The Tooth Extraction Survival Guide!

There is reason why the phrase “like pulling teeth” is so popular. Getting a tooth taken out is one of those dental experiences you don’t forget. Whether it’s the pain / discomfort of the procedure, the noises, or having a missing tooth afterwards, there is no part of this that is fun. Having a tooth pulled is usually a last resort when the tooth can no longer be fixed. All that said, knowing what to expect beforehand and being prepared can make the experience significantly better for you. Read on to learn everything you need to know in order to make the best of your tooth pulling experience.

Before The Procedure

Consider if you want sedation for the extraction/s. Sedation can range from taking a light sedative beforehand or laughing gas all the way up to full general anesthesia where you won’t remember anything. Most general dentists are able to offer light sedatives or laughing gas while you usually have to go to an oral surgeon for IV sedation or general anesthesia. If you are having multiple extractions, especially wisdom teeth that are impacted, IV sedation or general anesthesia can make the process significantly easier and less traumatic for you.

Take Ibuprofen before having an extraction and it will lessen the pain afterwards significantly. Several studies have backed this up. This assumes that you don’t have any health problems that make it so you can’t take NSAIDs (mostly GI or kidney problems). You’ll also want to be a little more careful if you’re on blood thinners. Ibuprofen can make you bleed slightly more. This isn’t a problem for most people but can make things more difficult if you are already of blood thinners. Ask your dentist or oral surgeon if you’re concerned.

The Procedure

During an extraction the dentist will numb the tooth and then proceed to slowly loosen the tooth with several instruments until it can be removed. Sometimes this process takes 30 seconds and other times it can take an hour, depending on the specifics of the situation. For especially difficult extractions the dentist may need to section the tooth into several pieces or remove bone around it to allow the tooth to come out.

There are several types of extractions…

• Simple extraction – This is when the dentist or oral surgeon is able to remove the tooth without needing to section or remove bone. Recovery from these types of extractions are the easiest lasting a couple of days.
• Surgical extraction – In these cases the dentist or oral surgeon has to remove bone and/or section the tooth in order to remove it. Recovery from these types of extractions takes a little longer with pain lasting anywhere from 2 days to several weeks.
• Soft tissue, Partial and Full bony impacted teeth extractions – In these cases the teeth are covered either by gum tissue or bone and they take the most effort to remove. Recovery in these cases usually takes the longest.

A tooth that is very sensitive or infected can be very difficult to numb even with the best of techniques.

What You Can Expect to Feel and Hear

During a tooth extraction, you will usually feel a lot of pressure as the tooth is slowly loosened. This sensation can be a bit uncomfortable but should not be sharply painful. Many people have a hard time differentiating between the pressure and pain. Usually this is because they aren’t sure what expect and the pressure makes them worried. Knowing this going in can help you to relax about the procedure. Expect a lot of pressure.

You’ll also hear some noises. These noises can range from small popping sounds, to cracking, to the sound of the drill if the tooth needs to be sectioned or bone removed. Don’t be worried if you hear this. It is a perfectly normal part of the process. The sounds sound a lot louder to you than what other people would hear.

When the dentist uses the forceps to start removing the tooth, occasionally they’ll slip off the tooth or break pieces off. This can also be scary if you’re not expecting it. Most teeth that need an extraction have quite a bit of the tooth broken or are about to break. Part of the process is that the dentist has to find a solid area of the tooth to grip on and this can take a couple of tries.

Common Complications of Extractions

Sinus exposure – The roots of upper molars are in very close proximity to your maxillary sinuses. If a small hole is noticed after the extraction your dentist will usually place a small

Dry socket – A dry socket forms when the blood clot is lost in the extraction site. This causes significant pain starting 3-5 days after the tooth is removed. Read below in “After The Extraction” for tips on avoiding a dry socket. A dry socket isn’t dangerous, but is very painful, usually worse than before the tooth came out. A dry socket will heal on it’s own in anywhere from a week to several weeks without treatment. Your dentist can also place a medication in the socket to help reduce some of the pain.

Bone or tooth fragments – Small pieces of bone or tooth can be dislodged and will slowly work their way out over time. Most of the time you’ll notice a small, slightly painful area where the tooth came out. You’ll then notice a small hard piece in the area. When it has come through the gums enough to grab it, you can pull it out and it’ll heal quickly. Your dentist can also do this for you if you’re squeamish or it is too painful.

Swelling – This most commonly happens with difficult extractions. You can have swelling right around the area where the tooth came out or you can have swelling that extends all the way onto your face. Impacted wisdom tooth extractions are famous for giving people the “chipmunk” look with large swollen cheeks. Ice packs for the first day will help lessen this.

Root tip left in place – Some teeth have very skinny, curved root tips. During the extraction these can break off and be very difficult to retrieve. If your dentist decides that the risk of removing them is too great, they’ll often leave these in place. Most of the time they don’t cause any problems long term.

Infection – This is the least likely of all the complications. It is most common with teeth that were abscessed prior to the extraction. If they infection doesn’t resolve after a couple of weeks or if you continue to have significant swelling, pus drainage, or pain your dentist may go back in to drain the area and put you on an antibiotic.

After The Extraction

Smoking, sucking on straws, very hot foods or liquids, or birth control medication all can raise your risk of getting a dry socket afterwards which is very painful. Dry sockets are most common with difficult extractions of lower wisdom teeth and molars.

Continue taking your pain medication as prescribed for the first couple of days so you can stay ahead of the pain. Only taking it when it hurts will lead to a bad cycle of pain. You usually need to do this for the first 48-72 after the extraction. Beyond that point, the pain will decrease significantly.

Avoid any heavy labor or exercise for the first 24 hours.

Eat a soft diet for the first day or two. You’ll also want to avoid anything excessively spicy or acidic as these can cause the area to burn. After the first couple of days you can go back to a normal diet, just being careful to avoid anything getting stuck in the socket.

You can start rinsing gently with warm salt water 24 hours after the tooth removed. Don’t do this too vigorously.

If you’re a smoker, avoid smoking as long as you are possibly able to. Three days should be a minimum and longer is better if you can. The heat and chemicals from the cigarette delay healing and can increase your risk of a dry socket.

Some discharge and bad taste are normal for about a week after the extraction. This will slowly decrease with time.

The extraction site will usually develop a white or grey coating over top of it. Ulcers right around the area aren’t unusual either. This is normal and nothing to be concerned about. The gum tissue will slowly heal over this area over the course of the next several weeks to months.

Long Term Consequences Of Having A Tooth Removed

If you pull a tooth, the teeth behind it tend to start falling forward over the course of several years.

If the tooth below it no longer hits on anything, it will start to erupt (move) upwards over time.

An extraction can cause you to lose additional bone on the tooth in front or behind it. This can compromise that tooth over time.

A tooth in front or behind the extraction can also become more sensitive. This can be a result of either the trauma of the extraction or surfaces of the tooth being exposed that weren’t exposed before. This sensitivity will decrease after several weeks to months.

You’ll continue to slowly lose bone in the area unless you have an implant placed. Bone loss over time can make it more difficult to fit dentures or place implants in the future.