With proper care and maintenance, the natural teeth that you have in your mouth will last a lifetime.
However, there may come a time when you need to have one or more of those natural teeth removed.
The reasons why can differ.
In this article, I will explain the main reasons for tooth extraction.
I shall explain the process of tooth removal and what you can expect, both before and after the process of tooth removal, as well as other useful associated information.
For those scared by the thought of having to have teeth removed, don’t be.
Although it may seem scary, tooth extraction is relatively painless and the recovery time is quick, providing you follow the advice given by your dentist.
Few people go to the dentist wishing for their teeth to be removed.
Other than for a checkup, most people go to the dentist as a result of pain and discomfort they are suffering with their teeth.
Before any diagnosis, an assessment needs to be made.
This will likely start with you explaining your symptoms and the dentist asking questions like:
- What does the pain feel like?
- When did it start?
- Is it constant?
- Does anything make it better or worse?
- Do you feel the pain in other teeth?
- Have you used pain killers?
Based on your responses, the dentist will be trying to piece together the information in their mind.
A visual inspection will then be undertaken, considering all that you have offered.
The dentist will look for:
- Broken or fractured teeth
- Signs of tooth decay
- Signs of gum disease
- Swellings such as an abscess
- Tooth wear
- Other irregularities within the mouth
A physical examination will include probing the gums and teeth, using specialist tools to check the overall health of the teeth and perhaps an x-ray of the teeth may well be required.
An x-ray gives the dentist extra information in diagnosis.
It can be used as another way to assess the situation. X-rays also help the dentist see the shape of roots of the teeth and if there is anything near the roots under the gumline.
An x-ray can also show the dentist the extent of any decay, whether a tooth might be likely to break if it needs extracting.
It can also help identify whether you are a candidate for particular post extraction treatments, to replace a missing tooth if extraction is required.
Where possible a dentist uses tooth extraction as the last option. You cannot reverse this procedure.
As a dentist assesses your mouth and teeth, if they think 1 or more teeth need to be removed, they will be asking themselves questions such as…
- Does it need to be removed?
- Can it be saved?
- Are there other options?
A dentist needs to consider what will happen should a tooth be removed.
It is not always the case of removing the tooth and having done with it.
Removing a tooth has consequences on the gum and jawbone, the other teeth as well as your smile, confidence and the ability to eat.
Your dentist will explain to you the situation as they see it. They will offer options and the consequences and give their professional opinion on the best course of action.
Based on this, you can make an informed decision on what to do.
Reasons for tooth removal
What is the most common cause for needing a tooth removed?
Teeth may need to be removed if they are broken beyond repair and unable to be saved. Sometimes teeth can also be removed elective for orthodontic treatments.
Dr Chhaya Chauhan – In-house dentist – GDC Number: 83940
A dental assessment has or might determine that removal is the best option.
The following are a number of common reasons for a tooth removal.
Damage or trauma
Sadly accidents happen in life.
The consequence of an accident may well be damage or serious trauma to the teeth.
The severity of the damage will impact the action a dentist will take.
Trauma, such as falling over, may cause only a small chip on the tooth. Larger breaks in the tooth may reveal the nerve of the tooth, and root canal treatment may be required. A very large break in the tooth may go underneath the gum line, and in this case, extraction may be the best option.
A loose tooth can potentially be saved, depending on how loose it is and if it responds to a simple splinting procedure to protect the tooth for a couple of weeks.
In extreme cases, a dentist or surgeon may have to take appropriate action without your consultation, but they will always act in your best interest. If this is the case, the dentist will do the best they can to save your teeth.
Alternatively, it may well be possible to offer painkillers as a temporary measure. This can reduce pain, but also allow time for swelling and bleeding to reduce and healing to begin. A better assessment can then be made when you are not in so much pain.
Infection within teeth is often as a result of decay.
Decay breaks down the tooth surface and bacteria can get inside the tooth where there are nerves and blood vessels.
Once this infection gets to the nerve area of the tooth, action needs to be taken to remove the bacteria. If this is not done soon enough you may develop an abscess.
Temporary fillings/dressings, root fillings, and (in rare cases) antibiotics are ways to manage infection. The first course of action is physically removing the bacteria and infection with a dressing into the root (pulp extirpation). Antibiotics are only required for severe swellings and where the infection is spreading.
Once an infection is within the tooth it can get into the bloodstream. Ultimately this could result in sepsis.
Severe infection may require tooth removal if a dressing cannot be placed, or if the tooth is not suitable for a root filling.
