Tooth Extraction — Procedure Guide, Recovery & Risks | MyMedicPlus

Tooth extraction is the removal of a tooth from its socket in the jawbone. Simple extractions are performed on teeth visible in the mouth using local anaesthesia and dental instruments (elevator and forceps). Surgical extractions are needed for teeth that are broken at the gumline, impacted (stuck beneath the gum), or have curved, fused, or multiple roots — requiring incision in the gum and sometimes removal of surrounding bone with a surgical bur. Wisdom tooth (third molar) extraction is the most common surgical extraction. Oral surgeons or specially trained dentists perform complex extractions, while simple extractions are routinely carried out in general dental practice.

Surgical extraction of impacted wisdom teeth (third molars) is the most commonly performed oral surgical procedure globally. Mandibular third molars are most frequently impacted — occurring in over 70% of cases — due to inadequate space at the posterior mandible. Classification by angulation (mesioangular, vertical, horizontal, distoangular), depth (A, B, C by Pell and Gregory), and relationship to the inferior alveolar nerve guides surgical planning and risk assessment. Panoramic radiograph (OPG) and, in selected cases, cone-beam CT (CBCT) are used for pre-operative planning.

Common indications include severe tooth decay that cannot be restored with a filling, crown, or root canal; advanced periodontal (gum) disease with severe bone loss making the tooth untreatable; dental abscess with insufficient tooth structure for restoration; crowding requiring space creation for orthodontic treatment; failed root canal with irreparable reinfection; fractured teeth below the gum line; retained deciduous (baby) teeth preventing permanent tooth eruption; and impacted or partially erupted wisdom teeth causing pain, infection, or adjacent tooth damage. Extraction is considered only after all tooth-preserving options have been explored and discussed with the patient.

Wisdom teeth are specifically indicated for extraction when causing pericoronitis (infection and swelling of the gum flap over a partially erupted tooth — the most common indication), adjacent second molar decay or root resorption, dental cyst formation (dentigerous cyst), or orthodontic treatment requiring space creation. NICE (CG89) recommends against routine prophylactic removal of asymptomatic impacted wisdom teeth without evidence of disease. Primary care referral for simple extractions is appropriate; specialist oral and maxillofacial referral for deeply impacted lower wisdom teeth with proximity to the inferior alveolar nerve on OPG.

Local anaesthetic is injected into the gum and bone surrounding the tooth; adequate anaesthesia is confirmed before proceeding. The dentist uses a dental elevator to loosen the tooth by breaking the periodontal ligament fibres, then forceps to rock the tooth in a buccolingual direction and remove it from the socket. For surgical extractions, a mucoperiosteal flap is raised, overlying bone is removed with a surgical bur, and the tooth may be sectioned into pieces for easier delivery. The socket is irrigated with saline, inspected for debris, and packed with gauze. Sutures (resorbable) are placed if a surgical flap was raised. The gauze is bitten firmly for 30-45 minutes to achieve haemostasis.

For surgical wisdom tooth extraction, a mucoperiosteal flap is raised, bone is removed with a surgical handpiece to expose the crown, the tooth is sectioned as needed (root separation, crown division) to facilitate delivery in sections rather than as a whole, and the socket is irrigated and closed with resorbable sutures (Vicryl 3/0). Piezoelectric ultrasonic bone surgery reduces inferior alveolar nerve injury risk in cases with close root proximity to the nerve (Rood and Shehab signs on OPG: darkening, deflection, or narrowing of root tips at the nerve canal). General anaesthesia or intravenous sedation is used for anxious patients or multiple simultaneous extractions.

Tooth extraction resolves acute dental pain and infection in virtually 100% of cases, providing immediate relief from toothache, abscess, and associated swelling. Removal of impacted wisdom teeth eliminates the risk of pericoronitis, adjacent tooth decay, and cyst formation. The socket heals with new bone formation within 3-6 months. Early extraction of unsalvageable teeth allows timely planning of tooth replacement, preventing adjacent teeth from tipping into the space and preserving occlusal function. Dental implants placed after socket healing provide the most durable and natural long-term tooth replacement option.

For extraction of teeth with periodontal disease or severe decay, the elimination of a persistent source of oral bacteria reduces systemic inflammatory burden — chronic dental infection has associations with cardiovascular disease and poor diabetic control that may improve after resolution. The healing socket following extraction heals completely within 3–6 months and can be replaced with a dental implant, bridge, or denture to restore aesthetics and function. Modern dental implants — titanium screws placed directly in the healed jawbone — provide a permanent, functionally equivalent replacement that preserves adjacent teeth and bone.

Dry socket (alveolar osteitis) — where the blood clot is lost from the socket causing severe throbbing pain — occurs in 2-5% of simple extractions and up to 30% of lower wisdom tooth sites, particularly in smokers. Other complications include infection requiring antibiotics, excessive bleeding, inferior alveolar nerve injury causing temporary lower lip or chin numbness (lower wisdom teeth), damage to adjacent teeth, and incomplete extraction requiring a repeat procedure. Sinus perforation (oro-antral communication) is possible with upper molar extractions and may require surgical closure if large.

Inferior alveolar nerve injury from lower wisdom tooth extraction causes numbness, tingling, or altered sensation of the lower lip, chin, and teeth on the affected side. Temporary neuropraxia resolves within 3–6 months in 85–90% of cases. Permanent sensory change occurs in less than 1% with experienced surgeons. Lingual nerve injury (rare, less than 0.5%) causes altered tongue sensation. Adjacent tooth damage (root nick, root fracture) during extraction is uncommon but possible with closely approximated roots. Post-extraction socket bleeding lasting more than 20 minutes requires direct pressure and dental review.

A gauze pad is bitten firmly for 30-45 minutes to control initial bleeding. Patients should avoid vigorous rinsing, spitting, drinking through a straw, and smoking for 24 hours to protect the blood clot. Swelling peaks at 48-72 hours and resolves over 5-7 days; ice packs applied for the first 24 hours reduce swelling. Soft, cool foods (soups, yoghurt, mashed potato) are recommended for 3-5 days. Regular paracetamol alternated with ibuprofen manages post-operative pain effectively in most patients. A warm salt water mouthwash from 24 hours after extraction promotes healing. Surgical sutures dissolve within 1-2 weeks. Tooth replacement options (implant, bridge, or denture) should be discussed with the dentist once healing is complete.

Warm salty water mouth rinses (half teaspoon salt in a glass of warm water) commenced 24 hours after extraction and repeated 4–5 times daily for 5–7 days promote socket healing and reduce infection risk. Pain peaks at 24–48 hours and is managed with ibuprofen (400 mg three times daily with food) and paracetamol (500–1,000 mg four times daily), alternated every 3 hours for better pain control. Return to eating and drinking on the opposite side is possible within hours. Hard, crunchy, or sticky foods are avoided until the socket is healed (2–3 weeks for simple extractions, 3–4 weeks for surgical extractions).