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Teeth can become too extensively damaged from tooth decay, infection, or trauma to be saved. When this happens to one or more teeth, your dentist will often recommend removing the affected teeth. Tooth removal is also frequently recommended for children with severely crowded teeth that cause discomfort or have impacted wisdom teeth. Removing a tooth or teeth can help avoid or simplify orthodontic treatment.

The decision to remove a tooth is sometimes based on cost because it is often less expensive than restoring a natural tooth. This can be a short-sighted decision in terms of the long-term cost of additional treatments. Failure to replace a missing tooth can also impact your long-term health. It's important to understand these consequences.

Not all dentists perform tooth removal. Your dentist may refer you to an oral surgeon for some or all of the procedures you need.

Two types of tooth removal

There are two types of tooth removal: "simple" and "surgical."

In simple tooth removal, a dentist removes a tooth in one piece without making an incision into the gums. Generally, teeth removed in this manner have straight roots and sufficient tooth structure extending through the gums.

In surgical tooth removal, a dentist needs to make an incision into the gum tissue to remove the tooth, cut the tooth into pieces to more easily remove it, or both. It may also be necessary for the dentist to remove some jaw bone to extract the tooth safely.

Your dentist may recommend surgical tooth removal if a tooth is extensively damaged and has multiple curved or twisted roots. It is also typically required for an impacted tooth.

Some of the benefits of having a tooth or teeth removed include:

• Eliminating infection to relieve pain and swelling.
• Creating more space in the mouth to allow the remaining teeth to move into their proper position through orthodontic treatment.
• Preventing the onset or spread of periodontal disease, which can damage adjacent teeth. This is a common reason for removing wisdom teeth, allowing a more successful solution than treating a natural tooth that may not have a favorable long-term prognosis.

Both simple and surgical tooth removal have some steps in common:

Before the procedure

• Review your health status: You will share information that will help ensure that your dentist and their staff can provide safe and effective treatment and provide appropriate post-care guidance. Get important information here: Health history and current health status.
• Treatment review: Your dentist will review the procedure with you, including its risks, benefits, and options you may have. Understanding the process will lead to the best treatment outcome. Ask any questions you have before the procedure is started.
• Anti-anxiety medication: If you are anxious about dental procedures, your dentist may recommend sedation.

During the procedure

• Anesthetic: Your dentist will numb the tooth with a local anesthetic.
• Preparing the tooth: Your dentist will use a special tool to detach the shock-absorbing ligament that suspends the tooth from the bony tooth socket.
• Safety: To prevent the tooth or pieces of the tooth from being swallowed or inhaled, your dentist may place a "safety net" of gauze in the back of your mouth.
• Removing the tooth: Your dentist will use another tool to loosen the tooth. The tooth-supporting bone is somewhat pliable, and this process enlarges the tooth socket enough to remove the tooth.
  • After loosening the tooth, your dentist will use another tool to remove the tooth. The device merely 'delivers' the loosened tooth without applying strong forces.
  • Your dentist will apply pressure directly to the tooth socket to minimize any bleeding.

Surgical tooth removal may involve one or more of the additional steps below:

• An incision in the gum tissue may be made to expose the underlying tooth and jawbone to give your dentist better visibility for the procedure. If an incision is made, your dentist will close the gum tissues with stitches (sutures) when the procedure is complete.
• A minimal amount of bone may need to be removed from around the tooth to allow easier removal.
• Your dentist may cut the tooth into pieces, making removal easier and less stressful on your gums and tooth socket. This is typically done if the tooth has multiple, curved, or twisted roots.
• Bone graft and/or soft tissue graft materials may be placed once the tooth is removed, particularly if the extracted tooth will be replaced with an implant or fixed bridge.

After the procedure

• Pain management:
  • Once the tooth or teeth are removed, the dentist will typically recommend a pain management strategy. The strategy will depend on age, health history, and current health status. Some medications are opioids, while some dentists prescribe a long-lasting local anesthetic to avoid using opioids. Be sure to discuss any specific concerns you may have with the medication prescribed.
  • Tooth removal, like any surgical procedure, has general post-surgical risks such as swelling, bruising, bleeding, and infection. These are typically well-managed with over-the-counter anti-inflammatory medications. Check with your physician or dentist before taking any unprescribed medications or using alternative treatments for these symptoms.
• Follow-up care:
  • Your dentist will give you instructions for at-home care following the procedure, taking into consideration your unique medical or dental conditions. You should request a copy of the instructions to refer to them later.
  • It is essential to follow the specific, post-treatment home care instructions. This will significantly increase your chances of having a successful outcome.
  • Your dentist or oral surgeon may recommend the use of an antiseptic irrigating solution. Follow your dentist's advice for safe and effective use.

  Wisdom teeth

  Your dentist may recommend removing a wisdom tooth if it is infected or causing pain. Wisdom tooth removal may also be recommended if it's clear that the tooth will not enter your mouth properly, if the tooth may harm adjacent teeth, or if the wisdom tooth will crowd your mouth.