There are some instances where the risk of infection is increased, such as those undergoing chemotherapy, which causes the immune system to be weakened. For these types of patients removing the tooth is the best course of action for overall oral and physical health.
Overcrowding, teeth straightening & orthodontics
Everyone’s mouths are different.
You may have a small mouth with no space between your teeth, whilst others may have a larger mouth with more gaps and space between each tooth.
Each mouth and the way teeth position themselves varies. We all normally go through 2 sets of teeth, baby and adult and should have the full 32 teeth develop in the latter set (depending on whether or not you have all of your wisdom teeth).
Ultimately for some people, there is simply not enough room for all the teeth to form and position correctly.
Some may erupt (break through the gum) twisted or only partially, whilst others will erupt correctly but can be malaligned with other teeth.
Removing a tooth can allow for space to be created for the remaining teeth in the mouth.
Your individual circumstances will dictate how many teeth need to be removed and whether simply removing them is enough.
It is quite common for teenagers and young adults to undergo a specialist treatment process that straightens malaligned teeth (orthodontics).
Managed by an orthodontist, their speciality is to use dental appliances such as braces to move and position the teeth in such a way to give them a more normal formation which aids with your smile, bite, speech and even eating.
The following video gives an animated example of how teeth can be removed and moved with orthodontics.
Periodontitis is a severe form of gum disease that, if left untreated, can cause the teeth to become loose and sadly need to in turn be removed.
Periodontitis occurs when bacteria in the plaque releases toxins that irritate your gums, making them red, swollen and painful.
Over time this results in break down of the tissue, ligaments and bone that hold the tooth in place within the jaw.
At the later stages of the disease, the tooth is unable to remain firmly held within the socket and becomes loose. Although this may not be painful, you may want to have these teeth to be removed to make it easier to eat (for example).
Gum disease can affect anyone but is generally managed by good oral hygiene.
Brush twice a day for 2 minutes and floss once a day too, then you are on a good path.
If you don’t brush regularly and fail to floss, then you could be the next victim of gum disease.
Wisdom teeth or as they are otherwise known, ‘third molars’ tend to form a little later than our other teeth.
Your third molars are right at the back of your mouth and develop after your adult set of teeth.
They tend to come through by your mid-twenties.
For many, they come through without issue.
For others, the development of wisdom teeth is a little more painful, because there is not enough space for them in the mouth.
They can become ‘impacted’.
The wisdom tooth collides with existing molars and is unable to properly erupt from the gum. If it does erupt, it does so at an angle.
It might be possible to go years without pain or problems, but it is common for those with impacted wisdom teeth to suffer pain, swelling and infection because they are more difficult to clean.
You may get decay in the wisdom tooth, in the tooth in front, or infection around the wisdom tooth (known as pericoronitis).
If the wisdom tooth causes issues because of infection, removal of the offending wisdom tooth may be offered.
The process of removing a wisdom tooth, how long it takes to remove, the costs and more are all covered in our comprehensive guide to wisdom teeth.
Do I have to have a tooth removed, what are my options for keeping it?
You don’t have to do anything you don’t want to, and a dentist cannot remove your tooth without your consent.
However, it is worth remembering that your dentist won’t recommend tooth removal unless they believe it is the best option. If a tooth is infected you will often be offered a root canal treatment or tooth removal.
In some cases a root canal treatment is not suitable because of the shape of the roots or infection below the gum level. You may also be offered tooth removal if the tooth is broken beyond repair. In any case, if are not in pain you may decline treatment. Just be aware that infection won’t go away by itself, and the tooth may cause problems in the future.
Dr Gemma Wheeler – In-house dentist – GDC Number: 259369
Tooth extraction alternatives
As suggested earlier, tooth removal is the last option that dental professionals wish to take in most instances.
Chipped, broken or damaged teeth can often be repaired or restored.
Your dentist will assess all the options available to you along with their recommendations. This may include taking an x-ray to analyse from a different perspective the situation you are faced with.
Believe it or not, actually removing a tooth is a cheaper and sometimes quicker option than the alternative treatments.
But, cheap and quick is not always the answer. There is more to consider than this.
Removing a tooth can affect the way you look, the way you eat and possibly the way you speak too.
Ultimately, removing a tooth can have a negative impact on the gums, jaw and other teeth in the mouth.
After a tooth is removed, the bone that once held it in place is no longer needed. Because you will not put pressure through the bone any more, the bone will shrink away. Your face could sag as a result.
