Oral surgery
Tooth extraction: what to expect and aftercare
A tooth too damaged to be repaired, an infection that keeps coming back, a baby tooth that will not fall out: having a tooth taken out (a tooth extraction, or having a tooth "pulled") is a common procedure. This guide explains when it is needed, what happens on the day, aftercare, what is normal while it heals and which signs, including dry socket, mean you should call back. It is based on published reviews and guidelines. It is here to inform you; it does not replace an examination. Wisdom teeth have their own particularities: see the wisdom teeth guide.
When does a tooth need to come out?
An extraction is usually suggested when the tooth cannot be kept in good condition:
- very deep decay that has destroyed the tooth down below the gum, or a split root (see tooth decay);
- an infection that cannot be treated while keeping the tooth;
- a very loose tooth caused by advanced gum disease (see gum disease);
- a lack of space, as part of a brace treatment planned in advance (see braces);
- a baby tooth that will not fall out and is in the way of the adult tooth.
Can the tooth be saved instead?
A painful tooth does not always have to come out (see toothache). The dentist examines it, often with an X-ray, and explains the options:
- decay, even a large cavity, can often be treated with a filling;
- decay that has reached the nerve, or an abscess at the tip of the root, can often be treated with root canal treatment;
- a weakened tooth can then be protected with a crown (see crowns, bridges and dentures).
Keeping your own tooth means you do not have to replace it, but sometimes an extraction is the most sensible option: the decision is made with you. The cost depends on the tooth and on the option chosen; it is explained before any decision.
Before the extraction: what to tell your dentist
Tell your dentist about all your illnesses and all your medicines, especially if:
- you take a blood-thinning medicine. Never stop it on your own: a Cochrane review points out that it is preferably continued at the same dose, because reducing or stopping it increases the risk of a clot, and that measures taken on the wound can allow this (Engelen et al., 2018, PubMed). Your dentist decides with your doctor;
- you have diabetes, which can slow healing if poorly controlled;
- you are pregnant or breastfeeding;
- you have had a treatment for your bones (osteoporosis, some cancers) or radiotherapy to the head and neck;
- you have a heart or blood condition, or an allergy to a medicine.
Eat normally before you come, unless told otherwise. If you smoke, this is the moment to stop or cut down (see dry socket below).
What happens during a tooth extraction?
- Local anaesthetic: the dentist numbs the area with an injection in the gum. You stay awake.
- Removing the tooth: the tooth is loosened from the bone and then taken out. You usually feel pressure, not pain; if it hurts, say so: more anaesthetic can be given.
- A surgical extraction, when the tooth is harder to remove (badly broken, curved roots): the dentist may open the gum a little or divide the tooth into pieces, then place a few stitches.
- At the end: a gauze pad is placed on the wound and you are given your aftercare instructions.
The numbness lasts a few hours: avoid chewing on that side and hot drinks, because you can bite your lip or burn yourself without feeling it.
A blood clot then forms in the socket (the hole left by the tooth). It protects the bone and allows healing: most aftercare instructions are there to keep it in place.
Tooth extraction aftercare
In a trial of 150 healthy patients, healing was uneventful in 86%; complications were linked to not following the instructions, and antibiotics given routinely did not bring any significant benefit (Gbotolorun et al., 2016, PubMed).
| When | What to do |
|---|---|
| Straight after | Bite firmly on the gauze for the time you are told, without changing it all the time |
| On the first day | Do not spit, do not rinse hard, do not touch the socket with your tongue, do not drink through a straw |
| On the first day | Something cold on your cheek, on the outside, for short periods |
| The first few days | Do not smoke; avoid alcohol and heavy exercise |
| The first few days | Eat soft, lukewarm or cold food, on the other side; avoid very hot, spicy or crunchy food and seeds |
| From the evening | Brush your teeth, gently near the wound |
| At night | Sleep with your head slightly raised |
| From the next day | If your dentist advises it, gentle rinses with warm salty water |
A trial of 120 patients found fewer cases of dry socket with warm salt-water rinses started 24 hours after the extraction (Osunde et al., 2013, PubMed); it is a single study. Only take medicines advised by your dentist, your doctor or your pharmacist.
Tooth extraction healing: what is normal
| Recovery timeline | What is normal |
|---|---|
| The first hours | Numbness wearing off, light bleeding or pink saliva, sometimes until the next day |
| Day 1 | The most pain, which then eases day after day |
| Days 2 to 3 | Swelling of the gum or cheek at its peak, then going down |
| The first week | A whitish layer on the socket: usually healing tissue, not pus |
| A few weeks | The gum closes over the socket |
| Several months | The bone reshapes underneath |
A difficult or surgical extraction takes longer to heal. A review measured, six months after an extraction, a loss of 29 to 63% of the width of the bone and 11 to 22% of its height, mostly during the first 3 to 6 months (Tan et al., 2012, PubMed).
