TOOTH EXTRACTIONS

RECOVERY | AFTERCARE | PROCEDURE | PAIN ADVICE

In 2019 you shouldn't be freaking out about tooth extractions.  Here's a comprehensive article covering everything you need to know about tooth removal from some of the UK's most talented and caring team of dentists, orthodontists and oral surgeons.

 

Extractions are just as much science as art and everything from pain relief to minimising the trauma of the extraction is highly dependent on the skills and talents of your dentist.  So read on and we will discuss everything you need to know about this common dental procedure.

 

Most people will need a tooth taking out at some point in their lives.  This can happen for a variety of reasons.  One very common reason is when the wisdom teeth become impacted and need taking out.  If you think you need help with your wisdom teeth then we have a specific page dedicated to that here: wisdom teeth removal.

 

Good dentists will always do everything they can to keep your mouth healthy and all of your teeth in your head.  But sometimes this just isn't possible for a number of reasons and the teeth need to be removed.

 

This article has been independently reviewed by:

Dr Laurence Masters BSc BDS MSc Orth
Dr MJ Rowland-Warmann BSc BDS MSc PGDip MJDF
Dr Billal Arshad BDS MSc MFDS RCS (Eng)

Here are the reasons dentists perform tooth extractions

  • The tooth is broken due to trauma or an accident

  • Severe decay is causing the tooth to fall apart

  • Gum disease may make your tooth loose and need taking out

  • You may have too many teeth (overcrowding)

  • You may need a tooth taking out to make space for braces treatment

  • The tooth may be impacted (like in the case of a wisdom tooth)

A tooth can be acutely painful when it’s been broken, is decayed or loose. Getting patients out of pain is the main reason dentists take teeth out. Removal of the tooth often causes immediate relief because the nerve (what's causing the pain) will be removed along with it.

*If you're in pain right now then visit our emergency page*

Do I need an extraction?

There are many reasons that dentists might need to extract your teeth, below is a radiograph of more than one reason to extract.  There's an Abcess on a broken tooth and the tooth will likely need replacement with a dental implant.  For more info on dental implants visit our page by following the link.  Alternatives include dental bridges, crowns and just to leave the gap as is (although this brings with it specific problems such as the surrounding teeth tipping into the gap or bone loss.

Broken crown with abcess

Trauma and Accidents

Accidents happen and especially in children or young adults who are playing contact sports. To minimise the risk of a traumatic evulsion always wear a mouthguard and practice sports such as cricket, hockey and martial arts using safety equipment.

 

If a tooth has not been broken but has fully come out (a traumatic evulsion) then if you get to the dentist within an hour there is a good chance that the tooth can be saved. However, when it is cracked and the crack goes through the pulp or has severely damaged the tooth then an extraction will most likely be necessary.

 

Here's some useful advice on what to do if you've experienced dental trauma.

Decay

Decay is tiny cracks and fissures opening up in the enamel and tooth surfaces that let in bacteria. Once in the cracks, the bacteria multiplies and produces harmful chemicals that eat away at the tooth structure and literally rot your teeth from within.

 

The main causes of decay are sugar, plaque and not brushing your teeth twice a day. Sometimes decay is so profound that the tooth is what dentists would call ‘unrestorable’. This means it needs to be taken out to prevent the further spread of bacteria and stop any pain you may be feeling from the infection.

 

If the nerve of the tooth is infected (a hot tooth) then the pain can be severe and patients in this unfortunate situation often attend for emergency appointments patients and we can get them out of pain extremely quickly. For an emergency appointment follow the link.

Gum Disease

Gum disease is another highly preventable dental disease. Over 90% of people will have some sort of gum disease at some point in their lives, the severity of which ranges from gingivitis (inflammation of the gums) to periodontal disease that can affect the ligaments and bone holding your teeth in place.

 

This is the reason teeth with gum disease become loose and eventually fall out. It is often better to extract them before this happens in order to treat the underlying disease and stop it spreading further throughout the mouth and body.

 

If you think you have gum disease and need treatment follow the link here to our gum disease page.

