Tooth Extractions: When Do You Need to Remove a Tooth?

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When a tooth becomes infected, damaged or heavily decayed and cannot be restored, the best course of treatment is often a tooth extraction. A tooth extraction is the removal of a tooth from its socket. This treatment is performed by a dentist or oral surgeon, and requires care afterwards to ensure proper healing.

Why would you need a tooth pulled?

Extractions are needed when a tooth is badly decayed, damaged, infected or has experienced trauma and cannot be repaired through a restorative procedure. A tooth cannot remain in the mouth if it is severely decayed, for risk of the infection worsening or spreading to other teeth. Similarly, it’s best to remove a tooth that has experienced extreme trauma or damage.

Types of tooth extractions and what to expect

There are two types of tooth extractions: simple extraction and surgical extraction. For both types of extractions, the dentist will numb the area around the extraction site and the procedure is virtually painless, although many patient report feeling pressure during the treatment. Aftercare is extremely important for proper healing, pain management, and to reduce the risk of infection.

Simple tooth extraction is performed on a tooth that is visible above the gum line. The tooth is loosened using a tool called an elevator, and then the dentist pulls the tooth from the socket using forceps. A simple extraction is needed for a number of reasons, most commonly due to tooth decay, crowding or trauma.

Surgical tooth extraction is needed when teeth are impacted tooth (has not erupted above the gum line), a tooth is broken below the gum line or must be removed in pieces, or in case where a tooth is so severely decayed to the point that forceps cannot be used to remove the tooth from the socket. A surgical extraction is also needed in more complicated cases of entangled or curved roots, when the bone around a tooth is dense, or when the roots of a tooth are long.

Wisdom tooth extraction

Tens of thousands if not more wisdom teeth removal surgeries are performed each year. Wisdom teeth are removed often because they can cause damage to the other teeth, the mouth simply does not have enough room, or because they can push the other teeth out of alignment. Wisdom teeth can also cause pain and discomfort as they shift, push into the other teeth or begin to erupt in mouth, although many patients who need a wisdom tooth extraction may never feel any discomfort from the teeth.

Whether or not wisdom teeth removal is necessary depends on a patient’s particular case. The dentist will take a series of x-rays to determine the positioning and movement of the teeth. In cases where wisdom teeth are causing irritation, disruption of daily activities, or pain, it’s best to remove the teeth. Similarly, if a patient is experiencing changes in bite, alignment or impacts to other teeth, the dentist will likely remove the teeth.

Many adults and adolescents may never develop wisdom teeth, or the teeth may be impacted below the gum line and will not grow in. Oddly, not everyone is born with all 4 wisdom teeth, some people are born with only 2-3 and others never develop the teeth at all. In fact, 35% of people are born without wisdom teeth.

How long does pain from an extraction last?

It is not uncommon for pain from an extraction to last for several days up to a week or even lasting two weeks. Swelling, jaw pain, stiffness or soreness are also all common complaints from patients who’ve had one or more teeth extracted. Be wary of pain that worsens over several days, which can be a sign of infection or dry socket. Proper care to ensure healing is important for reducing complications that can cause further pain. It’s recommended to stop smoking while healing from an extraction, as well as observing post-extraction care instructions that can keep the socket from developing dry socket or becoming infected. You may take over-the-counter pain relievers or your doctor may prescribe an anti-inflammatory pain medication to ease discomfort.

What is dry socket?

Dry socket is a condition that only affects about 2%-5% of patients who have teeth extracted. Despite the low occurrence, pain and complications stemming from dry socket are serious and proper precautions must be observed to prevent the condition. In essence, dry socket occurs when the blood clot that forms in the socket where the tooth was removed becomes dislodged, exposing the raw bone and nerves. Dry socket can occur up to several days after an extraction.

