Nobody looks forward to hearing that they need a tooth extraction, but the majority of Americans undergo the procedure at some point in their lives for the benefit of their oral health.
There are a number of reasons why a dentist may recommend having a tooth removed:
- Tooth infection or severe decay
- Periodoantal (gum) disease
- Irreparable damage from trauma
- Impaction (in the case of wisdom teeth)
- To make space for tooth realignment with an orthodontic appliance
- To allow dentures or implants to be fitted
In this guide, we'll explain what to expect when you have a tooth taken out. Many people worry about tooth extraction pain, but the good news is that modern anesthetic techniques make it as comfortable as possible. You'll feel a bit sore afterwards, but we have some advice for aiding healing and recovery after an extraction.
Table of contents
- 1 Reasons for removing a tooth
- 2 How are teeth removed?
- 3 How much does tooth removal cost in the US?
- 4 Healing from an extraction
- 5 Replacing an extracted tooth
Reasons for removing a tooth
Let's look first at the main reasons why a dentist may extract a tooth. You can discuss your situation with your dentist to get his or her professional opinion on the condition of your teeth. This procedure is not reversible, so be sure to raise any doubts you have before going ahead.
Infection or damage
Thanks to recent advances in dentistry, infected tooth removal is seen as a last resort. Many cases of tooth decay can be treated simply with a filling. Even if you have developed a dental abscess or a dead tooth as a result of tooth infection, root canal treatment can often preserve the tooth.
If the infection persists after this, it will be necessary to extract it to stop the infection spreading through the bloodstream to other parts of the body.
Where a large part of the tooth is missing due to tooth decay or injury, your dentist may be able to fit a crown. However, if not enough healthy tooth is left to support a reconstruction, it will have to be removed.
If you have an accident which loosens your teeth or you find yourself in sudden and severe pain, make an out-of-hours dental appointment. The dentist may perform an emergency extraction or other treatment, but they might just administer sufficient pain relief and advise you to make an emergency appointment with your regular dentist.
Wisdom tooth extraction
Wisdom teeth, also known as ‘third molars', cause problems for many people because our mouths simply don't have space to accommodate them.
When a tooth doesn't push through the gum properly because of overcrowding, it's known as ‘impaction'. A tooth can be fully impacted (completely covered by gum) or partially impacted (only part of it has emerged).
If a wisdom tooth is pushing up against the tooth next to it, this can cause pain and may ultimately damage the healthy tooth. In this case, it's probably best to have the third molar removed.
Another common reason for wisdom tooth removal is decay. Because these teeth are so far back in our mouths, they're often very difficult to clean. This means they are more susceptible to tooth decay. Even if the decay isn't causing any pain, it can eventually spread to the adjacent tooth if the wisdom tooth remains in place.
Not everyone has a full set of four wisdom teeth – and some fortunate people have none at all. But if you do have one or more of your third molars, the chances of complications at some point in your life are fairly high.
Upper wisdom teeth can be easier to extract than lower ones because their roots are often fused together, creating a smaller surface area and smoother shape. However, upper wisdom teeth usually have three roots compared to just two in lower wisdom teeth.
We have more information about how to manage wisdom tooth pain, including after extraction, in this article.
Periodontitis, a severe form of gum disease, may cause teeth to become loose. This is because the disease erodes the tissue and bone surrounding the tooth root, which is responsible for holding the tooth securely in place.
If the condition has not progressed too far, it may be possible to treat it and save the tooth. In more advanced cases, extraction may be the only option.
If you're getting braces to correct tooth misalignment, you might first need to have one or more teeth removed. This frees up some space in your mouth for your other teeth to move into.
You might not need to have any teeth out before having braces, but this will depend on the current state of your teeth as well as the type of braces you choose. With Invisalign invisible braces, for example, it's more common to have the sides of your teeth filed slightly to create a small gap between each one.
You'll need to speak to your orthodontist to find out whether your treatment will require any tooth removal.
In the video below one patient explains what it was like to have teeth removed for braces – including the days of recovery that followed. She offers some handy tips for anyone who might be about to have this done:
Hyperdontia (supernumerary teeth)
Did you know that some people are born with more teeth than they should have? In most cases, the extra tooth or teeth need to be removed to make room for the other teeth to grow into the correct positions. This condition is called hyperdontia.