Too Many Teeth

Some people are very special and actually are born with extra teeth in their mouths! These 'supernumary' teeth can often be asymptomatic but sometimes these extra teeth can become impacted and will need to be extracted.

 

If you’re one of the lucky one in fifty people with an extra tooth then make sure your dentist is keeping an eye on it so it doesn’t need taking out if it causes problems.

Orthodontic extractions

In order to make space for the teeth to move into position during orthodontic treatment, sometimes it’s necessary to remove teeth to make the rest of the teeth fit together correctly. Orthodontic extractions depend on each individual case, how the teeth are to be moved and the degree of crowding.

Impacted Teeth & Wisdom Teeth

These are normally wisdom teeth and are the very back teeth which come through usually between age 18-25. In some people wisdom teeth never come through. They can come through at strange angles and because they are so far back, can be difficult to brush. This is why they often suffer decay and why the gums become inflamed and painful as they try to erupt through the gum.

 

Lower wisdom teeth that are painful, have pathology such as cysts, or are causing damage to adjacent teeth may require removal. There are guidelines as to when it is right to remove wisdom teeth as there are important structures such as vessels and nerves near wisdom teeth and we want to prevent these getting injured. Asymptomatic wisdom teeth will not simply be removed in the UK without reason.

Imaging for safe extractions

Here at Smileworks we have invested significantly in a state-of-the-art CBCT scanner that renders extremely accurate imaging of the impacted teeth lowering the risk of complications significantly and keeping all our patients safe.

 

We have an entire imaging suite which we use not only to evaluate the clinical implications of extractions (and many other procedures) but also to help patients better understand what we do and how they will look before and after their procedures.

Imaging technology at Smileworks
Imaging technology at Smileworks

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I was at the dentist for a temporary dressing / filling and a scale & polish this morning, the ladies that tended to my teeth were Paula and Tamzin... they took extra steps to explain exactly what is going on with my teeth and to ensure that I was okay and comfortable with the forthcoming procedures... typically I would bee more nervous but today I felt comfortable at all times and the job on my teeth was great, safe, quick and efficient, I find solace in the fact that they will take extra lengths to preserve my natural teeth👍👌read more
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After bad experiences with dentists in the past, I decided to try Smileworks and I’m so happy I did. I received treatment from Zoe who is so lovely, chatting throughout the sessions and talking through each part of the treatment, she really makes it a calm and easy experience and I have never had any problems with any work done by her. Thank you, Zoe! The front of house staff are also extremely friendly and very helpful, an all-round, great dentist to go to!read more
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18:28 04 May 19
Excellent professionalism, swiftness and care when performing 4 of my wisdom teeth extractions. Didn't feel a thing! Thanks to the amazing Abd & Eva. The whole team have been so helpful in identifying the right treatment course for me. Many thanks!read more
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The ideal Place to visit if you have any dental fears. I needed treatment but was worried, these guys put me at ease and the treatment has been successful and much easier than expected. A great environment to get your teeth sorted.read more
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I Visited smileworks last week for a teeth whitening consultation. I had my appointment with Bambi. She was very welcoming and friendly as were all the staff.This place is amazing and the airline theming is great. The best dentist I've been to. I would recommend this place to Everyone.read more
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First of all I wanted to say a big thank you to all the staff at Smileworks for making me feel very welcome. I also wanted to say a huge personal thank you MJ for her complete transparency through the consultation period. The honesty demonstrated was so valuable to me and helped me make what I believe is the best decision.I have upcoming teeth whitening treatment and wouldn't recommend anybody else other than Smileworks.read more
Jay
Jay
09:54 04 Apr 19
Had an appointment with Patri for a painful wisdom tooth. I was terrified of the extraction but she was absolutely amazing. Fantastic job! Also, if you think Smileworks might be a bit pricey, think again. I ended up paying considerably less than what another dentist would have charged me. A super happy customer 🙂read more
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Susan (dentist) and Eva did my composite bonding and Susan is excellent at her work! I am in love with my new smile and can't recommend her enough! The staff at Smileworks are so professional and friendly. Thank you!read more
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Types of Tooth Removal

Simple Extraction (video)

A simple extraction is the taking out of any tooth for any of the reasons outlined above.  The reason it is referred to as simple is that it will usually not involve any nerves, blood vessels or difficult root positions.

