Having a tooth removed

Removing a tooth is a minor surgical procedure.

• The tooth and the area around it are numbed with local anaesthetic. Happy gas is available as well if you're nervous — just ask.
• Once you're numb, the tooth may need to be uncovered by lifting the gum back, and sometimes the gum needs a small cut. Occasionally we need to remove a little bone around a wisdom tooth; we'll tell you beforehand if that's the case.
• The tooth is loosened with movement and pressure. That may mean using a drill to divide it into two or more pieces before it comes out.
• Stitches may be needed. They normally dissolve after about two weeks.
• New bone begins to fill the socket over the next six to eight weeks.

• Root canal treatment and a crown, where the tooth is restorable — keeping your own tooth is almost always preferable when it's realistic.
• A filling or crown alone, if the damage is limited.
• Gum treatment, where the tooth is loose because of gum disease rather than decay.
• Referral to an oral surgeon, which we'd recommend ourselves if the tooth is difficult or the risk is higher than usual.

If the tooth isn't dealt with, what can follow includes loss of bone, gum inflammation, infection, sensitivity, abscesses, pain, loosening teeth, and eventually the need to remove it anyway. Jaw joint problems, headaches, referred pain into the back of the neck and facial muscles, and tired muscles when chewing are also possible as the bite changes.

Replacing the tooth. If it's visible or does real chewing work, it's worth deciding early how it will be replaced — an implant, a bridge or a denture — because bone shrinks over the first year and some options get harder the longer they're left.

All surgery carries some risk. Everyone heals differently, and there's no reliable way to predict how your gums, bone or pain response will behave.

• Dry socket — the blood clot in the socket is lost early, exposing the bone. It causes a constant throbbing pain that builds over the following days, sometimes with a bad smell. Ring us as soon as you notice it.
• Bleeding, pain, swelling and bruising after the procedure.
• Infection in the socket.
• Jaw pain or trismus — difficulty opening — for a few days or weeks.
• Numbness of the lip, tongue, chin or gum from nerve irritation or damage. Usually short-lived; on rare occasions permanent.
• Sinus perforation when removing upper back teeth, whose roots often sit against the floor of the sinus. Usually managed by closing the area with stitches, home care instructions and antibiotics; a larger opening may need a specialist and minor surgery.
• Fracture of bone, or damage to adjacent structures. The bone, vessels and tissue beside the tooth are stretched slightly to make room for instruments, so they can be injured. Minor damage usually heals uneventfully.
• Injury or sensitivity to neighbouring teeth or gums.
• Bony sequestra — thin slivers of bone chipped during the procedure can work their way out through the gum weeks later as small hard pieces. Come and see us and we'll remove them.
• Accidental swallowing of instruments or componentry. Great care is taken, but the pieces used are fine and small. If it happens, X-rays and surgical removal are needed.
• Allergic reactions to drugs or materials used.
• Delayed healing and bone resorption. Healing speed varies between people; we assess it at your follow-up and manage it if it isn't going as expected.
• Bone loss and tooth movement over time where a tooth is missing and not replaced. The neighbouring teeth tend to drift into the space.

Reactions to anaesthetic and medications

Rarely, a patient reacts badly to the anaesthetic or to a medication we use or prescribe. Reactions usually happen within the first two hours and can include paleness, palpitations, sweating, dizziness and nausea; a more serious anaphylactic reaction is possible. This is why we need your full medical history — allergies, prescription medicines, natural remedies, herbal preparations and anything over the counter. Tell us everything, even what seems irrelevant.

For the first day or two, please don't:

• Bite or suck a numb lip, cheek or tongue — you can injure yourself without feeling it.
• Smoke or drink alcohol for at least 48 hours; it delays healing. Ideally don't smoke at all for two weeks, as it significantly impairs it.
• Put fingers, pencils or anything else in your mouth, which risks injury and infection.
• Lie flat — relax, but keep your head raised to reduce bleeding.
• Be too active for about 24 hours.
• Rinse your mouth for about 24 hours. After that, rinse gently after meals with half a teaspoon of table salt dissolved in a glass of lukewarm water.
• Brush the teeth right beside the socket for the first 24 hours. Afterwards, brush gently and follow the instructions we give you.

Keep up your pain relief and follow the instructions we give you on the day. Full aftercare is on our aftercare page.

Attending your follow-up appointments lets us monitor and assess how the socket is healing. Beyond that, your mouth needs daily care at home and a check-up every 3 to 6 months, which isn't included in the cost of the extraction.

• Follow all the instructions you're given, so healing goes as well as it can.
• Clean your teeth, gums and any denture, crown, bridge or implant components thoroughly, as instructed.
• Come in for examinations and cleans every 3 to 6 months as your dentist advises. There's a fee for these visits.
• Take care not to abuse the area or any future replacement tooth, and tell us straight away if you notice a problem.

If you don't attend your follow-ups or keep up the maintenance — particularly where a replacement tooth is planned — problems can develop to the point of being difficult, costly, or impossible to treat, and you would be liable for the full cost of correcting them.