Tooth Extraction: The Complete Guide

Medically reviewed by Dr. Sam Wood

A tooth extraction is the removal of a tooth from its socket in the jawbone. It is done when a tooth is too decayed, broken, or loose to be saved, when it is causing crowding or infection, or when it is impacted. In the US a simple extraction costs $150 to $400 and a surgical extraction $250 to $700 or more. The procedure takes 20 to 60 minutes under local anesthetic, and most people are back to normal activities within a day or two, with the socket healing over one to two weeks.

When a tooth needs to come out

Dentists try to save teeth. Extraction is the choice when saving is not realistic:

• Severe decay that has destroyed too much of the tooth to support a filling or crown
• A fracture that runs below the gum line or splits the root
• Advanced gum disease that has destroyed the bone holding the tooth
• An infection that cannot be resolved with a root canal, or a failed root canal that cannot be retreated
• Impacted teeth, most often wisdom teeth
• Crowding, where teeth are removed to make room before orthodontics
• Baby teeth that have not fallen out and are blocking permanent teeth
• Before radiation or organ transplant, when teeth at risk of infection are removed proactively

If a tooth can be saved with a root canal and crown, that is almost always the better option. A natural tooth is cheaper to keep than to replace.

Simple vs. surgical extraction

Simple extraction is for a tooth that is visible above the gum and can be grasped with forceps. The dentist numbs the area, loosens the tooth with an instrument called an elevator, and removes it with forceps. It usually takes 20 to 40 minutes including anesthesia.

Surgical extraction is for a tooth that is broken at the gum line, impacted, or has curved or fused roots. An incision is made in the gum, some bone may be removed, and the tooth is often cut into sections. It is done by a general dentist or an oral surgeon, sometimes under sedation, and takes 30 to 60 minutes or longer.

What tooth extraction costs

Dental insurance usually covers extractions as a basic service at 70 to 80 percent, or as a major service at 50 percent for surgical extractions, after the deductible. Impacted teeth are sometimes covered under medical insurance. Dental schools and community health centers offer reduced-cost extractions; some advertise very low prices for simple extractions, but check what the exam and X-ray add.

What happens during the procedure

1. Anesthesia. Local anesthetic is injected around the tooth. You will feel pressure but not pain. Nitrous oxide, oral sedation, or IV sedation are options for anxiety or complex cases. 2. Loosening. The dentist rocks the tooth with an elevator to widen the socket and break the ligament fibers. 3. Removal. The tooth is lifted out. For a surgical extraction, the gum is opened and the tooth sectioned first. 4. Socket care. The socket is cleaned. If a bone graft is planned, it is placed now. Stitches are placed if the gum was opened. 5. Gauze. You bite on gauze for 30 to 60 minutes to form a clot.

You can drive yourself home after local anesthetic alone. After any sedation you need a driver.

Aftercare: the first 24 hours

The blood clot that forms in the socket is the foundation of healing. Almost all aftercare in the first day is about protecting it.

• Keep firm pressure on the gauze for the first 30 to 60 minutes; replace it if bleeding continues, and stop once oozing is minimal.
• Do not rinse, spit, or use a straw. Suction and swishing dislodge the clot.
• Do not smoke or use tobacco for at least 72 hours; ideally longer.
• Take pain medication before the anesthetic wears off. Ibuprofen is effective for dental pain; your dentist may recommend alternating it with acetaminophen.
• Cold compress on the cheek, 20 minutes on, 20 off, to limit swelling.
• Eat soft, cool foods: yogurt, applesauce, smoothies with a spoon, mashed potatoes. Avoid hot, spicy, crunchy, or seedy foods.
• Rest. Keep your head elevated when lying down.
• Brush your other teeth normally, avoiding the extraction site.

Days 2 to 7

• After 24 hours, begin gentle warm salt-water rinses (half a teaspoon of salt in a cup of warm water) after meals, letting the water fall out of your mouth rather than spitting.
• Swelling peaks around day two or three, then recedes.
• Move gradually to normal foods as comfort allows, chewing away from the site.
• Stitches, if dissolvable, fall out in a week or two. Non-dissolving ones are removed at a follow-up.
• The socket fills with gum tissue over one to two weeks; the bone underneath takes several months to fully heal.

Dry socket

Dry socket happens when the clot is lost or dissolves before the socket has healed, leaving bone exposed. It shows up two to four days after extraction as a deep, throbbing pain that may radiate to the ear, often with a bad taste or smell. It affects a few percent of extractions and is more common after lower molar removals, in smokers, and in women taking oral contraceptives. It is not an infection and not dangerous, but it is very painful. A dentist packs the socket with a medicated dressing, which relieves the pain within hours. Following the no-straw, no-smoking, no-rinsing rules in the first days is the best prevention.

Replacing the tooth

Unless it was a wisdom tooth or a tooth removed for crowding, a missing tooth should usually be replaced. Neighboring teeth drift into the gap, the opposing tooth over-erupts, and bone in the area shrinks. Options are a dental implant, a bridge, or a partial denture. If you plan an implant, ask about a socket bone graft at the time of extraction; it preserves the bone and makes the implant simpler later.

When to see a dentist

See a dentist if a tooth is broken, loose, or painful; extraction may be the answer, but only an exam can tell whether the tooth can be saved. After an extraction, contact the dentist the same day if bleeding continues heavily beyond a few hours, if pain worsens after day two or three instead of improving, if you develop a fever, pus, or foul taste, if swelling increases after the third day, or if numbness in the lip, chin, or tongue persists once the anesthetic should have worn off. Swelling that affects swallowing or breathing is an emergency.

Frequently asked questions

Sources

• American Dental Association (MouthHealthy) – Extractions
• Cleveland Clinic – Tooth extraction
• Cleveland Clinic – Dry socket
• American Association of Oral and Maxillofacial Surgeons – Tooth extraction

This article is for general information only and is not a substitute for professional dental advice, diagnosis, or treatment. Always consult a licensed dentist about your specific situation.