 

A simple extraction can be carried out by a general dentist and there is no requirement for an Oral Surgeon.  To determine whether your extraction is in fact simple you must make sure that your dentist takes the appropriate radiographs and images to discover their positions of important nerves, vessels and your bone levels.

Surgical Extraction (video)

A surgical extraction is carried out by a qualified oral surgeon [link to one] and may mean cutting the gum to get to the tooth. This is also for more complex root structures which may be curved, or teeth which are impacted (on their side) or fused into in the bone

Emergency Extraction

This is simply where a patient is in urgent need of an extraction because they might be in pain or they have suffered an injury. These tooth removals can be quite straight forward and booking an emergency appointment at Smileworks is simple.

Just follow the link here to our emergency dentist page or call 0151 236 5166

Tooth Extraction Pain

Do extractions hurt?

This is the most common question we get asked about taking teeth out; do extractions hurt?

The answer is no.

 

Before treatment your dentist will administer local anaesthetic that will numb the entire area so you will not feel a thing during the extraction.

 

For some nervous patients or more difficult cases (such as surgical extractions) you may elect to be sedated with pills for your procedure and will be unlikely to remember anything about it.  Speak to your dentist in advance about this option.

 

Although you won’t feel pain there will be pressure applied to your mouth and you will feel the sensation of something being pulled or jiggled out of your mouth.  This is not unpleasant though and 99% of patients tolerate it just fine.

Pain levels for dental extractions

Here's the pain scale that most medical people use to determine pain levels in patients.  Following your extraction when you return home the pain levels should be no more than about three.

 

If they are around 4/5 then it might be a good idea to call for reassurance or visit the pharmacist for some pain relief.  Anything higher and you'll need to keep in touch so that your dentist can keep an eye on the situation.

 

The importance of communication

It’s very important you communicate with your dentist.  Sometimes the local anaesthetic can take some time to start working.  If your dentist is in a rush they may not checked the entire area is fully numb.  This is what leads to the horror stories you sometimes hear about extractions.  Once again, the skills and how much time you get with your dentist are key to any happy dental procedure.

Pro Tip

Dr MJ Rowland-Warmann

Once the local anaesthetic has been administered the correct areas need to be adequately numb.  It is essential that you test the area by poking it with an instrument to see whether the patient can feel any sensation.  Sometimes it will take some time to get a patient numb and I will need to try a few different areas and wait varying lengths of time.

Depending on which block I use, it should take between five and ten minutes to get someone really numb but it can take longer – so be patient.  Also some patients – when they are a bit nervous – confuse pressure with pain and this is quite common.  So you must speak to your patient and make sure that they are absolutely comfortable before you proceed to the extraction.

Here at Smileworks we give the anaesthetic an appropriate amount of time to work and test that the area is numb before proceeding.  This is extremely important.

When you are out of the dental chair you may feel a little bruised and sometimes the socket (where the tooth used to be) can bleed.  You will be given full post-operative instructions and we will talk about aftercare below. So read on.

Minodora Zidaru
Minodora Z.
22:05 22 Mar 19
Had an appointment with Patri for a painful wisdom tooth. I was terrified of the extraction but she was absolutely amazing. Fantastic job! Also, if you think Smileworks might be a bit pricey, think again. I ended up paying considerably less than what another dentist would have charged me. A super happy customer 🙂

Minodora Z - 22 March 2019 - 5/5 Stars  ∗∗∗∗∗

How long should the pain last?

Another popular questions is how long should it hurt following your treatment and what type of pain is ‘normal pain’.

 

Following your procedure, the area is numb for around 2 hours. Once the Lignocaine® (or whichever local anaesthetic your dentist deems appropriate) has worn off, there may be some discomfort but it shouldn’t be painful.

