Oral surgery - The tooth extraction procedure.

What takes place when you have a tooth pulled?

This page contains an outline of the individual steps that a dentist uses when they extract a tooth for a patient. This includes: numbing up the tooth, removing the tooth, and providing post-operative instructions.

Where applicable, within the description of each of these steps we also explain some of the routine sounds and sensations (both pain and non-pain related) that the patient has the potential to experience.

Your cooperation makes it more likely your extraction will be uneventful.

If you have apprehensions about having your tooth pulled, take note of the descriptions we provide. You'll be more likely to experience a quick, uneventful extraction if you, the patient, contribute toward it. The contribution you need to offer is cooperation.

Patients who flinch, squirm, and moan at every routine, non-issue sound and sensation are simply making the extraction procedure more difficult and prolonged.

Be intelligent. Take the time to learn what is routine and expected during a tooth extraction and what isn't (and therefore needs to be brought to the attention of your dentist). Doing so will help to insure that having your tooth pulled will go as quickly and smoothly as possible.

A) Your dentist will "numb" your tooth.

Before the tooth extraction process is begun, your dentist will of course need to anesthetize ("numb up") both the tooth that will be extracted and the bone and gum tissue that surround it.

At this point in time, there is still no way for a dentist to predictably administer a local anesthetic (Novocaine or, more likely, Lidocaine) except as an injection (a "shot").

We'll admit that getting a shot can hurt a bit. But we'll also absolutely state that they certainly don't always. Actually, we've got quite a lot to say about why shots do and don't hurt. You can find our rant here: Will my dental injection hurt?

B) The extraction process - What to expect.

Here's the overall game plan.

The plan for any extraction is simply this. The root portion of a tooth is firmly encased in bone (its socket). And tightly bound within this socket by a ligament.

During the extraction process, the dentist needs to both "expand the socket" (widen and enlarge it) and separate the tooth from its ligament, to the point where the tooth is loose and free to come out.

What does it mean to "expand" the tooth's socket?

The bone tissue of the jaw is compressible to some degree. That means, if a dentist can apply firm pressure to a tooth (forcing it against one of the sides of its socket), the bone in that area will become compressed. The net result is that the socket becomes slightly enlarged ("expanded").

And after repeated application of pressure to a tooth, from many different directions, the entire socket becomes larger. (The ligament that holds the tooth in place will become detached from the tooth too.) Finally, at some point, enough space will have been created (and the ligament separated from the tooth enough) that the tooth will come out.

Here's the tools that your dentist will use.

Dentists have a variety of instruments that they use to manipulate and apply pressure to teeth. Some of them are specialized pliers termed "extraction forceps." Dentists also use levers that are called "elevators" (they look somewhat similar to small screwdrivers).

A dentist will usually use an elevator first. These tools are intended to be wedged between the tooth and the bone surrounding it. The force the dentist applies to the elevator in turn places pressure on the tooth. This action on the tooth helps to expand its socket and separate it from its ligament. It's somewhat common that a tooth can be extracted with just the use of an elevator.

Understanding the dentist's use of extraction forceps is more straightforward. The dentist will grasp the tooth with the forceps and then firmly and deliberately rock the tooth back and forth. They will also rotate the tooth as much as it will. The combination of these tooth movements expands the tooth's socket and separates its ligament.
[ For more information about how extraction instruments are used, see our page: Oral surgery principles. ]

You should feel pressure during the extraction process but not pain.

You absolutely will feel the sensation of pressure while you're having your tooth pulled. But don't confuse this with pain (or the precursor to feeling pain). Here's why.

The reason you will feel pressure during the tooth extraction process is because our bodies have different types of nerve fibers, each of which carry different types of sensations. And each of these different types of nerve fibers have different physical characteristics.

Due to these differences, the local anesthetic (Novocaine or, more likely, Lidocaine) that a dentist uses to "numb up" a tooth is very effective at inhibiting the function of nerve fibers that transmit pain sensations, but it doesn't have as great an effect on the nerves that transmit pressure sensations.

So, expect to feel pressure during the tooth extraction process, even a whole lot of pressure, but don't assume that this indicates that you will soon be feeling pain because it doesn't. If you do find you feel pain (discomfort that has a sharpness to it) during the extraction process, you should let your dentist know so they can "numb you up" some more. But more anesthetic will not have an affect on the pressure sensation you are experiencing.

You might hear some extraction noises.

While your tooth is being pulled, you may notice some of the noises associated with the extraction process. As an example, patients are sometimes concerned that they have heard a snap or breaking noise. In most cases the event that has produced this type of sound is just a minor issue.
[ Related page: Tooth extraction sounds: Snaps, breaks. ]

Surgical tooth extractions.

In some instances, your dentist may find that they need to incorporate a "surgical" component to the extraction process.
[ For more information see our page: Surgical Tooth Extractions. ]

» Gum and bone tissue removal.

Gum and/or bone tissue may cover over or surround a tooth in a manner that makes it difficult for the dentist to view and/or access it. If so, the dentist will need to reflect back or remove this tissue.
[ For more information see our page: Creating a gum tissue flap for oral surgery.. ]

» Sectioning a tooth during an extraction.

Sometimes a tooth is so firmly anchored in its socket, or else the tooth's roots are so curved, that the dentist can't get the tooth's socket expanded enough that it will come out. In this type of situation, one of a dentist's tricks is to cut the tooth into pieces and then remove each portion individually.

Don't be alarmed if your dentist tells you that this technique is required. Sectioning teeth is very commonplace and can significantly reduce the amount of time and effort needed to remove a tooth.
[ For more information see our page: Tooth Sectioning. ]

C) Closing your surgical site. / Post-operative instructions.

Once your tooth has been removed, your dentist will begin the process of closing your extraction site. This may include:

• Removing pathologic/infected tissue by scraping ("curetting") the walls of the tooth socket.
• Rounding off sharp bone edges.
• Using finger pressure to re-compress the "expanded" socket.
• Testing for tooth socket/sinus complications.
• Wash out ("irrigating") the socket, so to remove any bone and tooth fragments that have been left behind.
• Anchoring loose tissues or gum tissue flaps using stitches.
• Placing folded gauze over the extraction site and then asking you to bite down on it so to create firm pressure.

Your dentist will then provide you with a list of post-operative instructions to follow.