How are teeth removed?
A straightforward extraction can be done in your usual dental clinic under local anesthetic. This means you shouldn't experience any pain but you will be aware of what is happening.
Your tooth root sits in a deep hole in your gum, called a socket. Ligaments hold the tooth root tightly in place – giving your teeth the biting force you're used to.
Most often, dentists use a lever tool called an ‘elevator', which is wedged under the tooth to loosen it. Alternatively, they may have to rock the tooth from side to side to widen the socket. It's not that different from wiggling a tent peg around in its hole to make it easier to remove.
Once the tooth becomes loose, the dentist can pull it straight out with dental forceps. With the anesthetic blocking any pain, you will just feel some pressure in your mouth during this process. A simple extraction should only take a few minutes.
If you feel very nervous about having a tooth out, ask your dentist if you can have IV sedation for the procedure. This will make you feel calm and relaxed and you won't remember much about it afterwards.
Third molar removal, especially in the case of impaction, may require a more complicated surgical extraction. The dentist or oral surgeon has to cut into the gum to access the tooth. Larger teeth might be cut into smaller pieces to make them easier to remove.
The video animation below shows methods for extracting wisdom teeth at various levels of impaction. The same type of elevator tool is used as in a simple extraction.
Surgical extraction of a tooth can still be done with a local anesthetic, but more complex cases may require a general anesthetic. In this case, the extraction is performed by a dental surgeon in a hospital after you have been put to sleep.
General anesthetic may also be used when young children have teeth extracted, or if you need to have several teeth removed.
Another reason you may need a surgical procedure rather than a simple extraction is if there is no tooth remaining above the gum line. This might be because of severe decay or perhaps an injury. In this case, the dentist must cut into the gum to access the remaining tooth root.
Cracked or fractured teeth can also be more complicated to extract since there is a risk of them breaking.
As soon as the tooth is out, the dentist will clean the empty socket and make sure no tissue or bone fragments remain. He or she may press down on the sides of the socket to suppress bleeding and to keep the jawbone in the correct shape.
It's at this point that your dentist will places stitches in your gum, if needed. It's normal to get stitches after a surgical incision, and sometimes after a regular extraction. Dentists often use a self-dissolving material which breaks down by itself after a week or so.
Finally, you will be given a piece of folded gauze to bite down on. This absorbs any blood and creates pressure on the extraction site. You may also get an ice pack to minimize swelling. Carefully follow any instructions your dentist gives you with regards to these, as this will aid your recovery.
Does tooth removal hurt?
As we have already mentioned, the local area will be fully anesthetized. You will feel some pressure – but no pain. The injection to administer the anesthetic can be a little painful, but your dentist may use a special numbing gel to help with this.
In the unlikely event that you start to feel pinching or pain, alert your dentist immediately. If you're anxious about feeling pain during the procedure, agree in advance a signal you can use to show your dentist that you need to speak.
It's more likely that you'll feel some discomfort or pain after tooth extraction, once the anesthetic has worn off. You can read more about how to deal with this in the section below on recovery.
How much does tooth removal cost in the US?
The cost of removing a tooth will depend on the size and location of the tooth, and how complicated the extraction is.
For example, wisdom tooth extraction costs (and any types of surgical tooth removal) will typically be higher than incisors.
The table below gives an idea of tooth extraction costs in the US, if carried out at a dental clinic. Do keep in mind that private dental charges vary greatly from one practice to another, so it may be worth shopping around if you need to have several teeth extracted.
These costs include local anesthesia but IV sedation, if offered, will incur an additional charge. If you need general anesthesia for a surgical extraction this will increase the cost significantly.
Many dental insurance policies will cover at least some of the cost of tooth extraction. If you have a dental plan, check to see what's included.
If you need to have teeth removed for braces, this should be included in your overall treatment cost – but it's worth double-checking this to avoid unexpected bills.
Alternatives to extraction
You'll probably find that extraction costs less than alternative treatments such as root canals or crowns. If you're unable to afford the recommended restorative treatment then you may choose the cheaper option of extraction.
