dos and don’ts of tooth extraction

After having your tooth removed, there are some important steps you need to follow for a smooth and speedy recovery. If aftercare is not followed properly, however, it can delay the healing process and cause further problems.

Dr Moira Wong, a leading orthodontist based in London, explains what you can expect during your tooth extraction procedure and offers some dental dos and don’ts to help your recovery.

When is a tooth extraction necessary in adults?

In adults, there are many reasons why tooth extraction may be necessary. While it’s common to have your wisdom teeth removed, tooth extraction to treat other problems is generally considered the last resort in the treatment ladder - so we need to consider what we can do to save the tooth first.

After diagnosis, if we find the problem is gum-related then a periodontist will be able to treat you. Likewise, if it’s a structural problem, such as tooth decay, then your general dentist can manage it with the use of fillings and an endodontist - who specialises in treatments such as root canal fillings - can help if the damage is deeper.

It is only when all these avenues been exhausted will we then explore extracting the tooth. It is the very last resort, simply because after extracting a tooth, the underlying bone begins to disintegrate, or ‘resorb’. Typically, in the first year after a tooth extraction, around 25% of bone is lost, and this bone loss continues causing possible structural problems in the future that may require additional treatment.

Aside from issues with your wisdom teeth, tooth extraction is only used when tooth decay, periodontal disease or dental trauma damages the structure of your tooth so much that it’s considered unrestorable.

What should you expect during the extraction?

You will either be under general anaesthetic or sedation (a state of being very relaxed but awake).

General anaesthetic is usually reserved for when you need to have your wisdom tooth removed, whereas you would typically go under sedation, or just have the area numbed if it is a simple procedure. It depends entirely on the difficulty of the extraction.

If you need to have general anaesthesia, you won’t be allowed to eat or drink beforehand. The procedure is usually a day case, so you will be able to go home the same day.

If you are sedated, you should bring someone with you to accompany you there and also to take you home, as you won’t be able to drive or travel alone. You should have someone with you for 24 hours following the procedure.

If you have local anaesthetic, you will be fully awake during the extraction and be able to leave straight after. You will be given a sterile pack to bite on and some instructions that you can take home, and you can expect it to take a couple of hours for the numbness to wear off. The recovery is generally very quick, and most people go back to work straight after.

Is tooth extraction painful?

This depends entirely on why the tooth is being extracted, however, if it’s done well, the procedure should be painless.

You shouldn’t need painkillers afterwards; if you do have pain then you should come back in. There is also a small risk of developing an infection in the extraction site, which might cause some discomfort and pain, in which case, you will have to return to see your dentist who will need to treat it.

If you experience any pain post-extraction, you must inform your dentist.

What you should and shouldn't do after having a tooth removed

Do’s:

• Rest - take it easy over the next couple of days. You may feel fine to carry on as normal, but it’s important to rest and not overdo it after having your tooth removed.
• Eat on the other side - eat on the other side of your mouth. It may seem obvious but it’s important not to disturb the wound in your gum to allow it to heal. Eat soft foods - soft foods, such as soup, smoothies and yoghurt, are fine to eat. You should do this until the local anaesthetic wears off and you feel ok to eat harder foods.
• Apply ice - if there is some swelling, you can apply a cold pack to reduce it. Swelling may not appear straight away but can continue for a few days.
• Keep it clean - gargling salt mouthwash is an excellent and safe way to keep the wound clean and prevent infections. Try to do this at least once a day. Gargling too much or for too long though may dislodge the healing tissue, so be careful.
• Brush your teeth - brushing your teeth as normal is important, but try to brush the teeth carefully around the wound site as well to not let bacteria build up and cause an infection.

Dont’s:

• Don’t consume hot foods or liquids - hot foods can dislodge the healing tissue over the extraction sockets and lead to excessive bleeding. If you have had your mouth numbed, you also risk burning your lip or tongue without realising. Therefore, hot food and beverages should be avoided for at least 48 hours.
• Don’t smoke - smoking can lead to hypoxia, where your tissues don’t receive enough oxygen to heal properly, which can lead to infection in the gums and bone.
• Don’t exercise - this is important and should be avoided for at least 48 hours. High levels of activity increase your blood pressure, affecting the clot and leading to excessive bleeding from the extraction site. Once excessive bleeding starts, it can be difficult to stop it. You should avoid anything that involves increasing your activity levels, such as dancing, partying, high levels of physical work, etc.
• Don’t take aspirin - aspirin acts as a blood thinner, so if you take this it will cause a delay in clot formation and prevent healing.
• Don’t poke the gap - it may feel strange for a few days to have a gap and a small hole in between your teeth, but try your best not to poke it with your finger or touch it with your tongue. It will disrupt the clot formation and delay the healing process.

How long does it take to completely heal?

In a fit and healthy person, your wound should in 7-10 days - that is, if you follow the guidelines above and don’t interrupt the healing process. If there’s an infection or excessive bleeding, then the healing time will be prolonged.

After you leave the practice, we will give you a sterile pack to bite on and some instructions that you can take home. You shouldn’t need painkillers, if you have pain then you should come back in.

Dr Moira Wong is a leading orthodontist based in London with extensive experience in dentistry. During the COVID-19 pandemic, if you need her assistance for any dental problems or concerns, she is available via e-Consultation. Visit her profile and book an appointment.