Causes of dry socket include:

  • Smoking
  • Repeated spitting or rinsing
  • Drinking through a straw
  • Poor oral hygiene
  • History of dry socket during previous extractions

Signs of a dry socket include severe or worsened pain several days after an extraction, visually the socket will appear whitish (indicating exposed bone) versus the dark blood clot, bad breath, unpleasant smell and taste in your mouth, and pain radiating to your ear.

Do teeth grow back or regenerate?

First things first, permanent (adult) teeth do not grow back once they have been removed, extracted or lost. Likewise, decayed teeth will not reestablish shape and function naturally without a treatment such as a filling, root canal, crown, filling, etc. performed by the dentist, and this is IF they are in the condition to be restored. Similarly, cavities and tooth decay need professional care, and cannot be healed through tooth brushing or flossing. If you are in need of a tooth extraction your dentist will work to alleviate pain Once a permanent tooth (such as a molar) has been extracted, the dentist will likely recommend a replacement such as an implant, bridge or dentures to fill the space left by the missing tooth. Spaces from missing teeth left unfilled can cause teeth to shift and misalign, hence the need for a dental restoration.

Aftercare: How to manage extraction recovery

Managing care after a tooth extraction is extremely important to ensure proper healing. Follow these important steps following a tooth extraction:

  • Use pain relievers as prescribed by your doctor
  • Bite firmly on the gauze pad placed by your dentist, and replace the gauze once it is soaked in blood.
  • Apply an ice pack to the area to minimize swelling
  • Relax and avoid strenuous activity for at least one or two days or longer, until you start to feel better
  • Avoid spitting or rinsing for the first 24 hours, and also avoid drinking from straws to allow a blood clot to form in the socket.
  • Resume normal dental care the day following an extraction, however avoid brushing over the extraction site.
  • Avoid smoking, which can inhibit healing
  • Eat soft foods and gradually add firmer foods once the site begins to heal
  • Prop your head up when lying down

When to call the dentist:

  • Severe bleeding for more than 4 hours after the removal
  • Signs of infection, such as fever or chills
  • Nausea or vomiting
  • Swelling, redness or discharge from the area
  • If the blood clot becomes dislodged
How long does it take for an extraction to heal?

Healing is dependent on several factors including the complexity of the extraction, poor oral health or infection, smoking, Generally, the gum tissue can take anywhere from 3-4 weeks to heal, and the bone can take up to 6 months.

What to eat after a tooth extraction

Soft, creamy or liquid (eaten without a straw) foods are best after an extraction. Avoid eating on the side where a tooth was extracted. Tip: Many patients report that cold foods such as ice cream are soothing on the extraction site. Here is a list of recommended foods to eat after a tooth or wisdom tooth extraction:

  • Ice cream
  • Soup – cool or warm, not hot
  • Smoothies – without a straw
  • Scrambled eggs
  • Apple sauce
  • Pudding
  • Mashed potatoes
  • Soft cooked pasta
  • Cool, flat drinks such as water, Gatorade, milk or juice

Foods to avoid for at least 1 week after an extraction or longer until proper healing has occurred:

  • Spicy or acidic foods
  • Crunchy or hard snacks
  • Popcorn
  • Nuts
  • Chips
  • Anything tough to chew such as meat
  • Carbonated drinks
Can I smoke after an extraction?

For proper healing, do not smoke for at least 10 days after a tooth extraction or until the site is healed. Smoking can impede the healing process and also puts you at a higher risk for developing dry socket. For more details contact your dentist.

You probably have a dental emergency and are in need of emergency dental care. At Urgency Dental USA, our local emergency rooms are equipped with emergency dentists that can provide you with prompt emergency dental care that suits your dental needs. We are one of the few dental clinics in the US that you will find still open after hours. If you are in Cockrell Hill, Irving or any city within Dallas, Texas,, you can visit us at 1335 N Belt Line Rd Suite 13, Irving, TX 75061. For a restored smile, for improved oral health, for a professional touch that fosters lasting relationships, for affordable financing, call today to book a same-day appointment with us. Don’t wait, relieve your pain now!