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Tooth removal

You may need to have your tooth removed (extracted) if it’s damaged or decayed and can’t be repaired.

If your tooth is broken or decayed, your dentist may be able to repair it with a filling or crown. But if it can’t be repaired, your dentist may suggest the best option is to take your tooth out instead. They’ll discuss the treatment options available to you.

If you decide to have your tooth removed, your dentist will usually remove it in your dental surgery. But sometimes an oral surgeon will carry out the procedure in hospital. You can usually go home on the same day as the procedure.

You’ll meet the dentist carrying out your procedure to discuss your care. It may differ from what’s described here as it will be designed to meet your individual needs.

 

Your tooth or teeth may need to be removed for several reasons. The most common reasons include:

  • severe tooth decay
  • gum disease (periodontal disease)
  • a broken tooth that can’t be repaired
  • an abscess (a collection of pus) on your gums or around your teeth
  • crowded teeth – when your teeth don’t have enough space in your jaw
  • impacted wisdom teeth – your growing wisdom teeth can’t break through the surface of your gum and get stuck

If you need to have your tooth (or teeth) replaced, your dentist will explain all of the options available to you

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Details

  • Preparation Preparing for tooth removal

    Your dentist will explain how to prepare for your procedure. They will ask about your dental and medical history. It’s important that you mention any medical conditions, allergies or recent surgery, as well as any medicines you are taking.

    If you’re having your tooth (or teeth) removed by a dentist, you’ll usually have a local anaesthetic. This completely blocks pain from your gums, although you will still feel pressure. You’ll stay awake during the procedure so you’ll be aware of what’s happening. If you’re very anxious about having your tooth removed, it may be possible for you to be given a sedative as well. This relieves anxiety, makes you feel sleepy and helps you to relax during the operation.

    Having a general anaesthetic for tooth extraction is unusual. It’s usually only offered to young children or adults with learning disabilities. But your dentist may decide it’s right for you if, for example, you have several teeth that need to be removed.

    If you’re going to have a general anaesthesic, you’ll be referred to a hospital to have your procedure. It’s important to follow your anaesthetist’s advice when you’re preparing for your procedure. For example, you’ll be asked to follow fasting instructions beforehand. This means not eating or drinking anything, usually for about six hours, before your surgery. If you have any questions, or are unsure about anything, speak to your anaesthetist.

    Your nurse or surgeon will discuss with you what will happen before, during and after your procedure, including any pain you might have. If you’re unsure about anything, don’t be afraid to ask. No question is too small. It’s important that you feel fully informed so you feel happy to give your consent for the procedure to go ahead. You’ll be asked to do this by signing a consent form.

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  • Alternatives What are the alternatives to tooth removal?

    If you don’t want to have your tooth taken out, your dentist may be able to suggest other ways to treat your tooth. This will depend on what’s wrong with your tooth. They’ll also explain how not removing your tooth could affect your health.

    You can take painkillers to ease any pain and swelling, but this will just relieve your symptoms temporarily. Antibiotics and root canal treatment can help treat an infection in a tooth. Your dentist will be able to discuss all of your options with you.

  • The procedure What happens during tooth removal?

    Your dentist will check that you’re sitting comfortably in the chair. They will inject a local anaesthetic into the area around the tooth or teeth before starting the procedure. Once your dentist has injected the local anaesthetic, they will wait a few minutes to allow the injection to work. Then they will ask you a few questions to see if it’s taking effect.

    The roots of your tooth sit in a socket (hole) in your gum. Your dentist will widen your tooth socket and gently rock your tooth from side to side until it’s loose enough to pull out.

    You will feel some pressure in your mouth, but your dentist will help to relieve any discomfort you may feel. If you do feel any pain, it’s important to tell your dentist straight away.

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  • Aftercare What to expect afterwards

    Your gum may bleed for a few minutes after the procedure. Your dentist will give you a piece of soft padding to bite on to stop the bleeding. You’ll be able go home once the bleeding has stopped.

    If you have had a general anaesthetic or sedative, you’ll need to rest until the effects of the anaesthetic or sedative have worn off. Make sure someone can take you home, and ask someone to stay with you for a day or so while the anaesthetic wears off.

    Having a general anaesthesic or sedative affects everyone differently. You may find that you’re not so coordinated or that it’s difficult to think clearly. This should pass within 24 hours. In the meantime, don’t drive, drink alcohol, operate machinery or sign anything important. Always follow your dentist or surgeon’s advice.