If a gap is left between the teeth, the teeth either side may twist or tilt into the space.
You will probably want a denture or implant to help restore the natural look to your mouth and teeth as well as allow you to eat and speak properly.
These treatments incur additional cost as well as having their own benefits and drawbacks.
In some cases, the price of getting a denture, wouldn’t be too dissimilar to opting for the root canal treatment.
With a few exceptions, retaining your natural tooth for as long as possible it the best option.
You need to consider with your dentist what your other choices are.
If they don’t offer any, ask whether there are other options available, and consider getting a second opinion.
A root canal or crown might well be an option.
Bupa explains some of the options available to you if your teeth have become worn, decayed or broken.
Preparation for tooth removal
Should tooth extraction be the course of action that you chose, before the dentist takes out the tools and begins the process, there are some steps that need to be completed.
The exact process will vary from one dental clinic to another but most will follow steps that include:
- A detailed assessment of your mouth and teeth condition should be made prior to an extraction.
- X-rays will be taken to give a different view on the teeth causing concern.
- Diagnosis/consideration of alternative treatment
- The diagnosis will explain the cause of the problem.
- The treatment options may include tooth removal, but extraction is not always the only option.
- Make sure consideration has been made for possible alternative options such as root canal treatment.
- Ask what would happen if the tooth were not removed.
- Ask about the options for replacing the tooth after extraction.
- Explanation of the procedure
- The key steps involved should be explained to you so that you are familiar and comfortable with the process.
- Understand the risks.
- You should be made aware of the costs and payment options you have.
- Medical history
- Your medical history should be checked to ensure you are able to have the treatment and any risks are known.
- Let your dentist know of any medical history that may affect the extraction process or recovery. Examples include:
- Damaged or man-made heart valves
- A congenital heart defect
- An impaired immune system
- Liver disease (cirrhosis)
- An artificial joint, such as a hip replacement
- A history of bacterial endocarditis
- Medications that thin the blood, e.g. warfarin
- Medications that affect your immune response
- Explanation and directions for what steps to take once the tooth is out should be given.
- You want to be aware of the care required so you can prepare.
- This advice will usually be reiterated after extraction.
If you have any concerns about the extraction, raise them with your dentist.
Tooth removal is not something that can be reversed, make sure you are happy with the procedure and what is involved, before the removal.
There are no silly questions to ask.
Pregnancy and tooth removal
With proper consultation, there is no reason a tooth cannot be extracted whilst pregnant.
However, the possibility of delaying extraction will be looked at.
X-rays and any anaesthetic, be that local or general can theoretically have a negative effect during pregnancy. Generally, dental professionals wish to avoid unnecessary stress or harm to the mother or baby.
The National Radiological Protection Board (UK) gives guidance to dentists about x-rays, and explains that the radiation dose to the pelvic area is so small that potential risk to a developing baby is almost zero. For this reason x-rays during pregnancy are, for the most part, safe. However, if a pregnant woman decides she does not want an x-ray, this will always be respected.
In reality, dental professionals prefer to wait as long as is feasibly possible before undertaking treatment on pregnant women. Ideally, permanent treatment would be undertaken once the pregnancy has ended.
Types of extraction?
Tooth extractions come under 2 different classifications. These are:
- Routine extraction
- Surgical extraction
As the name might imply, the surgical extraction is for the more complicated removal procedure and may require a trip to a hospital or other specially equipped practice.
Lets also just dispel a myth that a male dentist is better at tooth removal than a female. It is not about strength, it’s about technique.
This is the most common type of extraction.
Routine extractions are able to be completed whilst in the dentist’s chair in your local dental practice, and it normally requires little planning.
Thankfully, it is fairly straightforward.
A local anaesthetic will block any tooth extraction pain during the procedure, but you will still be able to feel pressure.
With the help of local anaesthetic, during this extraction, you will be awake and aware of what is going on and will be able to hear.
Your tooth sits in a hole within the gum and bone. This hole is known as a socket, and the root of the tooth sits deep within this and is fixed in place with ligaments.
Once the anaesthetic has started to work the dentist will use a tool called an elevator.
The tool helps them loosen the tooth by placing in between the gum and the tooth and lifting it up.
There will be a bit of wiggling and multiple attempts at different angles to free the tooth from the socket. This helps widen the socket to make for easier removal.
Once there is a good bit of movement and access, a set of dental forceps will be used.
Forceps are used to get a tight grip of the tooth. The forceps allow force and leverage to be applied to the tooth and further help loosen and lift the tooth out in one piece.
