Tooth extraction is the removal of a damaged or unrestorable tooth.
There are 2 types of extractions: simple extractions and surgical extractions.
Wisdom tooth extractions are almost always surgical extractions.
A tooth extraction is a procedure where an unrestorable tooth is pulled out of its bone socket. An extraction is required in cases of a deep cavity, wisdom teeth, broken teeth, etc. However, some deep cavities can be restored by a root canal.
Depending on the complexity of your case, you may need a simple extraction or a surgical extraction. A surgical extraction has a longer healing time and higher cost than a simple extraction.
Tooth extractions cost anywhere from $140-$450 per tooth, depending on the complexity of your case, your location, your dentist, and your specific needs.
Simple vs. Surgical Extraction
There are two main types of tooth extractions: simple tooth extraction and surgical tooth extraction.
Simple tooth extraction is a more routine procedure where the tooth has no complications and is fully erupted (grown in) above the gum line.
The healing time, pain management, and swelling are usually milder with a simple extraction.
Surgical tooth extraction requires a more invasive dental surgery procedure for partially erupted or impacted teeth (when a tooth is blocked from breaking through the gum). You can expect a little more pain and swelling and a longer recovery time.
I recommend taking 2-3 days off after a surgical extraction procedure to allow adequate time to heal and recover.
In more complex cases, you may need to see an oral surgeon.
Your general dentist will determine whether you need a surgical or simple extraction based on:
- Visibility of the tooth
- Impaction of the tooth (related to wisdom teeth – when a tooth is blocked from breaking through the gum)
- Tooth root structure/shape
Reasons for Getting a Tooth Removed
Several situations may require a tooth to be pulled, including:
- Broken/fractured tooth: If your tooth is too broken or damaged to restore, your dentist will recommend extracting it.
- Large cavities: If you have a large cavity that causes pulpitis (inflammation and infection of the pulp) inside your tooth, you will need either a root canal or tooth extraction.
- Wisdom teeth: Third molars can cause issues by growing in incorrectly, causing crowding, developing cavities, and cause pain. Impacted wisdom teeth can cause infection, inflammation, and pain if not removed.
- Crowding: In some orthodontic cases, such as braces treatment, your orthodontist may recommend removing some teeth to allow more space for your teeth to align properly.
- Gum Disease (Periodontal Disease): Advanced periodontal disease is a chronic infection of the gums that can cause teeth to loosen, leading to more dental and health issues if not removed.
- Stubborn baby teeth (residual primary teeth): If a baby tooth still hasn’t fallen out when a permanent tooth is starting to come in, your dentist may remove the baby tooth to make room for the permanent one.
- Infection: If you have a big infection that has gone too far, treat with a root canal, it is better to remove the tooth.
If you are immunocompromised (have a weakened immune system), you may be more vulnerable to tooth decay and infection, and you may need a tooth extraction.
Wisdom Teeth Extraction
Third, molars can cause issues by growing in the wrong way, causing crowding, cavities, and pain. And impacted wisdom teeth can cause infection, inflammation, and pain if not removed.
You may not have to remove your wisdom teeth if they are not impacted and have enough space to grow in properly. They may cause a temporary infection around the affected site called pericoronitis. This should resolve in a couple of weeks. In some cases, your dentist may prescribe antibiotics to clear the infection.
The ideal age to get wisdom teeth pulled between the ages of 17-25.
How Much Does an Extraction Cost?
Tooth extraction costs anywhere from $140-$450 per tooth, depending on the complexity of the case.
A simple extraction can cost anywhere from $140-$250. And a surgical extraction costs anywhere from $250-$450.
Wisdom teeth extractions for removing all existing wisdom teeth cost around $2000, including exams, x-rays, anesthesia.
If you plan to get a dental implant after your tooth extraction, your dentist may recommend a bone graft to be placed during the extraction procedure.
Bone grafts can cost anywhere from $200-2,500, depending on the type of material.
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Before Your Tooth Extraction
To prepare for your tooth extraction, your dentist will review your medical history and ask about all medications you take before the procedure.
If you’re currently taking the following medications, your dentist needs to know:
- Bisphosphonates
- Blood thinners (anticoagulants)
- Steroids
- Immune-suppressing medication
- Denosumab
- other biological agents
Your dentist will need to know about any medical conditions you have, which may affect the extraction’s success.
These medical conditions can have a significant impact on your tooth extraction outcome:
- Diabetes
- Osteoporosis
- Hypertension
- Thyroid disease
- Bleeding disorders
- Joint replacements
- Heart valve replacement
- Heart disease or defects
- Bacterial endocarditis history (infection of the heart lining).