  Some wisdom teeth can be removed without surgery. However, if the tooth is impacted and removal is recommended, surgery will be required. In some cases, wisdom teeth do not need to be removed at all.

  Additional treatments you may need

  Missing teeth can seriously impact your ability to chew, speak clearly, and your appearance. It can also lead to changes in your nutritional status and contribute to obesity, diabetes, and heart disease. It is important to replace any teeth that have been removed.

  • If you plan to replace the tooth with an implant or bridge, your dentist may recommend a socket bone graft to slow bone resorption and preserve the bony ridge. This procedure is not done if teeth are being removed for orthodontic purposes or after removing wisdom teeth.
  • You may be able to have a dental implant placed immediately after the tooth is removed if there is no sign of infection and there is an adequate volume and density of the intact bone around the tooth socket.

General risks and concerns

• Anesthesia: Tooth removal may require the use of a local anesthetic or sedation. You should be aware of the risks associated with these services.
• X-ray images: X-ray images are essential to the tooth extraction procedure. The amount of radiation exposure is considered minimal compared to the importance of being able to visualize structures like nerves during tooth removal.
• Pain management: Your dentist will typically recommend a pain management strategy once the tooth or teeth have been removed. The specific strategy will depend on your age and health status. Some medications are opioids. Be sure to discuss any specific concerns you may have with the medication prescribed.
• Tooth removal, like any surgical procedure, has general post-surgical risks such as swelling, bruising, bleeding, and infection. These can be typically managed with over-the-counter anti-inflammatory medications. Check with your physician or dentist before taking any un-prescribed medications or using alternative treatments for these symptoms.

Procedure-specific risks and concerns

• Tooth replacement: Unless a tooth is a wisdom tooth or another tooth removed for orthodontic treatment, it is usually important to replace the tooth. Failure to replace a missing tooth can impact your oral health, overall health, and appearance. Bite collapse can occur if multiple teeth are removed and not replaced.
• Dry socket: Failing to care for the treated site following tooth removal can lead to a condition called dry socket.
• Nerve injury: Tooth removal in some areas of the mouth can have an increased risk of nerve injury. It is possible to have permanent numbness in the area of the injured nerve. The probability of nerve injury is usually low, but you should discuss the possibility with your dentist ahead of time. For impacted teeth that are located close to major nerves (most commonly lower wisdom teeth), it is becoming more common to remove only part of the tooth and leave its roots in place in the jaw. This is known as a "coronectomy."
• Sinus injury: If you have an upper back tooth removed, there may be a risk of perforating the bony floor of the maxillary sinus. Your dentist can determine how likely this is to happen by examining X-ray images. If a small hole does open, it can generally be closed with soft tissue. Larger holes may need to be repaired using powdered bone in a procedure similar to sinus augmentation. Perforations of the sinus floor can result in infection and may require antibiotics to treat.

Ideally, an infected or damaged tooth can be treated before tooth removal becomes necessary. If removal is necessary, there are no true alternatives. In some cases, the root(s) of a tooth can be left in the jaw but may require root canal therapy. If roots are left in place, the dentist or oral surgeon is obligated to tell you so you can discuss expectations for healing.

• If you have an infected tooth and do not receive root canal therapy, there may be no practical option other than tooth removal. If you do not get the tooth removed, infections can recur. Treating recurring infections with antibiotics may not be considered medically responsible since the bacteria causing the infection can become resistant to antibiotics over time. This can make the infections difficult or impossible to treat.
• Infections of the upper teeth can spread to the brain. Infections that cause swelling in the tongue, the floor of the mouth, or throat can ultimately prevent air from reaching the lungs. Infections can also spread into the neck toward the heart, lungs, and other organs with serious complications.
• Failure to follow your dentist or orthodontist's advice to remove one or more of your child's teeth for orthodontic reasons may undermine the success of your orthodontic treatment.
• The decision to remove wisdom teeth isn't always clear. Talk to your dentist about the position and health of your or your child's wisdom teeth and what's best for the particular situation. Wisdom teeth may not need to be removed if they are healthy, fully erupted, properly aligned, and are not crowding other teeth. On the other hand, wisdom teeth that are not fully emerged or impacted may cause crowding or damage to nearby teeth. They are also more difficult to clean and can increase the risk of tooth decay and periodontal disease. If your dentist recommends removing one or more wisdom teeth, keep in mind that local and general anesthesia used during dental surgery have risks of their own.¹

• Why are you recommending that my tooth be removed? Are there ways to save it so it can remain functional? If so, what other procedures may be required?
• If my tooth is removed, how important is it to replace it?
• If you can't save my tooth, what are my options for replacing it — both on a temporary and permanent basis? What is the best long-term option based on my age and medical and dental health?
• How soon should I have the tooth removed, and why?
• What can I do to relieve my pain until my appointment to remove my tooth?
• After my tooth is removed, how should I care for the area? Is it possible to use a long-acting local anesthetic to avoid pain? Is there an extra charge for that?
• How soon should I arrange for my child to see an oral surgeon now that wisdom teeth are coming in? Are the wisdom teeth likely to affect their orthodontic treatment? Will it be necessary to remove one or more of them?