It is possible that the tooth will break or chip during the extraction, especially if there is a large hole or filling in the tooth.
It is also possible that the dentist will choose to break the tooth into smaller pieces to help with the removal.
However it ends up coming out, in one piece or multiples, a dentist is trained to remove all of the tooth and do it safely.
Once removed, a piece of gauze will be used to help absorb any blood and to apply pressure to the empty socket. Overall, this will help a blood clot to form and protect the bone where the tooth has been removed.
In some instances, a stitch or 2 may be given to seal the gum and help with healing and blood loss.
Certain tooth extractions, particularly the removal of impacted wisdom teeth, require a more complicated procedure.
Some cracked, broken or decayed teeth may also require this type of approach.
A surgical extraction will normally require an incision to be made into the gum to give greater access to the tooth and the underlying bone.
Specialist drills can often be required to remove bone and even break the offending tooth up into pieces.
Removing the tooth in one piece is not always possible, so by breaking it up, the surgeon can achieve a more successful extraction.
Often completed in a hospital, it is more common for a general anaesthetic to be given, particularly for children or if multiple teeth are being removed.
However, it is still perfectly possible to have it completed with the use of a local anaesthetic.
With surgical extractions, the use of a stitch or 2 is common as the gum tissue has been disrupted more than in a routine removal. These will usually be dissolvable.
Surgical extractions performed within hospitals are normally completed by a maxillofacial surgeon. Oral and maxillofacial surgeons are specialists in surgical procedures that involve the head and the neck, and most consultants are qualified in medicine and dentistry.
The following animation from Bupa shows the steps involved in removing a wisdom tooth
If you are not too squeamish, then you may want to watch a video that actually shows a real world example of a wisdom tooth being removed.
How long will the extraction take?
As every case is different, the amount of time required to remove a tooth can vary.
Typically a routine extraction will take 20-40 minutes to complete, including the time taken for you to go numb and after the procedure for the dentist to check it has stopped bleeding.
An extraction is not as quick as your routine checkup, but unless you are undergoing a more complex surgical extraction you need not write the whole day off.
Affecting the time required will be the number of teeth that you are having removed and their condition.
A healthy tooth that must come out for teeth straightening may take longer to remove than one that is already loose because of gum disease.
Removing a lower incisor tooth with their short single root will take less time generally than a molar in the upper jaw.
A molar has up to 3 roots and access to that tooth can be more difficult as it is at the back of the mouth.
Before the extraction begins it may take 10-15 minutes to get you and the dentist ready for the extraction, including numbing the area with anaesthetic.
The actual tooth extraction may take 3-5 minutes per tooth, a little longer if it’s stubborn.
Molar teeth have more roots, so can be the more difficult of all the teeth to remove.
Once the tooth is removed there will be about 5-10 minutes of post extraction duties. This will include stopping bleeding and ensuring you know what is required to care for your mouth with the tooth now out.
Will the extraction be difficult?
A common question is whether the extraction will be difficult.
It is not one that is not easily answered without a full picture of your condition and the circumstances for the extraction.
Everyone is different and your dentist will be able to advise you more accurately.
Trained to deal with more complex extractions, a dentist will consider any risks and complications that may be encountered and bear them in mind during the extraction process.
If there are greater risks or complications that are likely to make the extraction too difficult for a normal routine extraction the dentist may refer you on for surgical extraction.
Generally, the teeth of older people are likely to be more brittle and more likely to crack or break. However, these teeth are also likely to have less bone holding them in place, making them easier to remove.
People with African and Caribbean ethnic backgrounds often have denser bone and teeth with thicker roots (or even extra roots). This can mean that the teeth can be harder to remove.
Small mouths can pose a problem as can particularly overcrowded teeth, due to the difficult access when reaching the teeth.
Does tooth extraction hurt?
Removal of teeth is not natural, nor is it the most comfortable of procedures.
During the procedure, it should not hurt.
Under a routine extraction, anaesthetic will be applied locally.
This means the area around the tooth that has to come out will be injected with a numbing agent that stops the pain.
Once injected it will take a few minutes to work.
The dentist will ask a series of questions and make sure the area is numb before commencing.
Once the removal begins, you should really only feel pressure, no actual pain.
Should you feel pain, you should alert the dentist without delay.
Many will advise you before extracting the tooth as to what to do if you feel pain.
Once out, in the hours and days after the removal, there will be some discomfort as you have just removed a tooth from the bone.