Dry socket: the complication to know about
Dry socket happens when the blood clot does not form properly or is lost: the bone is left exposed. A Cochrane review describes it as severe pain that starts 2 to 3 days after the extraction, sometimes with bad breath, in a socket that is partly or completely empty (Daly et al., 2022, PubMed). The typical sign: the pain had eased, then it gets worse again around day 2 to 4, may spread to the ear, and is hard to relieve.
- How common: from 1 to 5% of routine extractions, and over 30% of surgically removed wisdom teeth, according to the same review.
- Smoking increases the risk: in a review of 11 studies, about 13.2% of smokers developed dry socket against 3.8% of non-smokers, a more than three-fold increase in the odds (Kuśnierek et al., 2022, PubMed).
- The instructions matter: an observational study of 201 patients linked not following the instructions with dry socket (Alsaleh et al., 2018, PubMed).
- Other factors described: a difficult extraction, a previous infection (Taberner-Vallverdú et al., 2017, PubMed), and the contraceptive pill (Bienek and Filliben, 2016, PubMed).
Dry socket is not dangerous, but it is very painful and cannot be treated at home: call your dentist, who will gently clean the socket and may place a dressing.
Infection and other warning signs: when to call back
Call your dentist soon if you have:
- bleeding that does not stop despite firm pressure on a clean gauze pad for half an hour;
- pain that gets worse instead of better, especially from day 2 or 3;
- swelling that increases after day 3, pus, or a bad taste that does not go away;
- a fever;
- a lip or chin that is still numb the next day.
Go to the emergency department straight away if you have difficulty breathing or swallowing, swelling that spreads quickly towards the eye or the neck, or heavy bleeding that will not stop, especially if you take a blood-thinning medicine.
Replacing the tooth after the extraction
A front tooth is almost always replaced. For a back tooth, the gap can, over time, let the neighbouring and opposite teeth move. The options are explained in the guides on dental implants and crowns, bridges and dentures. As the bone changes mostly in the first months, discuss replacement before or soon after the extraction.
Taking out a baby tooth
A very wobbly baby tooth usually falls out on its own: do not force it. The dentist removes it when it is badly decayed, infected or broken, or when it stays in place while the adult tooth is coming through. Afterwards, make sure your child does not bite their numb lip. If a baby molar is taken out early, a small appliance may be suggested to keep the space. For very anxious children, see dental treatment under general anaesthesia.
Booking an appointment
Consultations take place in Rabat, Monday to Friday from 9 am to 6 pm and on Saturday from 9 am to 2 pm; the address is given when you book. The easiest way is to send a WhatsApp message saying which tooth is bothering you, since when, and which medicines you take. See the appointment section. If you have an emergency sign, or outside these hours, go straight to the emergency department.
Frequently asked questions
Does a tooth extraction hurt, and how long does the pain last?
It is done under local anaesthetic; afterwards, the pain eases day after day; if it gets worse again around day 2 to 4, think of dry socket and call your dentist.
How long does it take to heal after a tooth extraction?
The gum usually closes within a few weeks, and the bone keeps reshaping for several months.
How do I stop the bleeding after a tooth extraction?
Bite firmly on a clean gauze pad, or a clean rolled-up handkerchief, for half an hour without checking it, keep your head raised and do not spit; if the bleeding is still heavy, call your dentist or go to the emergency department.
What can I eat after a tooth extraction, and when?
Wait until the numbness has worn off; then, for the first few days, eat soft, lukewarm or cold food (yoghurt, mashed food, lukewarm soup, eggs) on the other side, avoiding very hot, spicy or crunchy food and seeds, before gradually returning to your normal diet.
Can I drink coffee after a tooth extraction?
Avoid hot drinks, including coffee and tea, while your mouth is numb and on the first day; after that, let them cool down to lukewarm, do not use a straw, and do not swish the drink around the socket.
Can I smoke after a tooth extraction?
It is better not to smoke, at least for the first few days: smoking increases the risk of dry socket about three-fold; it is also a good opportunity to stop, with your doctor's help.
Is swelling after a tooth extraction normal?
Yes, moderate swelling is common in the first 2 to 3 days; if it increases after day 3, or comes with fever, pus or difficulty swallowing, see your dentist quickly.
What is the white stuff in my tooth extraction socket?
It is usually healing tissue, which is normal; if it comes with worsening pain, a bad taste, pus or fever, call your dentist, as it may be dry socket or an infection.
Can I have a tooth taken out while pregnant?
Yes: published guidelines agree that extractions and emergency dental treatment can be done at any time during pregnancy (Bao et al., 2022, PubMed); tell your dentist you are pregnant, and they will take the right precautions and choose any medicines with you.
Why are teeth sometimes taken out for braces?
When the teeth are very crowded or stick out a lot, the plan sometimes includes removing teeth to make space; this is decided after a full assessment and is not systematic.
Can I pull out a tooth myself at home?
No: an adult tooth pulled out at home can break, leave a root behind, bleed heavily or become infected; only a very wobbly baby tooth can come out on its own.