Removing a tooth should really only be a last resort, though. An empty space in the mouth affects the appearance of the smile and may eventually cause the face to sag. It can also present problems with eating. In the long term, the surrounding teeth are more susceptible to damage and may start to shift position, causing problems with oral hygiene.
As a general rule, it's best to keep your original tooth for as long as possible. If it has to be extracted, it's better to get some kind of replacement tooth rather than leave the gap empty.
Artificial teeth such as dentures, bridges, and implants (which you can read more about below) all come at their own cost. In the long run, therefore, it might be more cost-effective to preserve the original tooth rather than have it extracted.
So if your dentist feels confident they can perform a root canal treatment or fit a crown to save your tooth, you should seriously consider this rather making a decision based purely on the immediate cost.
Healing from an extraction
One thing that many people worry about when it comes to teeth extraction is healing and recovery.
Your dentist will give you advice on what to do after tooth extraction. As this may vary depending on the procedure you had and the position of the tooth, you should follow their instructions first and foremost. Here we have some general information and advice so you know what to expect.
How long will it take?
After an extraction, a blood clot forms in the empty socket. It's important to do what you can to keep this in place. If the blood clot becomes dislodged the socket is exposed, which is very painful. This condition, known as ‘dry socket‘, will require additional dental care.
In simple cases, the average tooth extraction healing time is around 7-10 days. After this time the gum tissue is significantly healed and your stitches can be removed (or will dissolve by themselves). Within two weeks, smaller sockets may appear completely healed.
Wisdom tooth extraction recovery can take a little longer, especially if the tooth was impacted and had to be removed surgically. This is simply because the wound from molar extractions is larger and takes longer to heal.
Under the surface, it takes 6-8 months for your jaw bone to grow back and ‘fill in' the hole left by the tooth.
What if I feel pain after an extraction?
It's normal for patients to feel some discomfort, soreness or pain after getting a tooth pulled. Your dentist should give you painkillers to help manage this – or they may recommend suitable over-the-counter products.
The area around the socket will probably feel tender and you may experience some swelling in your face.
This discomfort should subside 2-3 days after the extraction. If you continue to experience pain or you suddenly notice the pain worsening several days later, contact your dentist immediately as this could be a result of infection at the extraction site.
Tips for speedy recovery
Giving yourself the right aftercare will help speed up your recovery so you can get back to normal.
In the first 24 hours following the removal of a tooth you should:
- Apply gauze as instructed
Consider taking a day or two off work to give your body time to rest. 24 hours after the procedure you can use a saltwater rinse for cleaning. Dissolve half a teaspoon of salt in a cup of water and gently swish it around your mouth.
For a few days afterward it's best to stick to soft foods and eat on the opposite side of your mouth. If you have had multiple extractions in different locations, your dentist might recommend a liquid diet. You may have to maintain these precautions for up to a week after a surgical extraction.
Keep drinking plenty of water so your body stays hydrated for healing. Just remember not to use a straw.
Once you have fully recovered, try to maintain good oral hygiene to reduce the chances of you needing another extraction or other dental treatment in the future.
Replacing an extracted tooth
Should you need to have a tooth removed, particularly one at the front, you'll soon be thinking about your options for replacing it. The three main choices are:
- Dentures (false teeth)
- A bridge
- A dental implant
Dental implants are the most permanent option, and also the closest to a natural tooth. The titanium implant is inserted into the jaw bone and an artificial tooth crown is attached on top. The bone fuses with the implant and this minimizes bone loss.
But implants are the most expensive option, costing around $4,000 for a single tooth implant and crown. Fortunately, there are ways to save money on the treatment to make implants more affordable.
Bridges and dentures are both types of prosthetic tooth which sit on top of the gum. A bridge is fixed permanently in place while a denture is removable. Both can serve as long-term solutions for missing teeth. They are cheaper than implants but come with a risk of underlying bone loss over time.
You may be able to have a temporary prosthesis fitted straight away if one of your front teeth is removed. Speak to your dentist to find out which options are available to you, and how much they will cost.
Whatever your current situation, thanks to modern dentistry there are ways to restore your smile and your confidence.