You might get a bit of swelling or a throbbing pain in and around the extraction site as your body reacts and heals.
There should not be any excruciating pain. If there is you need to contact your dentist without delay.
Any mild discomfort can be treated with paracetamol and ibuprofen and following the tooth extraction aftercare instructions provided by the dentist.
Does getting a tooth removed hurt?
A dentist removing a tooth will give you local aesthetic so that the procedure doesn’t hurt. You will only feel pushing, but no discomfort. When the numbness of the injections wears off there will be some aching from where the tooth was removed but this will be helped with painkillers and will get better within a day or two.
Dr Gemma Wheeler – In-house dentist – GDC Number: 259369
How long after tooth extraction can I eat and drink?
You can eat almost immediately after the tooth extraction procedure. The same goes for drinking.
Ideally, you want to give your mouth some time to recover and form a clot in the socket.
Clotting actually happens fairly quickly, but the longer you can leave it, the better the clot will be and the less chance you have of disrupting it or causing any complications.
This does not mean you should not eat or drink after having a tooth extracted, but if you can leave it a few hours, this is going to be better than eating just a few minutes after the extraction.
There is nothing stopping you eating whatever you like after a tooth extraction. However, you are wise to follow the advice of dental professionals if you want to ensure a speedy recovery and not cause more problems and complications with the tooth removal.
For the first 24 hours at least be sure to stick to soft foods and preferably foods that a not hot or too cold.
Yogurt is a great food to start with, soups are also good too.
If you are able to allow cold food stuffs to come a little nearer to room temperature or allow hot food to cool down so it is warm, you have less chance of experiencing pain.
Hard and crusty foods are best avoided for 24 hours.
Any chewing you do need to do, should be done, if possible on a different side of the mouth to the extraction or mash it prior to eating.
Within 48-72 hours you should be able to return to a more normal diet although you might still notice a slight tenderness when applying pressure to the area.
Alcohol after tooth extraction
Avoid alcohol for at least 24 hours.
Alcohol can thin the blood and make it more difficult for the blood to clot, which is a vital part in the healing process following a tooth extraction.
Consuming alcohol puts you are greater risk of dry socket.
Although you might think alcohol may take your mind off the matter, it could very likely make you think about it a lot more when it causes the healing process to stall.
If you are alcohol dependant it can be worth discussing this with your dentist prior to an extraction.
Complications – Tooth root left in the gum
An adult tooth can have up to 4 roots.
The job of these roots is to keep the teeth in place within the mouth as best as possible.
Under a normal extraction procedure, the idea is that the tooth and all its roots come out together in one piece.
In some instances, however, when a dentist removes a tooth, a piece of the root can intentionally or unintentionally be left behind.
It depends on the circumstances as to why this might be, but a dentist should always tell you if a piece of the tooth, has been left within the gum.
Extractions are a fairly routine part of dentistry and the dentist will use their tools to the best of their abilities to remove the entire tooth.
However, sometimes the tooth can break during the extraction and the remaining root is too difficult to remove as part of the routine extraction.
There may be a nerve very close to the root of the tooth and removing it could cause nerve damage which is more dangerous than leaving the root in the jaw.
The dentist will always advise based on the exact circumstances, but in many instances, the root can be left in place and the gum can heal around it.
Sometimes it will be necessary for what should be a routine extraction to evolve into a surgical extraction to avoid the risk of infection and further complication.
Surgical extractions rely on a surgeon to perform more advanced surgery to remove the offending piece of root.
This is particularly likely if the tooth has broken or become extremely decayed, meaning there is no crown to the tooth and only the roots remain in the gum.
Tooth extraction aftercare, healing and recovery
Once the dentist has done their bit of removing the tooth or teeth in question, you then begin the healing process.
There are 4 key tooth extraction healing stages.
- Stage 1 – The first 24 hours – Immediate aftercare/blood clotting. This involves stopping the bleeding and forming the initial blood clot and ensuring the gum can heal.
- Stage 2 – The first 24-48 hours – Tissue granulation. This is usually within 24 hours or so, that the clot within the gum will be covered by a white or cream coloured granulation tissue.
- Stage 3 – Within 72 hours (3 days) – Gum closing. This is where the pink gum tissue begins to close up over the hole that was left behind by the extraction.
- Stage 4 – 7-10 days – Healed – For most teeth the gum will have closed or nearly closed entirely. Extractions of larger teeth like molars will take a little longer.
Stage 1 of the healing process begins within minutes of the tooth being pulled from the socket.