    Before you go home, your dentist or surgeon will give you advice about looking after your teeth and gums. They may recommend painkillers and an antibacterial mouthwash. You may be prescribed some antibiotics, to reduce your chances of developing an infection. You don’t always need a follow-up appointment after you’ve had a tooth removed. But if you had a complicated procedure, you may also be given a date for a follow-up appointment. During this appointment, your dentist or surgeon will check that your mouth is healing well.

  • Recovery Recovering from tooth removal

    If you had a local anaesthetic, it may take several hours before the feeling comes back into your mouth. Be careful not to bite your lip or tongue if these are numb. Rest as much as possible and keep your head up to reduce the bleeding.

    Your mouth will feel sore once the anaesthetic wears off. If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen (as long as these medicines are suitable for you). Your dentist or surgeon may suggest that you take paracetamol and ibuprofen together. Always read the patient information leaflet that comes with your medicines. If you have any questions, ask your pharmacist for advice.

    Some people find that their pain is worse about three days after the procedure, but then settles down again within seven to ten days. If you’re in severe pain, or have any concerns, contact your dentist. He or she can check that nothing else is causing it, such as an infection.

    After your tooth has been removed, the following steps may help to speed up your recovery.

    • Don’t rinse your mouth out for at least 24 hours. This is because it could disturb any blood clot that may have formed and you may start bleeding again. After that, rinse gently with a salt water mouthwash. You can make up a salt water rinse by dissolving a teaspoon of table salt in a glass of warm water. Using this salt water rinse twice a day should help to keep the area clean. Hold the rinse in your mouth for a couple of minutes before spitting it out each time.
    • When you feel ready to eat, start with sips of warm soft or pureed food that you don’t need to chew. Don’t eat on the side where you had your tooth removed.
    • If your gum bleeds, bite down on a clean pad of material such as a clean handkerchief for at least 15 minutes.
    • Don’t drink alcohol for at least 24 hours and don’t smoke for as long as possible – at least 24 hours.

    It may take you several days to recover enough to return to your normal routine. You can brush your teeth but keep your toothbrush away from the healing wound to begin with, brushing closer to it each day. You could try softening your toothbrush in hot water before you start brushing.

    You may have stitches, depending on which tooth was removed and why. The stitches will dissolve by themselves and won’t need removing. It’s important to brush these carefully for three to four days after your surgery to stop food getting trapped. But be careful when brushing so that you don’t dislodge any newly-formed blood clots that may have formed over your empty tooth socket.

  • Side-effects What are the side-effects of having a tooth removed?

    After your tooth is removed, you may have some side-effects, which should be mostly temporary.

    You’re likely to have some discomfort for a few days afterwards. If you’ve had a surgical procedure such as having a wisdom tooth removed, you may have some swelling. Using an ice pack, or bag of frozen peas wrapped in a towel, over your jaw for the first day will help reduce the swelling. Your jaw may feel a little stiff too. This may last for a couple of weeks, and it’s important not to force your jaw open if it’s stiff.

    You might notice some bleeding for a day or two. The blood will be mixed with your saliva. This can make it look like there’s more blood than there actually is. If you think you’re bleeding heavily, contact your dentist.

  • Complications What are the complications of having a tooth removed?

    Complications are when problems occur during or after a procedure.

    Sometimes other teeth may be damaged when your tooth is removed or the procedure may dislodge a filling or crown. This tends to happen if the teeth next to the one being removed have a large filling or crown.

    Your teeth may feel sensitive next to where you had your tooth removed. This may last several weeks. If you feel a burning sensation or you have increased swelling or pain, you may have an infection. Contact your dentist, as you may need antibiotics.

    If the blood doesn’t clot in your tooth socket, you won’t heal properly. This is called dry socket and can be very painful. You’re more likely to develop dry socket if you smoke or take oral contraceptives. See your dentist straight away, who may put a dressing in the socket and prescribe antibiotics.

    You may notice pain, tingling, pins and needles or a numb feeling in your gum near the tooth socket. This may be caused by bruising of your nerves and is usually temporary. It affects around two in every 100 people who have a tooth removed. Very occasionally, it’s caused by the local anaesthetic.

  • Having more than one tooth out at a time I have two appointments to take out my lower teeth– one from each side. Can’t it be done in one appointment?

    Answer

    It’s usually possible to have more than one tooth taken out at a time. But sometimes, your dentist may suggest doing this separately so that your jaw isn’t numb on both sides at the same time.

