Tooth Extraction

A tooth extraction means removing a tooth from its socket because it is too damaged to save or is causing problems in the mouth. In dentistry it is the last resort: treating a tooth and keeping it is usually less trouble than taking it out and replacing it, and it costs you less bone. So our first question is not "how do we take it out?" but "does it really need to come out?"

This page sets out the general picture: how the decision is made, how a simple extraction goes, the days afterwards and the gap left behind. Removing teeth with broken or curved roots, or teeth buried in the bone, is a different job; we cover those on their own pages.

When does a tooth really need to come out?

How much it hurts does not decide the matter on its own. A very painful tooth can often be saved, while a tooth with no symptoms at all sometimes has to go. We decide after an examination and X-ray, by looking at these questions:

• Has decay or a fracture reached below the bone? If there is not enough sound tooth left to hold a filling or crown, any restoration has nothing to hold on to.
• Is there a vertical crack in the root? A tooth whose root has split along its length usually cannot be treated.
• What state is the supporting bone in? If advanced gum disease has destroyed most of the bone support and the tooth is clearly loose, treatment only postpones losing it.
• Is the tooth in the way of other treatment? Making space for orthodontic treatment, or removing a wisdom tooth that keeps getting inflamed, is a planned decision.

Could a root canal save it?

An inflamed nerve inside the tooth, or an abscess at the tip of the root, is not on its own a reason to extract. Root canal treatment cleans out the inflamed tissue and keeps the tooth in your mouth; it usually needs a crown on top afterwards. With mild to moderate gum disease, too, gum treatment is tried first.

Sometimes we meet a borderline case: root canal treatment, a post and a crown are all possible, but so little tooth is left that it is quite likely to fracture within a few years. With a tooth like this we explain both paths — trying to save it, and the options after extraction — with their pros and cons. The decision is yours; our job is to make sure you have the whole picture.

How a simple extraction goes

First, always tell us about any medicines you take. Blood thinners, some medicines for osteoporosis (such as bisphosphonates), uncontrolled diabetes and heart valve problems all change the plan. Do not stop a blood thinner on your own; if it needs adjusting, we decide together with the doctor who prescribed it.

1. X-ray. Shows how many roots there are, their shape and how close they lie to nearby structures.
2. Local anaesthetic. You usually feel no pain during the procedure; a sensation of pressure and pushing is normal.
3. Loosening and removal. The socket is gently widened with fine instruments, and the tooth is loosened and lifted out.
4. Checking the socket. We make sure no fragment of root is left behind and place gauze for you to bite on.

Removing a visible tooth with straight roots usually takes less than half an hour, anaesthetic included. If the tooth breaks or the roots are curved, the procedure becomes a surgical extraction; we can usually see this on the X-ray beforehand and tell you from the start.

The first few days after an extraction

The blood clot that forms in the socket is the foundation of healing. Almost every rule is there to protect it:

• Bite firmly on the gauze for 30–45 minutes. Slightly pink saliva on the first day is normal.
• For the first 24 hours, do not rinse your mouth, spit or drink through a straw.
• Stop smoking for at least 48–72 hours; a longer break helps healing even more.
• Do not eat until the numbness has worn off, or you may bite your cheek. On the first day choose lukewarm, soft food.
• On the first day, hold something cold against the outside of your face, on and off; keep your head slightly raised when you lie down.
• From the next day, rinse gently with warm salt water after meals; brush your other teeth as usual.
• Do not take aspirin-containing painkillers, as they can increase bleeding. If you take low-dose aspirin prescribed for your heart or circulation, though, do not stop it on your own.

After a simple extraction, tenderness usually eases within a day or two. If after the third day the pain is getting worse instead of better, radiates to your ear and comes with a bad taste in your mouth, the clot may have been lost too early (dry socket); see a dentist — us, or the nearest one if you are no longer in İzmir. Fever, swelling spreading across the face or neck, or difficulty swallowing or breathing are not things to wait out: contact your dentist or go to the nearest emergency department straight away.

What happens to the gap?

This should be discussed before the extraction. If the space left by a tooth you chew with stays empty, over time the neighbouring teeth tilt into it, the tooth opposite in the other jaw over-erupts and the bone thins. Bone loss is fastest in the first few months.

If you are considering a dental implant, placing a bone graft in the socket at the same appointment as the extraction can reduce bone loss later. In some suitable cases the implant can be placed on the day of the extraction; in most, two to three months of healing come first.

Which kind of extraction sounds like yours?

Not every extraction is the same; the page closest to your situation will give you a clearer idea:

• The tooth is broken, the root is curved, or a root was left behind after an earlier extraction: surgical tooth extraction.
• A wisdom tooth at the back that is only half through, keeps getting inflamed or is lying on its side: wisdom tooth removal.
• A canine that never came through, or another tooth stuck in the bone: impacted tooth surgery.

What the cost depends on

The deciding factors are whether the extraction is simple or surgical, whether a 3D (CBCT) scan is needed and whether a bone graft is placed at the same appointment. At our clinic in Bayraklı, İzmir, you receive a written, itemised quote after the examination and X-ray. Insurance cover for extractions varies, so check with your own insurer if you plan to claim.