extraction is the last option rather than the first, because nothing replaces a natural tooth as well as the tooth itself. The usual reasons are decay too extensive to restore, a fracture running below the gum, advanced gum disease that has taken away the bone holding the tooth, infection where a root canal is not possible or has not worked, and crowding where a tooth is removed to make room as part of orthodontic treatment.
It is fair to ask what the alternatives are before agreeing to an extraction, and what each of them costs in time, money and likely lifespan. Sometimes keeping a tooth means a root canal and a crown that may last many years, and sometimes it means spending a lot on a tooth that will be lost anyway. Both answers exist, and which one applies depends on the specific tooth.
At the appointment
An X ray is taken so the shape and length of the roots are known. Tell the office about medications and medical conditions in advance, particularly blood thinners, bisphosphonates, diabetes and heart conditions, because those affect the planning. The area is numbed with local anaesthetic, and you should feel firm pressure and hear noise but nothing sharp.
A simple extraction loosens the tooth in its socket and lifts it out whole. Where the tooth is broken at the gum line, has curved or spread roots, or is buried, a surgical approach is used instead: the gum is lifted, a small amount of bone may be removed, and the tooth may be divided so it comes out in sections. The socket is then cleaned, stitched if needed, and you bite on gauze so a clot can form.
Visits, Recovery and When to Call
Visits and timing
Normally one appointment. A simple extraction takes a matter of minutes once the anaesthetic has taken. A surgical extraction takes longer. Non dissolving stitches need a short visit about a week later to be removed.
Afterwards
Bite on gauze for the first hour. Ice on the outside for the first day, then soft food on the other side. No smoking, no straws and no vigorous rinsing for twenty four hours, because suction and rinsing dislodge the clot. Start gentle warm salt water rinses the following day.
Call sooner if
Pain increases from day three, which is the pattern of a dry socket where the clot has been lost, bleeding restarts and does not stop after twenty minutes of firm continuous pressure, swelling is still increasing after day three or comes with a fever, or the lip or tongue is still numb the next day.
Think about the gap in advance
Once a tooth is out, the bone that held it gradually shrinks, and the teeth beside and opposite it start to move into the space. That is not always a problem, and a lone back tooth may not need replacing. But the options for replacing it, and how straightforward they are, are best discussed before the extraction rather than a year later once things have shifted.
Keep reading
Questions About Tooth Extraction?
Describe the problem on the phone. That conversation is usually enough to work out the first appointment. Mandarin, Taiwanese, English and Japanese are spoken.