The natural teeth that you have in your mouth, with proper care and maintenance, can 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 we will explain the main reasons behind tooth extraction.
We shall explain the process of tooth pulling 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.
It certainly seems scary, but it is relatively painless and the recovery time is quick, providing you follow the tips.
Few people go to the dentist wishing for their teeth to be removed.
Most 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
The dentist may take a bit more of a physical examination by probing the gums and teeth, using specialist tools to check the overall health of the teeth. 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, see the roots of the teeth and how they align 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 too help identify whether you are a candidate for particular post extraction treatments to replace a missing tooth, if extraction is required.
Where possible, they really will make pulling out your teeth the last option. You cannot reverse this procedure.
As a dentist assesses your mouth and teeth, if they think 1 or more 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 dentists 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
A dental assessment has or might determine that removal is the best option.
The following are a number of common reasons for 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.
Removal might be the only option if the tooth is loose, but chipped or broken teeth may well be salvageable with cosmetic treatments.
In extreme cases a dentist or surgeon may have to take appropriate action without your consultation, but they will always do the best they can to save your teeth.
Alternatively, it may well be possible to offer painkillers. This can reduce pain, but too allow time for swelling and bleeding to reduce and healing to begin. A better assessment can then be made.
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.
Fillings and antibiotics are ways to manage infection. The filling plugs the gap whilst the antibiotics treat the infection.
Severe infection may require tooth removal.
Once an infection is within the tooth it can get into the bloodstream,
There are some instances where the risk of infection is greater, such as those undergoing chemotherapy, as the immune system is 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.
Ultimately for some there is simply not enough room for all the teeth to form and position correctly.
Some may erupt (break through the gum) at funny angles or only partially, whilst others will form correctly, but can be misaligned with other teeth.
Removing a tooth can allow for space to be created and for the remaining teeth to sit more comfortably 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 misaligned teeth.
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.
This occurs when plaque releases toxins that irritate your gums, making them red, swollen and painful.
Over time this bacterial disease,breaks down the tissue, ligaments and bone that holds 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.
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.
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 a funny 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.
Removal of the offending wisdom tooth is then required in most instances.
Tooth extraction alternatives
As suggested earlier, tooth removal is the last option that dental professionals with to take in most instances.
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 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.
Pulling a tooth out can have a negative impact on the gums, jaw and other teeth in the mouth. Other teeth may be weaker and need additional support. Your face could sag as a result.
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.
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, get a second opinion.
A root canal or crown might well be an option. Although these cosmetic procedures are typically more expensive they may well be better for you.
Bupa explain 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 may well be taken to give a different view on the teeth causing concern.
- Diagnosis/consideration of alternative treatment
- The diagnosis might be tooth removal, but extraction is not always the only option.
- Make sure consideration has been made for possible alternative options.
- 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
- 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 pulling 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 pulling
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 anesthetic be that local or general, can potentially have a negative effect and professionals wish to avoid unnecessary stress or harm to the mother or baby.
Dental professionals prefer to wait as long as is feasibly possible before undertaking such treatment, preferably once the pregnancy has ended.
If it must be undertaken, treatment in the 2nd trimester is attempted.
How are teeth removed/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 usually requires a trip to hospital.
Lets too 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 typical type of extraction.
Able to be completed whilst in the dentists chair in your local dental practice, it requires a little less planning.
Thankfully, it is fairly straightforward.
With the help of local anaesthetic, during this extraction, you will be awake and aware of what is going on, but you will not feel any pain when the teeth are removed, just a bit of pressure.
Your tooth sits in a hole within the gum and jawbone. Known as a socket, the root of the tooth sits deep within this and is fixed in place with ligaments.
Once the anaesthetic has been applied, a dentist will use a tool called an elevator.
The tool helps them loosen the tooth but placing in between the gum and the tooth and lifting it up.
There may have to be a bit of wiggling and multiple attempts at different angles to free the tooth from the socket. This helps enlarge 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.
Clamping to the tooth, the forceps allow force and leverage to be applied and help loosen and lift the tooth out in one piece.
It is possible that the tooth will break or chip during the extraction.
