What Is A Tooth Extraction?

Have you ever asked yourself, what is a tooth extraction? In this article I am going to explain exactly what a tooth extraction is, how a tooth is actually extracted,  and what typically happens after a tooth extraction.

pulling own tooth


A tooth extraction is the technical way of saying “pulling a tooth out”. It is just a more fancy way to say it.

Dentists don’t actually “pull” teeth out. It would be more accurate to say that we “push” teeth out. The method of removing a tooth is to expand the bone surrounding the tooth and we do this by applying a pushing pressure to the bone surrounding the tooth so that we can pick the tooth out of the mouth without damaging the bone around it.

When does a tooth need to be extracted?

The four main reasons a tooth may need to be extracted are:

  1. Severe tooth decay
  2. Severe gum disease
  3. To create space for dental braces
  4. Wisdom tooth problems

The most common reason to take out a tooth is when the tooth has developed an infection due to the decay travelling all the way to where the nerve and blood vessels are within the tooth. If there is enough tooth structure left it is possible to save the tooth with a root canal treatment instead. But if there is too little tooth structure to be able to restore the tooth, then the tooth will need to be extracted.

tooth decay

Tooth decay is the most common cause of tooth loss https://commons.wikimedia.org/wiki/File:Toothdecay.png

In severe gum disease the bone can be gradually eaten away. When most of the bone supporting the tooth is gone, the tooth can become infected and loose and will need to be taken out to treat disease and make the person comfortable.

If you have a small mouth and big teeth, the teeth become crowded and crooked because there is not enough room for them to be positioned correctly. In this situation your dentist or orthodontist will likely recommend you get some of your teeth removed to allow space to move your teeth into the correct alignment.

dental braces

Sometimes teeth need to be extracted for orthodontics

Often wisdom teeth come through tilted and only partially pop out from the gum. there is a space between the gum and the tooth when this happens that allows food particles to become trapped. This trapped, festering food can cause a painful infection and the wisdom tooth may need to be removed because of this.

What are the alternatives to a tooth extraction?

The only alternative to an extraction is root canal treatment. This is only an option if there is enough tooth structure left for the tooth to be restored though.

Simply placing a filling without doing a root canal treatment first is not an option once the decay gets all the way to the tooth’s nerve and blood supply.

If a filling is placed on top of the decay without taking the nerve and blood vessels out first the bacteria will remain in the tooth and create an abscess in the bone under the tooth. This abscess may spread to other areas of the body and make you very sick. It is possible to die from a dental abscess. Hugo Boss, the famous fashion designer, died from a dental abscess!

Hugo Boss

Hugo Boss, the fashion designer, died from a dental abscess https://www.flickr.com/photos/fufuwolf/8663320174

Make no mistake, a dental abscess needs to be treated to avoid serious illness and even death. The tooth either needs to be extracted or root canal treated.

If a tooth is so broken down that the tooth can’t be restored it is sometimes possible to avoid extracting the tooth. Unfortunately, this is usually only an option when the tooth has had a prior root canal treatment because once this much tooth is lost the bacteria is usually deep inside the tooth and a dental abscess will develop if not removed.

facial swelling from abscess

Facial swelling caused by dental abscess. This is dangerous to leave untreated.

If the tooth has been root canal treated and is too broken down to restore, the tooth can be trimmed down to the gum level and be sealed over with a dental filling material . This will avoid the bone loss that occurs when the root is no longer present. This way the bone is preserved and will allow a dental implant to be placed more easily in the future without needing a bone graft first.

What is involved with having a tooth extracted?

Once a decision has been made to remove your tooth the first step is to thoroughly numb the tooth up so you don’t feel any discomfort during the extraction.

pain relief

The tooth is totally numbed up with local anaesthetic before the extraction.

It’s normal to hear clicking and cracking noises as a tooth is extracted. It’s also normal to feel a lot of pressure. It’s not normal to feel pain and your dentist will stop if you feel any pain whatsoever and will numb you up some more.

