Introduction

Tooth extraction involves having one or more teeth completely removed from your mouth by a dentist. This can be carried out at one appointment or over a few sessions. Depending on the reason, you may or may not need to have the teeth replaced. Your dentist will be able to advise you about what this will involve.

Why have a tooth removed?

There are a number of ways in which your teeth can be damaged resulting in the need for an extraction. Some of the most common include:

• having bad gum disease (periodontal disease) - if bacteria build up on your teeth, they will start to damage the ligaments and bone that hold them in place and a tooth may become loose
• having a decayed tooth - if the decay is very advanced, it can cause the nerve and blood vessels (tooth pulp) to become infected and eventually this may lead to a painful abscess
• breaking a tooth
• having crowding - if you have a small jaw or lost your milk (baby) teeth early, causing your second teeth to come through before your mouth had grown big enough - this means your teeth may be crooked and you may need to have one or more removed so the rest can be straightened
• not having enough space in your mouth for your wisdom teeth - they may become impacted (stuck behind the tooth in front) and need to be removed

What are the alternatives?

If you don't wish to have your tooth taken out, sometimes alternative treatments are available. Taking painkillers or antibiotics may ease any pain and swelling, but these will just relieve your symptoms in the short term and won't get rid of the underlying problem.

If you have crooked teeth, it's sometimes possible to have them corrected without having any removed. An orthodontist (a dentist who specialises in straightening teeth) will be able to give you information about fitting appliances such as braces to do this.

If an infected tooth is identified early enough, you may be able to have root canal treatment instead of having the whole tooth removed.

What is involved?

Your dentist will ask about your dental and medical history. It's important to tell him or her if you have any medical conditions, allergies or have recently had an operation. You should also tell your dentist if you use an inhaler or are taking any medication, including the contraceptive pill or over-the-counter medicines such as aspirin.

If you are particularly anxious about having treatment, your dentist may give you a sedative - this relieves anxiety and causes temporary relaxation without putting you to sleep. So that you don't feel any pain during the procedure, your dentist will give you an injection of anaesthetic. This will probably be a local anaesthetic injected into your mouth, which completely blocks feeling from the area. You will stay awake during the procedure. The General Dental Council advises that in certain situations, people may need to go into hospital and have treatment under general anaesthetic. If you have a general anaesthetic, this means you will be asleep and feel no pain while your tooth is being removed.

After the anaesthetic has taken effect, your dentist will widen the socket (the area your tooth sits in) using a tool called an elevator or a pair of special forceps to loosen the tooth. Your dentist will then hold the tooth's root and move it gently from side to side until it can be removed completely.

During the procedure you will feel some pressure in your mouth and hear some noise. You should not feel any pain.

There will be some bleeding and your dentist may put in stitches. After the extraction, you will be given a piece of soft padding to bite on to stop the bleeding.

In certain cases, your dentist may not be able to reach the root of your tooth so he or she will make small cuts in your gum. If necessary he or she can then drill away some of the bone so the tooth root can be removed. If the root isn't completely removed, it could cause an infection and possibly an abscess. However, it's sometimes better to leave a small piece of root where it is if it's difficult to remove.

After the procedure

If you have had your tooth removed under local anaesthesia, you will need to stay at the dental surgery until the bleeding is controlled, probably about 10 to 15 minutes. Afterwards, the best thing is to go home and relax for the rest of the day. The effects of any sedative may last longer than you expect. Both sedation and general anaesthesia can temporarily affect your coordination and reasoning skills. Don't drive, drink alcohol, operate machinery or sign legal documents until your dentist tells you it's safe. This will be at least 24 hours after your procedure if you had sedation and 48 hours for general anaesthesia. If you are in any doubt about driving, please contact your motor insurer so you are aware of their recommendations, and always follow your dentist's advice.

You may have some discomfort and swelling for a few days afterwards, and your jaw may feel a little stiff. Over-the-counter painkillers, for example paracetamol, should be enough to relieve this. However, it's important that you don't take aspirin as this thins your blood and may cause more bleeding from the wound. Always follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice.

Wait until the anaesthetic has worn off before having hot food or drinks - you might burn your mouth or chew the inside of your cheek while it's still numb. Once you regain some feeling, stick to lukewarm, soft food and try not to chew in the part of your mouth where the tooth has been removed. It's important not to drink alcohol or smoke for at least 24 hours after the extraction - this may cause further bleeding.

It's best not to rinse out your mouth for the first 24 hours after the extraction. This is because any blood clot that may have formed could be disturbed and the bleeding could start again. It could also lead to an infection and this will mean it takes longer to heal. After the first day, it can be helpful to rinse out your mouth with salt water (one teaspoon of salt in a glass of warm water) three or four times a day.

It's important to keep your mouth as clean as possible so continue brushing your teeth after the extraction.

You may notice some slight bleeding for the first couple of days after having a tooth removed. This is normal and rather than rinsing out your mouth, try to stop it by biting down on a clean pad of material such as a handkerchief. If the bleeding doesn't stop within a couple of hours, contact your dentist.

If you had stitches during the procedure, you may need to go back to your dentist to have them removed. Otherwise you probably won't need a follow-up appointment.

Deciding on treatment

Tooth extraction is a minor surgical procedure. Therefore, as with all surgery, it can have risks and you may have problems afterwards. Contact your dentist immediately if you experience:

• prolonged bleeding
• swelling
• severe pain
• high temperature (fever)

These may be the sign of an infection or other complication.

One of the most common problems that can occur after tooth extraction is a dry socket. This is when there is no blood clot and the tooth socket is slow to heal. It may become infected. This usually happens very soon after the extraction and can be extremely painful. Go back to your dentist who will rinse the area, put a dressing on it and may give you antibiotics. Dry socket is more common if you are taking the contraceptive pill or if you smoke.