It is also possible that the dentist will actively 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 ay blood and pressure will be applied to help a clot in the blood form.
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 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 an oral maxillofacial surgeons. Specialists in procedures that involve the head and the neck, most 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.
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.
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 anesthetic.
The actual tooth extraction may take 3-5 minutes per tooth, a little longer if its stubborn.
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.
Generalisations surrounding teeth pulling are that the teeth of older people are likely to be more brittle and more likely to crack or break.
African and Caribbean ethnic backgrounds can mean that in heavily built men the teeth are harder to remove, due to the denser bone structure.
Small mouths can pose a problem as can particularly overcrowded teeth.
Does tooth extraction hurt?
Removal of teeth is not natural, nor is it the most comfortable of procedures.
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.
There should not be 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 aftercare instructions provided by the dentist.
Aftercare: healing from a tooth extraction
Once the dentist has done their bit of removing the tooth or teeth in question, you need to follow some simple steps to help ensure your gums heal and your remain well after extraction.
Within the first few minutes 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 bit down on the gauze.
By applying pressure it helps stop the bleeding and allows the blood to naturally 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.
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 extraction and how to help with the healing process.
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.
When the bleeding has stopped, you still need to be careful and take care as the socket remains exposed and vulnerable.
Your dental professional will provide you with their advice and suggestions on how to care for you 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 your mouth bleed.
- 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 rinsing the mouth for at least 24 hours to ensure the clot properly forms in the socket.
- Avoid smoking.
- Eat healthily.
- Eat soft or liquidy foods for the first 24 hours or so. Soup, and yoghurt are great examples.
- Prop your head up if lying down. Lying flat may prolong bleeding.
- Continue to brush and floss your teeth and brush your tongue, but avoid the extraction site.
- Avoid hot food and drinks.
- Avoid alcohol for at least 24 hours.
To aid with the healing, after 24 hours a saltwater rinse can be used.
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 twice a day.
Keep this up for about a week.
If you are unsure of what steps to follow, have lots of bleeding or require reassurance, contact your dentist.
Tooth extraction healing time: how long does it take?
The tooth extraction healing process will take a few days. Typically between a week and ten days.
The first 24 hours will of course be the most uncomfortable and you may well feel a little sorry for yourself.
The body has an amazing ability to heal naturally and time helps with this healing process.
Within 3 days (72 hours) you will probably feel a bit more ‘normal’ and will have become used to it.
Within 7-10 days the gum will hopefully have healed nicely. Any stitches will need to be removed, if they are not dissolvable.
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.
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 been filled and the jawbone as regrown.
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 need to clot.
The clot acts as a barrier, like a plaster might to a cut on your finger.
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.
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.
For more information on dry socket, head over to Mayo Clinic.
Pain after tooth extraction: when to call the dentist
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.
Follow the tips provided and you should not have to seek any further dental assistance.
- The pain becomes severe
- There is a lot of bleeding
- 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 are concerned in any way
…make contact with your dentist.
Tooth extraction costs in the UK & abroad
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?
Tooth extraction on the NHS
The National Health Service (NHS) in the UK has fixed tooth extractions costs.
It is covered under Band 2 of their pricing structure and is charged at £56.30.
Good or bad, if you need multiple teeth out at the same time, this is covered under the one cost.
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 or you are pregnant, 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.
Private tooth extraction
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 their 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 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.
Extraction in the USA
If you are within the USA and need a tooth extracted, the costs are likely to be a little higher.
You may have medical or dental insurance that covers you for such situations.
However, for a simple extraction you can expect to part with $100-250.
Surgical extractions range from about $180-400.
These costs do not include other necessary associated treatment like x-rays that will normally be required.
Replacing the extracted tooth
Assuming you have no option but to proceed with 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 and 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, where an implant for example if 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 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.
However, gum disease and decay as causes of tooth loss can.
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 too vitally important. A dentist can pick up on things you wouldn’t and hopefully resolve them before it becomes an issue.
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
- Dentures: a guide to types of false teeth and their costs
- Tooth, mouth & gum abscess treatment: a detailed guide