Once you are numb, a tool called a luxator or elevator is used to loosen the tooth within the bone it is contained within. This tool looks a lot like a flat head screwdriver. The luxator/elevator is wedged between the bone and the tooth which creates a space between them, loosening the tooth and allows for easy removal.

Now that the tooth is loose a tool called a dental forcep is used to grip the tooth, loosen it even more by moving the tooth around in the bone and finally pick the tooth out of the mouth when it is totally loose.

dental forceps

Dental forceps grip onto the tooth and lift it out of the mouth. https://commons.wikimedia.org/wiki/File:Dental-Extraction-Forceps.jpg

If the tooth roots are very long, thin or curved or if the tooth has erupted into a very tilted position, the tooth may need to be surgically removed. This is not a big deal and is not painful because you are already totally numb in the area of that tooth.

A surgical extraction is usually done with the patient still awake and you can expect to need a few stitches after the tooth has been taken out. In some cases (usually for very anxious patients) the dentist may sedate you with a drug similar to Valium or they may even put you under using general anaesthetic.

Keep in mind if general anaesthetic is used the cost of the procedure will be much more expensive because a trained anaesthetist needs to be there during the procedure to put you under and keep you safe.

What to expect following a tooth extraction

When the tooth is out you need to apply pressure on the tooth socket to stop the bleeding. After about 5 to 20 minutes most of the bleeding will have stopped and a blood clot will be forming.

For the next 24 hours this clot needs to be left alone as much as possible to allow it to not be dislodged. If it becomes dislodged the tooth socket can become dry and this can be quite uncomfortable. This is termed a dry socket and I will discuss this again within this article.

After 24 hours the clot is not easily dislodged and you should start warm salty water rinses for a few days. Do this about five times a day – when you wake up, after meals, and before bed. The salty water helps prevent infections and allows the socket to heal faster by keeping it clear of food debris. Just add half a teaspoon of table salt to a cup of warm water.

warm satly water rinse

Warm salty water rinses prevent infection and assist healing.

It’s common to get some pain and a little bleeding for a few days following the extraction. However if simple pain relievers like Advil and Tylenol aren’t helping with the pain or you are bleeding heavily, then you need to get back in touch with your dentist.

After 1 to 2 weeks the gum will heal over and it will feel normal. The bone underneath can take up to 6 months to completely heal over but is not something that you will notice and will not cause any problems.

What are the possible problems from a tooth extraction?

Usually teeth are extracted without any major problems. However, there are some possible problems that may occur during and after the extraction.

During the tooth extraction

Although your dentist will take care not to damage the next door teeth while they are extracting the tooth, it is common for a dental filling or crown on the next door tooth to be damaged. If this happens the dentist can usually repair the filling or crown.

Sometimes a root can be pushed into one of the sinuses in your cheek bone. If this happens the root will have to be surgically removed and is usually performed by an oral surgeon rather than a  general dentist. Again, this is not painful as you are totally numbed up.

Rarely if a lower tooth is taken out, particularly a lower wisdom tooth, the nerve that supplies the teeth and your lower lip can be damaged. This will result in numbness in the lower lip. This is almost always a temporary numbness that gets better slowly. However, on VERY rare occasions the nerve is so badly damaged that the loss of feeling in the lower lip will be permanent. Again, this is a very rare event and you shouldn’t be overly concerned about this happening to you.

tooth nerve

The blue highlighted nerve can be damaged during tooth extraction.

After the tooth extraction

The most likely problem is to develop a painful condition called a dry socket. A dry socket is pretty much what it sounds like. The clot is lost from the socket and the socket becomes dry and painful. This can happen to anyone, but is much more common in smokers.

If you develop a dry socket, you need to go back to the dentist and the dentist will put something in the socket that makes it feel better. You can also take over the counter pain relievers like tylenol and advil.

pain relief

Pain after a tooth extraction can usually be treated with over the counter pain killers.