 

How long the pain lasts and what pain is ‘normal’ are very difficult questions to answer and very from person to person.  Think of an extraction like a bruise.  It needs time to heal and non-surgical extractions heal on a similar timescale to other soft tissue traumas like bruises.

 

After 2-3 days the area should be quite comfortable and then from 3-7 days any pain should be gone.

If the pain has not resolved after a week then you may have a dry socket.  We will talk more about this in the ‘complications’ section below.

WARNING! Increasing pain after 5 days is something you need to speak to your dentist about

Is jaw pain normal?

Bruising, swelling and bleeding can all be normal in small amounts but if they are bothering you then you might need to speak to your dentist. These are also covered in the Complications section below and could be from other unerupted teeth, wisdom teeth, trauma or infection.  Also any gum pain should be checked out by your dentist.  Any pain radiating to your ear is a sign of a possible dry socket and you must get in touch with your dentist about this type of pain.

Is throbbing pain normal?

Before your treatment the tooth might well have been throbbing or really painful at times.  This usually means the nerve of the tooth is involved or is damaged.

 

The extraction should remove the entirety of the nerve from the socket and the throbbing should stop.  If there is still throbbing after the extraction this could be the normal effects of the trauma of having the tooth taken out on your surrounding tissues.

 

However, throbbing after the extraction or any increasing pain after about 5 days is a bad sign and if the pain radiates to the ear then this could be a sign you have a dry socket which is a complication of an extraction procedure and will require you to return to the dentist.  More on dry sockets in the complications section below.

Does the type of tooth make a difference?

Different people experience pain in different ways and sometimes the type of tooth extracted can have an effect on how much pain might be associated with the procedure.

 

For example, if you come in with an infected tooth or big abscess then you may already be in terrible pain and the result will be a blissful absence of pain so you will likely report a painless procedure.

 

However, it you weren’t in any pain to begin with and feel pressure and slight pain than you may report feeling some pain.  Although the two procedures could have been done precisely the same.  So things are all relative and pain – especially – is relative and different for all people.

 

That’s not to say if you have a low pain threshold it’s going to hurt because it’s not.  Your dentist will make sure of that.  And if they do not.  Find another one.

Recovery and aftercare

You will receive aftercare instructions tailored to the type of extraction that you've had.  We've put together a helpful table to give you some advice on pain, swelling, what you can eat, what to avoid and when to call us below.

 

Once the procedure is over you might be feeling a little woozy from the local anaesthetic that can make some people feel drowsy and others feel on edge or worried. This is because sometimes the local anaesthetic dentists use contains a chemical similar to adrenaline that makes you feel edgy.

 

You may also have not eaten or not feel like eating so be aware of potential problems with low blood sugar. Try to drink something sweet with no caffeine in it like orange juice or your favourite squash.

 

You can combat anxious feelings by breathing deeply and sitting still for a while. You will have received comprehensive aftercare instructions from the team at Smileworks and will know precisely what to do depending on the extent of the treatment you’ve had.

Tooth Extraction Recovery Timetable

 Day of Extraction24-48hrs+2-5 Days5 Days +
PainAnaesthetic wears off after 2 hoursPainkillers from pharmacyIf pain increasing call dentistIf pain increasing call dentist
BleedingBlood in saliva. Slight bleeding. Bite down on gauze for 15 mins if bleeding persistsNo bleedingif bleeding increases call dentistif bleeding increases call dentist
SwellingSlight swelling possibleMay increase 24-48 hrs. Max at around 48-72 hrsSwelling will begin to decreaseSwelling should be mostly gone
FoodsLiquid foodSoft foods & liquids
Soft foodsEat as you feel able
Oral HygieneAvoid treated area with brush. Rinse with salt waterAvoid treated area with brush. Rinse with salt waterBrush normally avoiding extraction siteBrush around extraction site as you feel able. Best to still avoid.
ExerciseRest. No gym or strenuous exerciseRest. No gym or strenuous exerciseHard exercise may dislodge clotExercise as you feel able
AlcoholNoneNoneDrink in moderationdrink in moderation
SmokingNoneNoneNoneNone
Please don't smoke after an extraction, you just increase the chances of a complication called a dry socket. Which hurts. Not as much as lung cancer. But it still really hurts.