After extracting the tooth, the dentist will normally apply a piece of gauze to the empty tooth socket.
This will absorb a lot of the blood that will come from the hole the tooth was sat in.
Bleeding is normal at this stage.
The dentist or the assistant may apply pressure to the area, or you may be asked to bite down on the gauze.
By applying pressure it helps stop the bleeding and allows the blood to clot.
Checks will be made to ensure the extraction site is clean and there are no fragments of tooth or tissue left behind.
If required a stitch may be placed to help the gum heal and reduce the bleeding. If you are at higher risk of infection, the dentist may pack a dressing into the socket.
This process will take a few minutes and usually, you will not leave the dentists chair until they are happy that it is safe for you to leave.
Before you leave you will be given clear instructions on how to best care for your mouth in the days after the extraction and how to help with the healing process.
Stages 2 to 4 of the healing process happen at home, away from the dentist’s office.
What should you do after a tooth extraction?
Pain after tooth extraction should be expected. Often there is a throbbing pain in and around the extraction site.
By the time you leave the dentist, hopefully, the bleeding will have subsided and the clot will have begun to form.
However, it is important to remember, that by the very nature of the event, there may well be some slight bleeding once you have left the dental office and for the next 24 hours.
Unless there is lots of blood, do not be too concerned.
It can look worse than it is, as blood mixes with the saliva in the mouth, making it look more dramatic.
Applying pressure is the best way to reduce bleeding. You may leave the dentist with a bit of gauze still applied, continue to bite down on this.
If at home, a clean cotton material can be folded and have pressure applied to it and the affected area. Don’t use tissues as these can get messy as they break down when moist.
When the bleeding has stopped, you still need to be careful and take care as the socket remains exposed and vulnerable.
There are a few simple things you can do to help the recovery and healing process and help dull the tooth extraction pain.
Your dental professional will provide you with their advice and suggestions on how to care for your mouth post extraction. Always take their advice.
Likely suggestions will be:
- Take painkillers such as ibuprofen or paracetamol should you have mild pain or aches.
- Do not take aspirin as this could make the area bleed.
- Prop your head up if lying down. Lying flat may prolong the bleeding.
- Apply ice to the area soon after the extraction to keep the swelling down.
- Relax, take it easy and don’t overdo it for 24-72 hours. Avoid strenuous exercise.
- Avoid rinsing the mouth for at least 24 hours to ensure the clot properly forms in the socket.
- After 24 hours a salt mouthwash may be used to aid healing:
- Put a teaspoon of salt in a glass of warm water.
- Give it a stir to create a salty solution.
- Gently rinse it around the mouth at least twice a day.
- Avoid cleaning around the socket that day but make sure you brush everywhere else as normal.
- Avoid smoking as this increases the risk of infection and dry socket.
- Eat soft foods for the first 24 hours or so. Soup, and yoghurt are great examples.
- Avoid hot food and drinks which can dissolve the clot
- Avoid alcohol for at least 24 hours as this thins the blood and increases the risk of bleeding.
If you follow the advice above and the information given to you by the dentists, this reduces the chances of any pain or infection after the tooth is removed.
A little discomfort should be expected. Throbbing and sensitivity are normal.
However, should the pain feel intense, should you have lots of bleeding or want reassurance, contact your dentist.
How long does it take to heal?
It will normally take about seven to ten days for the hole to close after the tooth has been extracted.
The body, and the mouth especially has an amazing ability to heal naturally and time helps with the healing process.
The first 24 hours will, of course, be the most uncomfortable and you may well feel a little sorry for yourself. A clot will form in the hole and this will be replaced with a white or creamy coloured granulation tissue, this is stage 2 of the healing process.
Within 3 days (72 hours) you will probably feel a bit more ‘normal’ and will have become used to it. You are now at stage 3 of the extraction healing process, where the gum will start to cover the hole in the bone.
The 4th and final stage of healing happens usually within 7-10 days (a little later for larger tooth extractions). At this point, the gum will hopefully have healed nicely. Any stitches will need to be removed if they are not dissolvable. Whilst most of the hole will be covered by the gum you may still get food stuck in the small gap that is left.
On the surface, things heal a bit quicker than they do underneath.
Routine extractions will usually see internal gum tissue heal within a couple of weeks, but larger holes such as those taken up by molars and wisdom teeth take longer to heal.
The gum will cover the hole, but it takes months for the bone to restructure. The bone will shrink as it is no longer needed to hold a tooth in place. During this time the bone may feel rough, or even sharp to your tongue. This is normal.
