Pulling a Tooth (Tooth Extraction)

Having a tooth pulled in adulthood is sometimes necessary.

Possible Reasons for Pulling Teeth
Although permanent teeth were expected to last a lifetime, there are some reasons why tooth extraction may be required. A common reason involves a tooth that is too severely damaged, from trauma or decay, to be repaired. Other causes include:

A full mouth. Occasionally dentists pull teeth ready the mouth for orthodontia. The goal of orthodontia is to correctly align the teeth, which may not be desirable if your teeth are too large for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is no room in the mouth for it, your dentist may suggest pulling it.

Infection. If tooth damage or decay extends to the pulp — the middle of the tooth holding nerves and blood vessels — bacteria in the mouth can enter the pulp/flesh, leading to infection. Often this can be corrected with root canal therapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.

Risk of infection. If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant), even the risk of infection in a particular tooth may be reason enough to pull the tooth.

Periodontal (Gum) Disease. If periodontal disease — an infection of the tissues and bones that surround and support the teeth — have caused loosening of the teeth, it may be necessary to the pull the tooth or teeth.

What to Expect With Tooth Extraction
Dentists and oral surgeons (dentists with specialized training to perform surgery) perform tooth extractions. Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed. If you are having more than one tooth pulled or if a tooth is impacted, your dentist may use a powerful general anesthetic. This will inhibit pain throughout your body and make you sleep through the medical procedure.

If the tooth is affected, the dentist will cut away gum and bone tissue that wrap the tooth and then, using forceps, grip the tooth and slowly rock it back and forth to extricate it from the jaw bone and ligaments that maintain it in place. Sometimes, a hard-to-pull tooth must be extracted in pieces.

Once the tooth has been extracted, a blood clot forms typically in the socket. The dentist will insert a gauze pad into the socket and have you bite down on it to help close off the bleeding. Times the may dentist will place a few stitches — usually self-dissolving — to close the gum edges over the extraction site.

Sometimes, the blood clot in the joint or socket snaps loose, revealing the bone in the socket. This is a painful condition described as dry socket. If this happens, your dentist will probably place a sedative covering over the socket for a several days to shield it as a new clot develops.

What to know about Your Dentist Before Having a Tooth Pulled
Although having a tooth removed is generally very safe, the dental procedure can enable harmful bacteria to enter the bloodstream. Gum tissue is also at risk of contamination and infection. If you have a condition that puts you at high risk for forming a severe infection, you may require to take antibiotics before and after the extraction. Before having a tooth removed, let your dentist know your comprehensive medical history, the medicines, and supplements you use, and if you have one of the following:

  • Damaged or human-made heart valves
  • Congenital heart defect
  • Chronicle of bacterial endocarditis
  • Liver disease (cirrhosis)
  • Impaired immune system
  • Artificial joint, such as a hip replacement
  • After You’ve Had a Tooth Pulled
  • After the extraction, your dentist will send you home to recover. Recovery generally takes a few days. The following can help minimize discomfort, decrease the risk of infection, and quicken recovery.

Take painkillers as prescribed.
Bite firmly but tenderly on the gauze pad fitted by your dentist to lessen bleeding and enable a clot to form in the tooth socket. Adjust gauze pads before they become saturated with blood. Otherwise, keep the pad in position for three to four hours after the tooth removed.
Apply an ice bag to the impacted area quickly after the procedure to reduce swelling. Apply ice for 10 minutes for a few cycles.
Relax for at least 24 hours after the extraction. Limit your movement and exercise for the next day or two.
Avoid spitting and rinsing vigorously for 24 hours after the tooth removal to avoid dislodging the clot that develops in the socket.
After 24 hours, rinse out with your mouth with a substance made of ounces of warm water and1/2 teaspoon salt.
Do not drink from a straw for the initial 24 hours.
Do not smoke at all and try to avoid smoke, which can hinder healing.
Eat soft foods, such as applesauce soup, yogurt, or pudding the day after the extraction. Slowly add solid foods to your diet as the extraction site heals.
When lying down, rest your head with pillows. Lying flat may extend bleeding.
Proceed to brush and floss your teeth, and brush your tongue, make sure you avoid the area of the mouth where the tooth was site. Avoidance will help prevent infection from your floss or toothbrush.

When Should You Reach Out To Your Dentist
It is typical to feel some pain after the anesthesia wears off. For 24 hours after a pulled tooth, you should also expect some inflammation and continuing bleeding. However, if either bleeding or pain is still severe after more than four hours following your tooth extraction, you should call your dentist. You should also discuss your dentist if you encounter any of the following:

Signs of infection, including chills and fever
Nausea or vomiting
Swelling, redness, or extreme discharge from the affected area
Shortness of breath, coughing chest pain, or severe nausea or vomiting
The primary healing period takes typically about one to two weeks. Additional bone and gum tissue will grow into the gap. Over time, however, having a tooth (or teeth) missing create let the remaining teeth to shift, impacting your bite and making it difficult to chew. For that reason, your dentist may suggest replacing the missing tooth or teeth with an implant,denture or fixed bridge.