Tooth Extraction Options

Simple Extraction

£100 per tooth

Moderate Extraction

£150 per tooth

Minor Oral Surgery

£200 per tooth

Complex Extraction

£280 per tooth

Complex Oral Surgery

£350 per tooth

Itemised Tooth Extraction Prices | 2019

  • Emergency fee (for emergency appointments only) | £50
  • Deposit (to secure booking & deducted from treatment) | £40
  • Simple extraction | £100 per tooth
  • Moderately complex extraction | £150 per tooth
  • Monor oral surgery | £200 per tooth
  • Complex extraction | £280 per tooth
  • Complex oral surgery | £350 per tooth

The Procedure

Preparing for a tooth extraction

Many patients ask us if there is any way they can prepare for a tooth extraction. The best way is to make sure you are under the care of a skilled and talented oral surgeon or general dentist who you trust and who explains the process to you in as much detail as you want.

 

Even for damaged and painful teeth it is still your choice whether to have an extraction and you must weigh the risks and benefits – more on this below.

 

The best advice we can give is to be calm and ask lots of questions. Sometimes this can be difficult when you are in pain which is all the more reason to make sure you are under the care of a dentist you trust.

Tooth Extraction surgery setup

Tips to prepare for a tooth extraction

  • Make sure you're at a dental practice you feel comfortable in and in the care of a dentist you trust

  • Try to keep calm and ask lots of questions

  • Remember it's your decision whether to have a tooth extracted

  • Always make sure you are properly consented and understand what consent means

  • Try to eat something before the procedure to reduce the chances you might feel ill or faint

  • Relax and let the experts do their work

  • If something doesn't feel right then you have the right to say no or to wait and possibly make another appointment at a later date.
    A good dentist will not mind this at all.

Wisdom tooth extraction by Dr Rowland-Warmann at Smileworks

Here's how your dentist might prepare for your extraction

  • 1 Assessment of medical history
  • 2 Check the tooth which is causing the problem
  • 3 Take x-rays to check the roots of the teeth
  • 4 Discussion about risks, benefits and alternatives
  • 5 Decide to take out the tooth or maybe leave it where it is
  • 6 Prepare the surgery for the procedure
  • 7 Administer Local anaesthetic *and make sure it's working*
  • 8 Take the tooth out
  • 9 Decide whether to have a replacement with bridge, denture, implant or leave the space
  • 10 May decide to refer to a specialist

Patient Testimonial

Tracy Carrison - Local Guide 12 March, 2019

Absolutely amazing care!

I rang up after exhausting all NHS dentists, from the first call to see if an appointment was available on a Saturday to leaving, I cant praise this practice enough. When my partner rang up the lady on the phone was really helpful and explained there procedures. We were given a 12.30 appointment and paid the £50 check up fee.

On arrival I was in severe pain from a painful wisdom tooth, they were very sympathetic and helpful and so friendly, after a very short wait in there quirky airplane waiting room, I was seen promptly by the dentist and nurse. He diagnosed my problem straight away and was given an xray and then removed my tooth. I'm a very nervous patient and didn't even no my wisdom tooth had been removed.

I was amazed when they said it was out.the dentist and nurse were so kind and caring and very professional in there work. After the extraction they let me rest in the chair for a while till the bleeding stopped and were so chatty and made me laugh as they explained what they had done. The dentist then took me to reception where we chatted to the lovely Australian girl on reception who again was amazing happy friendly.

The other lady who first saw me when I came in came up and asked me how I was and the pair of them were amazing and both made us feel relaxed. I cant recommend this practice enough and will now be going back to them for future check ups and any work needed.

Home remedies and natural pain relief

The best natural remedy following an extraction is salt water.  Stir a teaspoon of normal table salt into a large glass of hot water until all the salt has dissolved away.

Leave the mixture to cool until it is just hot enough to drink and then rinse gently for around 30 seconds.

