Tooth extraction: when a tooth has to come out, how it works and what matters afterwards

“I’ll have that tooth looked at later.” – Those “laters” often add up to weeks and months, until the tooth can no longer be saved. Without knowing what to expect, an extraction can feel daunting. So here is a step-by-step explanation of how it works and what matters afterwards.

In an extraction, the dentist removes a tooth from its socket in the jawbone. It is always the last resort: if a tooth can be saved – with a filling, root canal treatment, post or crown – that comes first.

Typical reasons for an extraction include:

• Advanced decay that can no longer be treated in other ways
• Infections in or around the tooth that can no longer be treated and may spread
• Trauma that has severely damaged the tooth
• Orthodontic reasons, for example severe crowding
• Impacted teeth such as wisdom teeth that have not or only partially erupted

How complex the procedure is depends on the position and condition of the tooth.

Simple extraction – for visible, easily accessible teeth

1. Examination and X-ray: the X-ray shows the tooth and its roots, which determines the plan.
2. Local anaesthesia: the area is numbed so that you usually only feel pressure.
3. Loosening: special instruments gently loosen the tooth in its socket.
4. Removal and cleaning: the tooth is removed and the site cleaned.

Surgical extraction – for impacted, broken or hard-to-reach teeth

1. Examination and 2D or 3D X-ray to assess roots, nerves and neighbouring structures precisely
2. Local anaesthesia, in special cases sedation or general anaesthesia
3. Access: the gum is opened and some bone may be removed
4. Sectioning: the tooth may be divided into smaller pieces and removed completely
5. Cleaning and stitches if needed

Recovery after a surgical extraction usually takes a little longer than after a simple one.

What to do after an extraction

• Control bleeding: bite on sterile gauze for about 30 minutes. Do not spit or rinse forcefully – the blood clot protects the wound and is especially important in the first 24 hours.
• Soft food: for the first 24 hours choose soft, lukewarm food and drinks – nothing very hot, cold, spicy or hard.
• Cold compress: cool the cheek from the outside with breaks to reduce swelling and pain.
• Medication: take any prescribed medication exactly as instructed.
• Gentle brushing: from the second day, brush with a soft toothbrush, taking extra care around the wound and without pressure.

• Smoking and alcohol – at least for the first 24 hours, ideally a few days; both can delay healing.
• Very hot or cold food – it can promote bleeding and cause sensitivity.
• Touching the wound – neither with fingers nor tongue, so the clot is not dislodged.
• Strenuous activity – no sport or heavy lifting for the first few days, as higher blood pressure can trigger bleeding.

How healing progresses

Healing is individual. As a rough guide:

• First 24 hours: bleeding stops and a clot forms.
• Days 3–4: swelling and pain decrease.
• Days 7–10: stitches are removed or dissolve.
• About 2 weeks: the gum has largely healed.
• 3–6 months: the bone in the socket rebuilds.

If you have severe pain, ongoing bleeding or signs of infection, contact the practice promptly. If the gap is later to be closed with an implant, this can sometimes be done at the time of extraction.

About the authorDr. med. dent. Hasan CoşkunCo-founder of LHC Clinic, Istanbul

Dr. Coşkun studied dentistry at Charité – Universitätsmedizin Berlin (graduated 2000) and worked as a dentist in Germany for around 20 years. He has placed more than 10,000 implants and now practises in Istanbul with a focus on implant dentistry.

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This article is for general information and does not replace a personal examination. Whether and which treatment is suitable for you can only be assessed after examination and a consultation.