If a surgical extraction was completed and the bone had to be cut away, expect it to be 6-8 months before that socket has healed and for the bone to feel smooth.
This extended healing time for the bone should not affect your day to day life after a couple of weeks from the extraction.
After an extraction, the blood within the socket needs to clot.
The clot acts as a barrier, like a plaster might to a cut on your finger, or a scab on your knee if you fall over.
If the clot fails to properly develop or dislodges prior to healing, (often as a result not following the aftercare directions) dry socket can occur. In this case, the bone in the socket is exposed to the mouth.
A dull aching sensation will be felt within the gum or jaw. This is because the underlying nerves and bones have become exposed to saliva and food debris that they would not have, had the clot remained in place.
Coming from the empty tooth socket, there can be a bad smell or taste too.
It is not an infection and is not associated with swelling, because it occurs entirely within the bone.
Sadly there are no antibiotics that can help reduce the chance of this occurring.
Dry socket after tooth extraction usually occurs if the aftercare advice has not been followed. Smoking within 24 hours of having a tooth removed and poor oral hygiene drastically increase your risk of this happening.
If the pain does not get better within 48 hours of having a tooth removed, you should see your dentist.
If the dentist diagnoses you with dry socket they can rinse the socket out and place a dressing (possibly a medicated dressing) in the hole to protect the bone and help it heal. You may too be prescribed some pain medication. The healing time for dry socket is around 7-10 days.
Due to the prolonged pain and discomfort that can be experienced as a result of dry socket, it really is best to follow aftercare guidance given with tooth extraction. The 24 hours or so required to help the extraction site heal will be well worth it, to forgo the possible consequences of dry socket.
Pain after extraction
It is normal for there to be some mild discomfort and pain after a tooth extraction and when the anaesthetic wears off.
There will likely be some swelling and a bit of bleeding. There will too likely be a throbbing pain after tooth extraction.
Most pain or discomfort will be felt within the first 24 hours and should have really settled or stopped 48 hours or so after extraction. There shouldn’t be any prolonged pain.
Follow the tips provided by your dentist and you should not have to seek any further dental assistance.
- The pain becomes severe (i.e. does not get better with painkillers, or worsens after 24-48 hours)
- There is a lot of bleeding which does not stop if you apply pressure for 20 mins
- You feel sick and the need to vomit
- There is any abnormal discharge from the extraction site
- You appear to have an infection, fever or chill
- You have tooth extraction pain 5, 7 or 10 days after having the tooth pulled
- You are concerned in any way
…make contact with your dentist.
Tooth extraction costs in the UK
If you focus just on the cost of actually removing a tooth and nothing more, the costs appear relatively good value, considering the skill and process involved.
However, as this article has shown, removing a tooth is only part of the matter. What do you do once it is removed?
It is not free to have a tooth removed with the National Health Service (NHS) unless the person requiring the extraction is:
- under 18, or under 19 and in full-time education
- pregnant or have had a baby in the previous 12 months
- being treated in an NHS hospital and your treatment is carried out by the hospital dentist (but you may have to pay for any dentures or bridges)
- receiving low income benefits, or you’re under 20 and a dependant of someone receiving low income benefits
For those required to pay for treatment, it is covered under Band 2 of their pricing structure. The price and is charged at £62.10 (England), £46 (Wales), whilst costs vary from approx £6 – £50 in Scotland and Northern Ireland.
Good or bad, if you need multiple teeth out at the same time, this is covered under the one cost in England and Wales.
However, if you require a tooth out now and another in a few years time, these will be considered separate charges.
If you require a tooth extraction under the age or 18, if you are pregnant, or if you are exempt from dental charges for any other reason, then this will be carried out for free.
Should it be considered necessary to remove wisdom teeth, if this requires a surgical procedure and you are admitted to a hospital this will likely be covered by the NHS and no fees charged.
If you are having teeth out as part of orthodontic treatment that is being covered by the NHS, there should be no cost associated.
If you are not registered with an NHS dentist through choice or are unable to do so, then you can have teeth extracted privately.
Whether a routine extraction or surgical it can be done privately.
There tends to be greater variance in the costs with this option though. Each practice has its own pricing structure.
Some may charge less for a simple incisor extraction than they might if they have to pull out a molar. There will likely be a higher cost if you need multiple teeth out rather than just 1.
Wisdom teeth can be removed privately too, even if it requires hospital treatment. The associated costs here tend to be much higher.