    Explanation

    When you have a tooth, or teeth, removed, your dentist will usually give you a local anaesthetic to block the pain. Your dentist may numb the affected tooth only or a larger area of your mouth.

    When you have one of your lower teeth removed, the local anaesthetic can numb your lower jaw, tongue and lip as well. Depending on the type of anaesthetic used, this numbness can last for three to four hours. When your mouth is numb, you won’t be able to feel pain as you normally would. This means you could burn your mouth on hot food or drinks. Also, you may bite or chew your cheeks or lips without realising.

    Your dentist may suggest that you have your teeth removed in separate appointments. Then you will be able to feel at least one side of your mouth.

  • Wisdom tooth removal I’ve had pain and stiffness in my lower jaw. My dentist is going to remove the upper wisdom tooth on the same side. Is this a mistake?

    Answer

    It’s unlikely to be a mistake. Sometimes your dentist will remove an upper tooth that’s causing pain and biting into your gum or cheek below it.

    Explanation

    Your dentist won’t remove your wisdom tooth if it isn’t causing any problems. But they may remove it if it’s biting into your lower tooth or gum. Upper wisdom teeth are generally easier to remove than the lower ones.

    Your wisdom tooth may not have enough space to come through. If it starts to come through but gets stuck, it may be covered completely, or partially, by a flap of gum tissue. You may find it difficult to clean your gums properly, which means food and bacteria get trapped under the gum flap. This may cause an infection called pericoronitis. If you have pericoronitis, you may be in severe pain. You may also find it difficult to open your mouth, which may stop you talking and eating normally.

    You may be able to treat pericoronitis with mouthwashes and antibiotics. But if the problem keeps coming back, you may need to have your wisdom tooth removed.

    If you’re worried about having a healthy tooth taken out, discuss this with your dentist as other options may be available.

  • Other helpful websites Other helpful websites

    Sources

    • Tooth extraction. Medscape. www.emedicine.medscape.com, published 30 April 2015
    • Dental decay. Cracked teeth. Bridges and partial dentures. British Dental Health Foundation. www.dentalhealth.org, accessed 30 July 2015
    • Wisdom teeth extraction. Royal College of Surgeons. www.rcseng.ac.uk, accessed 30 July 2015
    • Removal of wisdom teeth. British Association of Oral Surgeons. www.baos.org.uk, accessed 30 July 2015
    • Complications related to use of medicines in surgery. OSH post-operative complications (online). Oxford Medicine Online. www.oxfordmedicine.com, published October 2011 (online version)
    • You and your anaesthetic. The Royal College of Anaesthetists. www.rcoa.ac.uk, accessed 6 August 2015
    • UK national clinical guidelines in paediatric dentistry: guideline for the use of general anaesthesia (GA) in paediatric dentistry. Royal College of Surgeons, 2008. www.rcseng.ac.uk
    • Clinical guidelines and integrated care pathways for the oral health care of people with learning disabilities. Royal College of Surgeons, 2012. www.rcseng.ac.uk
    • Nursing patients requiring preoperative care. Oxford handbook of adult nursing (online). Oxford Medicine Online. www.oxfordmedicine.com, published August 2010 (online version)
    • Wisdom teeth. Root canal treatment. Veneers. Crowns. What to do following an extraction. British Dental Health Foundation. www.dentalhealth.org, accessed 6 August 2015
    • Practical local anaesthesia. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 19 October 2011
    • What to expect after the operation. Royal College of Surgeons. www.rcseng.ac.uk, accessed 6 August 2015
    • Postextraction problems. The Merck Manuals. www.merckmanuals.com, reviewed July 2014
    • Tarakji B, Saleh LA, Umair A, et al. Systemic review of dry socket: aetiology, treatment, and prevention. J Clin Diagn Res 2015; 9(4):ZE10–13. doi:10.7860/JCDR/2015/12422.5840
    • Post-operative instructions following oral surgery. British Association of Oral Surgeons. www.baos.org.uk, accessed 6 August 2015
    • Toothache and infection. The Merck Manuals. www.merckmanuals.com, reviewed August 2014
    • Magraw CB, Golden B, Phillips C, et al. Pain with pericoronitis affects quality of life. J Oral Maxillofac Surg 2015; 73(1):7–12. doi:10.1016/j.joms.2014.06.458
    • Personal communications. Dr Steve Preddy, Dental Clinical Director of Bupa Dental Services. September 2015
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