The socket can become infected. If this happens the socket will not heal and will likely be quite painful. You need to go back to your dentist. The dentist will need to check the socket for any foreign objects and will likely prescribe you an antibiotic.

It’s common for a bit of bone to come out along with the tooth during an extraction. This will not cause any more pain than normal because there are no nerves within the bone itself.

The pain you get when a tooth is taken out is from the gum, the ligament around the tooth and the membrane around the bone, but not from the bone itself. I was quite surprised when I discovered this fact because I remember my old PE teacher at high school telling us that bone has nerves in it. You were wrong Mr T!

But I digress, if a bit of bone breaks off during the extraction some fragments can come loose in the socket and these bone fragments slowly come out of the clot and can get stuck in the healing gum. This will feel sharp to your tongue. Don’t worry, your dentist will easily and painlessly take these fragments out for you.

What do I do about the missing tooth?

Now that the tooth is no longer in your mouth, there will obviously be a space showing from where the tooth was.

Most people will want to do something about the missing tooth if it is at the front of their mouth because it’s unattractive missing a front tooth. However, a lot of people aren’t too concerned about a space at the back of the mouth. After all, nobody can really see it.

missing tooth

Unlike this chap, most people would be concerned by a missing front tooth.

If the space is just left without replacing with a denture, a bridge, or an implant, the teeth either side of the missing tooth will tip in towards the space in the same way as books in a bookcase do when a book is taken out from the middle. Also, the opposite tooth that normally bites into the missing tooth will now grow into the space where the tooth was. The remaining teeth will have to work harder and will be more susceptible to breaking when a tooth is lost. If any of this concerns you, then you need to look at your missing tooth replacement options.

The main complaint I get from people who have lost a back tooth is foods like potato chips cutting into the gum and not being able to eat as easily as they did when they had the tooth.

potato chips

Potato chips can painfully dig into gum where a tooth is lost.

Most people aren’t too affected if they have only lost one or two back teeth. If they lose more than that, then they start noticing it’s harder to chew their food and that their face looks sunken in from the tooth and bone not supporting their cheeks as well.

If you lose more than two or three back teeth and you want to chew food properly and not have your appearance affected, I recommend replacing the teeth.

That’s pretty much all you need to know about tooth extractions, so I will finish here. You now know what a tooth extraction is and what to expect during and after a tooth extraction.

If you have had a tooth extraction and would like to share your experience or if you have any questions about tooth extractions, please do so in the comments section and I will get back to you.


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14 thoughts on “What Is A Tooth Extraction?

  1. John

    Just a subject that I did not need to hear about. I broke part of a tooth off last month, my next dentist appointment is in January. He has fixed the last two that I broke off, I hope he does not have to do a tooth extraction. I did have my wisdom teeth taken out many years ago, I still have all of the rest. I try to brush a couple of times a day to make sure that they stay clean, sure does make food taste better. I will look around at some of your other post to get some tips on how to keep the teeth that God gave me and avoid Extractions.

    1. David Post author

      Hi John
      That’s great you have most of your teeth left. Well done!
      From what you say, I doubt you will need an extraction. Your dentist will probably just need to place a filling on the tooth or crown the tooth to strengthen it and prevent it breaking again. I would just avoid very hard foods like hard lollies and pork crackling from now until your next appointment.
      I hope you learn something on my site that helps you.

  2. Dinh

    Hi David,
    you’ve certainly covered this subject well- what is tooth extraction, when it is needed, what to expect before and after tooth extraction!
    I had to have 2 wisdom tooth taken out a few years back because the were lying on their side horizontally instead of being vertical. My dentist recommend I have them taken out because they could move and hit my other teeth and then cause a considerable amount of pain.
    I was told to expect some pain after the procedure but not as much as detail as your article. I did have pain and the pain killers didn’t work. I had to go back to the oral surgeon to have it seen and was told that I had dry socket and possibly an infection. I remember having to do the salt water rinse and taking the antibiotics as well. It took me a while to get over it.
    Thanks for sharing this article with educating and helping people know what is involved in tooth extraction.