Typical costs for extractions are as follows:
- Simple tooth extraction – £50-140
- Surgical tooth extraction – £100-300
- Wisdom tooth extraction – £80-350
If the tooth removal is required as part of orthodontic treatment you have elected to have completed through a private practice, you should consult your orthodontist as to whether the cost of removing the teeth is included in the price of your orthodontic treatment.
Replacing the extracted tooth
Assuming you have no option but to proceed with the removal of the tooth, you then need to consider what you do about replacing the extracted tooth (or teeth).
You should take the advice of the dentist and consider your options.
Your age, budget, health and personal preference will all come into play.
If the teeth are being removed because of overcrowding, the gap will usually be closed up by the other teeth.
Removal of wisdom teeth will not require any replacement teeth to be considered.
If decay, gum disease or trauma are the cause of tooth loss, then there are different options to consider.
If you have never had a tooth out before a partial denture (false tooth) is a great option.
Or a more permanent option includes an implant or a bridge.
If you have previously had teeth out, then a new or adapted denture might be an option.
If you are expecting to have more or all of your teeth out, a complete set of dentures or implant retained dentures are worth considering.
Where false teeth are normally removable, they tend to be cheaper, whereas an implant is a more permanent option. It may cost more but can last longer and give you a more normal look and feel.
Make sure you know the options you have available to you, preferably before having the tooth removed.
Preventing tooth extraction
If you have not got to go through the process of tooth extraction, then fantastic.
There are some relatively simple steps you can take to reduce the chances of having to have teeth removed.
Sadly there is no way to stop all chances of tooth extraction because some things are outside of your control.
An injury or accident that knocks a tooth out can not necessarily be stopped. If you play contact sports you can reduce your risk by wearing a protective mouthguard.
However, gum disease and decay as causes of tooth loss can be prevented.
Eating a healthy balanced diet, reducing sugar intake, brushing your teeth twice a day for 2 minutes, with the correct technique as well as flossing will help.
Regular dental checkups are also vitally important. A dentist can pick up on potential problems early and give you the advice to stop any issue developing.
Tooth extraction is a routine procedure for dentists, but not one they wish to have to perform.
Taking steps to prevent the causes of tooth loss and considering alternatives is certainly worth doing.
If you have to undergo an extraction, make sure you understand everything involved and what your choices are. Do not commit unless you are happy.
Speak to your dentist to get all the answers to the questions and concerns you might have.
Thankfully restorative dental surgery and cosmetic treatments are so good that should a tooth have to come out, a replacement can be offered and others need not know you have lost a tooth.
For a recap and summary of most of what has been covered in this article, take a look at the video below by Dr Atena.
How long does it take the hole to close after tooth extraction?
- The hole that is left behind when a tooth is pulled, usually takes 7-10 days on average to heal.
- Within 24 hours of extraction the blood will have clotted and a white/creamy coloured granulation tissues will have formed.
- Within 3 days the gum will begin to close up over the hole and then about 10 days after the extraction the gum should have pretty much healed.
- In some instances, the gum will be stitched closed straight after extraction, so it will be closed before you leave the dental surgery.
What should a tooth extraction look like when healing?
- What the gum looks like depends upon what stage of the healing process you are at.
- Within the first 24 hours it will usually be a bit red and swollen, with blood visible in the socket from which the tooth was removed.
- Around 24 hours, the blood inside the hole will begin to take on a white/yellow colour as the tissues begin to heal.
- By stage 3, about 3 days later, the swelling and redness will have died down and you will begin to see the pink coloured gum tissue beginning to close up the hole.
- A week or so later, the hole should be closed or close to being fully covered by the same pink coloured gum tissue you see around other teeth in the mouth.
How long does pain last after tooth extraction?
- You shouldn’t be in any extreme pain after a tooth extraction. It certainly shouldn’t be the type of pain where you want to scream, it hurts that bad! However, there will be a numbness and discomfort that you may consider pain. This will be worst immediately after the extraction. It can last for 28-48 hours normally. In this time the discomfort should subside. If it does not improve with the use of painkillers, be sure to speak to the dentist for further information and advice.
Infection after tooth extraction – What to do?
- It is not that common to experience an infection after tooth extraction, particularly if you have followed the aftercare advice, but it is possible. Some people are more at risk of infection. If you think you have an infection, you should speak to your dentist. Signs of an infection after tooth extraction can include, a throbbing or a dull aching pain or even a smell. What you think is an infection, might be a condition called dry socket, which is not an infection, but a possible complication associated with tooth removal.