- Immune-suppressing conditions or circumstances (such as AIDS or chemotherapy)
Some patients may require antibiotic prophylaxis for invasive dental treatment. Your doctor or dentist can prescribe the antibiotics for you to take before (and sometimes also after) your procedure to prevent health complications.
- Avoid smoking and drinking alcohol, which can greatly increase your risk for complications.
- If you are getting IV sedation (moderate to deep sedation), don’t eat for 6-8 hours before the procedure. Ensure you have a ride who can also help you with your post-op care instructions as you recover from the sedation.
The Day of Your Procedure:
Be sure to let your dentist know if you have had a cold or nausea and vomiting during the week of the procedure. You may need to reschedule or adjust the anesthesia method accordingly.
Anesthesia Options
Simple tooth extractions usually don’t require anything more than a local anesthetic to numb the area being worked on.
But you can request mild sedation of nitrous oxide – referred to as “laughing gas” – which calms you during your procedure and wears off almost instantly so you can still drive yourself home.
For surgical extractions, your options for anesthesia include:
- mild sedation: nitrous oxide
- moderate sedation: oral or IV sedation. You’ll need a ride home.
- Deep sedation (general anesthesia): IV sedation administered by an anesthesiologist or dentist with anesthesia training. You will need a ride home afterward.
Based on your anxiety level, you and your dentist can decide which type of anesthesia would be best for you.
The Tooth Extraction Procedure
Before your tooth extraction, your dentist will do an exam and take x-rays.
He or she will also check for possible infections and assess your teeth’ position in relation to your inferior alveolar nerve. This is the nerve that provides feeling gives feeling to the entire bottom half of the mouth and face, including your teeth and jaws.
Depending on your medical history, infection present, or possible complications, your dentist may prescribe antibiotics before the procedure.
Note: Not all cases of tooth extractions require antibiotics.
During the Procedure
During the procedure, you will feel pressure but should not have pain. But if you do experience any discomfort beyond just pressure, let your dentist know right away.
Simple Tooth Extraction Procedure:
- Your dentist will numb the affected area with a local anesthetic.
- Then your dentist will carefully loosen your tooth from the surrounding bone and ligaments using an elevator instrument.
- He or she will pull out your tooth with forceps once it’s properly elevated and dislodged.
- Your dentist will gently squeeze the bone around the extraction site and smooth out any rough edges. This allows for better healing.
- If you’re planning to get a dental implant after your extraction, a bone graft will be placed.
- The tooth socket is rinsed with a saline solution.
Surgical Tooth Extraction Procedure:
For a surgical extraction, you will be fully numbed with local anesthesia.
You shouldn’t feel anything except pressure. If IV sedation is used, you will not remember the procedure.
- Your dentist will administer a local anesthetic into the affected area.
- If you’re getting IV sedation, the anesthesiologist will insert the IV and administer the sedative.
- Then your dentist will make a small incision along your gum line to access, elevate, and extract the tooth.
- The gums will be retracted to expose the underlying bone.
- If necessary, your dentist will use a surgical high speed to remove some bone to expose the impacted tooth expertly.
- Then your dentist will elevate and remove the tooth. He or she will also smooth out any sharp edges of the bone.
- A sterile saline solution will be used to irrigate (rinse) the tooth socket.
- Your dentist will then suture the extraction site closed.
- The anesthesiologist may administer IV steroids or antibiotics to prevent swelling and infection.
After the Procedure
About an hour after your procedure, you may experience some pain and swelling as the anesthesia wears off.
The bleeding should subside within the first couple of hours of your extraction.
After the procedure, your dentist or oral surgeon will review the aftercare instructions that you’ll take home with you. Make sure to follow the instructions for a speedy recovery.
Before you leave, your dentist will place gauze at the extraction site and tell you to bite down (and stay biting). You will continue biting down on the gauze for another 3-4 hours after the procedure. You will be sent home with extra gauze to change out.
One of the side effects of moderate or deep sedation is nausea and vomiting during the 12 hours it takes for the anesthesia to wear off.
Pain Medicine After an Extraction
Your dentist may only recommend over-the-counter anti-inflammatory pain medication like ibuprofen. Or your dentist may prescribe stronger pain medication if needed.
Avoid aspirin which is a blood thinner that will increase bleeding.
In some rare cases, your dentist may prescribe an opioid after surgical extraction. But opioids should be prescribed and used with great care as they can be dangerously addictive and unnecessarily prescribed. You should take the smallest effective dose possible when taking these drugs.
What is the most effective pain killer?