    1. David Post author

      Hi Dinh

      I’m glad you found my article interesting.

      Personally, and some dentists will disagree, I only take wisdom teeth out if they are causing pain, infection, or decay on the other teeth. If not, I don’t really care if they are angulated or not, I don’t take them out. There is an argument that if you are quite young, about 25 or under, that the wisdom teeth should be taken out if they even have the potential to cause problems later. This is because when we are young our bone is less brittle and the wisdom tooth will come out easier than if we wait until we are older and the bone is harder and more brittle.

      That’s tough when the pain relievers don’t work very well. A dry socket can be very painful!


  3. Lynne

    Great article David. I never knew that having a tooth “pulled” is actually having it pushed out.
    I have only had one tooth extracted when I was a young child. I had an abscess. I honestly don’t remember much about it except the fact that the dentist gave me a tooth brush afterwards as a present for being a brave girl. I just couldn’t figure out why he gave me a tooth brush and not a lollipop like the doctor did lol.

    1. David Post author

      Hi Lynne

      Thank you. I remember being surprised when I first learned how teeth are actually taken out by dentists.

      I bet you were disappointed getting a lousy toothbrush instead of a lollipop!


  4. Johnathan Tarter

    Amazing information about tooth extractions on why someone would have to have this procedure performed on them! It’s very important to take care of your teeth so that these type of things never become a necessity and hopefully your genetics will treat you well so you can avoid this painful ordeal if you want braces or something of that nature! Keep up the great work! 🙂

    1. David Post author

      Hi Johnathan

      Thanks for your thoughts on this topic.

      I agree, it’s so important to look after your teeth so you never need to have a tooth extracted. It’s interesting your comment about genetics. I assume you are talking about genetics causing crowded teeth and hence the need for braces. While genetics are very important, there is arguments made by some researchers that things like diet, breast feeding, thumb sucking, mouth breathing, and other factors can also cause crowding. Personally, I think genetics are the main factor, followed by thumb sucking.


  5. Jason

    Hello David,
    Judging from the knowledge that you have about tooth, I think you will be the best person to ask.

    I have a significant gap between my two bottom front teeth. It is obviously not a missing tooth. Do you have any suggestions on what to do to bring it back to normal?

    Looking forward to a reply.

    Thank you.


    1. David Post author

      Hi Jason

      Thanks for the question.

      From what you are describing you have a diastema, which is a technical word for a space between your teeth. Diastemas commonly occurs in people with relatively large jaws, but small teeth.

      I usually treat diastemas by simply adding a white dental material (composite) on the teeth either side of the gap. This is inexpensive, looks good, conserves tooth structure and is easy to do. The second option is to veneer or crown the teeth either side of the gap. This will be much more expensive, is not very conservative of tooth structure and often takes at least two appointments, but looks a bit better and lasts longer. Your final option is to close the gap using orthodontics (braces). This is expensive and takes a long time, but is the most conservative of tooth structure and the results should be permanent if you wear a retainer.

      You and your dentist will have to make the assessment about what the best treatment is for you.

      Hope that helps. If you have any more questions, just fire them at me Jason.


  6. Lukas

    Hi David,
    this post will be very uncomfortable for some people to read imo, as teeth are very sensitive subject 🙂 I had all my wisdom teeth extracted couple of years ago and I’m very thankful for that. So I know exactly what a tooth extraction is 🙂 But as mentioned in your post, it can be very dangerous if left untreated, which is usually impossible anyway because of the pain.

    thank you for sharing this!

    1. David Post author

      Hi Lukas

      You might be surprised to learn that not all dental infections cause pain. In fact, it is not uncommon for me to see a patient for a routine check up and discover a dental abscess! Can be hard convincing somebody they need to do something about it in that situation because they don’t sense any problem at all.

      That’s why we recommend regular check ups. Because not all dental problems cause symptoms.

      Thanks for sharing your experience.



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