HUC Dental

What happens during a tooth extraction

And what the first few days afterwards look like

5 min read

Procedures
On this page7
  1. Before
  2. During
  3. Immediately after
  4. The aftercare, and why it is what it is
  5. If it bleeds again
  6. When to get in touch
  7. Healing

Few things in dentistry generate as much anticipatory dread as being told a tooth needs to come out. Most of that dread is about not knowing the sequence.

If the dread is the main thing, rather than the tooth, there is a guide on what you can ask for, and how to ask for it.

Before

The tooth and the area around it are examined, and an X-ray is usually taken to show the shape and length of the roots and their relationship to anything nearby.

The area is then numbed with local anaesthetic. This is the part worth understanding: anaesthetic removes pain, not pressure. You will feel firm pushing and movement during the extraction, and that is expected. What you should not feel is pain. If you do, say so — more anaesthetic can be given.

During

A tooth is not pulled so much as eased out. It sits in a socket of bone attached by fibres, and it is gradually loosened until those fibres release and it lifts free. For a straightforward tooth this takes a few minutes.

Where a tooth is broken down, heavily curved at the root, or impacted — wisdom teeth especially — a surgical approach may be needed. That can mean a small incision, or sectioning the tooth so it comes out in pieces rather than forcing it whole.

Immediately after

You will be asked to bite firmly on gauze for twenty to thirty minutes. That pressure is what lets a clot form in the socket, and the clot is the thing the entire recovery depends on.

Normal in the first day or two:

  • Mild soreness as the anaesthetic wears off
  • Some swelling
  • Light oozing for a few hours

The aftercare, and why it is what it is

Nearly every instruction exists to protect that clot. Lose it and the bone is left exposed — dry socket, a severe, radiating ache that usually begins around day three, and the commonest reason pain gets worse rather than better after an extraction.

For the first 24 hours, do not:

  • Rinse, swill or spit forcefully
  • Drink through a straw
  • Smoke or vape — smoking makes a painful socket considerably more likely, and slows healing
  • Drink alcohol
  • Do anything strenuous

Do:

  • Rest for the remainder of the day
  • Take pain relief as advised. Paracetamol first — and if you take a blood thinner (warfarin, apixaban, rivaroxaban, edoxaban, clopidogrel, or aspirin a doctor put you on, and also dabigatran, ticagrelor, prasugrel or dipyridamole), take paracetamol and not any anti-inflammatory painkiller — ibuprofen, aspirin, naproxen, diclofenac, or anything containing them — because they add to the bleeding. If your medicine is not on that list and you are not sure which kind it is, ask a pharmacist. If you are not on one, ibuprofen is an option if it suits you
  • Do not stop your blood thinner on your own. Keep taking it as prescribed unless the dentist, or the doctor who prescribed it, tells you otherwise. Most extractions are done without stopping it at all, and stopping it carries a risk of its own. Tell the practice which one you take when you book
  • Eat soft food — yoghurt, soup, mashed potato — and keep it lukewarm
  • Keep brushing your other teeth normally, going gently near the site
  • From the day after, rinse gently with warm salt water a few times a day

If it bleeds again

A socket that starts bleeding again in the first day is common and is almost always settled at home. The technique matters more than anything you could buy:

  1. Roll a clean damp handkerchief or a piece of gauze into a firm pad — damp, not dry. A dry pad sticks to the clot and pulls it off when you take it out.
  2. Put it directly over the socket, not between your teeth beside it, and bite down firmly.
  3. Twenty minutes, by the clock. Sit up, and do not lift it to look. Most failures are people checking at five minutes.

If it is still bleeding after a full twenty minutes, do it once more with a fresh pad. If that does not settle it, ring someone — see below.

If you take a blood thinner, press for a full thirty minutes rather than twenty — that is what SDCEP's advice for these medicines says — and do not wait for a second round. Ring after the first one, keep the pressure on while you do it, and tell whoever you speak to which blood thinner you take.

When to get in touch

Healing

Most people feel broadly normal within a few days. The gum closes over in around two to three weeks, and the bone underneath continues to fill in quietly for several months after that.

Almost every aftercare rule is protecting one small blood clot. Once you know that, the list stops being arbitrary and starts being obvious.

Read next