It’s been proven that 400-800 milligrams of ibuprofen is the best pain medication for tooth extraction. Your dentist may have you take it 1-3 times a day, depending on your case’s severity.
But it’s important to be careful not to take too high of a dose, which leads to bleeding and GI problems.
Aftercare
It’s important to follow your dentist’s aftercare instructions after your procedure carefully. This will help prevent complications like infection and dry socket (an excruciating condition where the blood clot is dislodged from the extraction site).
- Keep your head elevated: To avoid throbbing around the extraction site, keep your head elevated for 2-3 days after oral surgery. You can place an extra pillow under your head to prevent lying flat.
- Ice your face: As soon as you notice any swelling, ice the side of your face to help reduce the swelling. Apply the ice for 20 minutes on and 2o minutes off as often as possible for the next two days.
- Don’t smoke: Smoking can lead to complications and significantly lengthen your recovery time.
- Avoid vigorous rinsing or sucking: It’s crucial to avoid disturbing the extraction site and dislodging the blood clot. This can lead to dry socket. Avoid drinking through a straw, spitting, or any other sucking or vigorous mouth movement. When you rinse your mouth, let the water gently roll around in your mouth and let it dribble out (rather than spitting it out).
- Salt water rinses: You can start to gently rinse your mouth with warm salt water solution after the first 24 hours. Salt water promotes faster healing, helps soothe the extraction site, and is anti-bacterial. You can take a teaspoon of salt and mix it in warm water, then gently swish it around in your mouth.
- Avoid touching the extraction site: Avoid touching or playing with the tooth socket while it is healing.
- Eat soft foods: For the next 2-3 days, you want to eat soft foods that won’t harm or irritate your extraction site while it heals. Avoid sugary foods like ice cream, which can slow the healing process.
How Soon Can I Eat?
You can start eating soft foods 4-6 hours after your tooth extraction. Avoid foods that are spicy and hot in temperature.
When Can I Brush My Teeth?
Wait 24 hours after oral surgery before you start brushing your teeth and flossing. Be careful to avoid brushing or flossing near the extraction site for at least 3 days.
Recovery Time
You will need about 2-3 days to recover after a simple tooth extraction. You should be able to return to normal activities after 2 days. It takes about 2-3 weeks for the extraction site to heal completely.
The recovery time for a surgical tooth extraction is a little longer – around 7-10 days. Avoid any heavy lifting during this time. You should be able to return to normal activities after 4-5 days. It will take about 4-6 months for complete healing.
I recommend taking 2-3 days off to heal and recover after oral surgery.
How Long Will Pain Last?
You may experience mild pain for 1-2 days after a simple extraction.
After a surgical extraction, you may experience some pain for 3-7 days.
If you experience intense pain for longer than this, see your dentist.
Complications
There are some possible complications of tooth extractions to be aware of.
These complications are usually associated with surgical or wisdom teeth extractions.
Here are the factors that can put you at risk for complications:
- poor oral hygiene
- bottom wisdom teeth extraction
- age (the risk increases with age)
- certain medical conditions
- preexisting infection before the procedure
- birth control (hormonal)
Possible problems:
- Dry Socket: When the blood clot is dislodged too soon (before 3 days after surgery), a dry socket (an excruciating condition) can occur.
- Infection: Infection after tooth extraction can occur. If you have a fever, pain, swelling, or a foul taste in the mouth, make sure to see your dentist.
- TMJ pain: Pressure on the jaw and keeping your mouth open for a long time can lead to soreness of the jaw or the TMJ (temporomandibular joint).
- Damage to adjacent teeth: Teeth adjacent to the extraction site can get damaged during the procedure, requiring a lot of pressure.
- Sinus communication: A hole (communication) in the sinus that opens up during the extraction of an upper back tooth can occur. This condition usually heals on its own after several weeks.
- Paresthesia (Numbness): If the inferior alveolar nerve gets aggravated, the lower lip, chin, and tongue may still feel numb or tingly for 3-6 months. In rare cases, this can be permanent.
- Residual roots: In some cases, the root tips are left behind if the risk is too high to extract them.
- Teeth shift: If a tooth is extracted and not replaced with a dental implant or other restoration, your teeth may shift and disrupt your bite.
- Bleeding: If you experience heavy bleeding after the procedure, be sure to let your doctor know right away. This is not normal, and there could be an underlying condition causing this.
Conclusion
In conclusion, a tooth extraction is a procedure where an unrestorable tooth is pulled out of its socket in cases of a deep cavity, wisdom teeth, broken teeth, spacing issues, etc.
If you need an extraction or have wisdom teeth that are bothering you, don’t wait.