 

!*Do not drink the salt water*!

 

Spit it out and repeat if necessary. There’s nothing to worry about if there’s some blood in the spit. This is normal. Salt water helps fight infection and soothes the area. Some people also get pain relief from hot or cold compress to the face.

  • Home Remedies for Tooth Extraction

  • Salt water rinse twice a day and following meals

  • Hot compress to the face to sooth the affected area

  • Cold compress to the face to reduce swelling

Home remedies to avoid

Unfortunately honey, black tea, aloe vera, vinegar, clove oil, garlic and turmeric are commonly suggested, they are more likely to give you an infection than stop one so take your advice from dentists and not quacks when deciding what you should do flowing your procedure.

 

Sometimes just a nice relaxing hot bath can soothe a multitude of aches and pains or some people swear by getting fresh air and going for a gentle stroll outside to calm themselves. All of these are fine. Including meditation and whatever makes you feel happy.

 

If you have tried a random home remedy and the pain has worsened then call your dentist immediately.

 

Also avoid eating sweets, hard or crispy foods or chewing on the affected side of your mouth if you are eating anything chewy.

Tooth Extraction Complications and Risks

Minimising Complications

A safe and well stocked surgery and a talented and highly experienced dental surgeon will be able to keep the risks and complications of an extraction to an absolute minimum.  Make sure you choose the right surgery, the right dentist and that you trust them implicitly.

Surgical extraction setup

Dry Socket

Alveolar Osteitis (Dry Socket) is a rare complication occurring in 2-5% of individuals following an extraction of an adult tooth. It most commonly happens following disintegration or loss of the blood clot that helps the wound heal.

 

When the bone is exposed it becomes infected causing severe pain and a foul smell from the infection. Dry socket is statistically more likely to occur following wisdom tooth extractions or a traumatic extraction (evulsion) as the hole is larger or there is more damage to the bone.

 

Smoking, spitting out the clot or sticking your tongue in the gap is likely to dislodge the clot in the same way as aggravating it with your toothbrush, Tepe brushes or your fingers.  So avoid doing these things following your extraction.  If you have a dry socket you'll certainly know about it and should call your dentist immediately as it is an easily treatable condition.

How do I know if I have a dry socket?

Symptoms of dry socket are:

  • Moderate to severe pain
  • Pain increasing after 3-5 days of your procedure
  • Soreness, redness or swelling,
  • Pus, discharge and a foul smell
  • You may have noticed the clot coming out and felt yourself swallowing it or seen that you've accidentally spat it out
  • You may be able to see the hole or exposed bone (it won't always appear white but pink, red or black)

 

General infection at extraction site

Infections are a potential risk of any surgical procedure and you will be properly consented and a medical history taken to minimise the chances of an infection occurring.  Following your aftercare instructions will also minimise the risk.

If you do get an infection at the site then you may feel pain increasing and swelling / hotness increasing after the normal reduction period of 24-72 hours.  Also pus, swelling and redness and a foul smell from your mouth are all signs of infection.

Call the dentist and they will be able to diagnose the problem.  Potential treatments involve salt water rinses, application of gauze  and antibiotics in severe cases.

Tooth or root fracture

Sometimes during an extraction the tooth may fracture or the root may fracture and small parts of each may be left in your jaw.  They may need further surgical extraction or may be stable and able to remain in place.

Your dentist will know if this complication has occurred and will be able to council you on the possible options available to you.

Damage to nerves and blood vessles

There is a very small change that impacted teeth may be lying on nerves or blood vessels in the jaw.  Having proper imaging and diagnostics should alert your dentist to these risks so that they can work appropriately and allow you to decide how you would like to proceed in the knowledge that there is an increased risk of damage to nerves or vessels.

 

Here's a radiograph of a nerve extremely close to an impacted wisdom tooth.  A surgeon should be extremely careful considering this radiograph, interpreting it correctly and informing the patient of the risks before proceeding with the extraction.

Impacted Tooth In Clost Proximity to Inferior dental nerve