Will a dentist pull your tooth on the first visit?

If you have a tooth that’s been bothering you and you’re eager to see it go, you may wonder, once you have your appointment scheduled, will (or can) your dentist pull your tooth on your initial visit, or will it have to wait until a second one?

What decides if your dentist can pull your tooth immediately or not?

This page explains various issues that your dentist must consider when making their decision about offering a same-day extraction for a patient. They include:

• Factors dictated by your tooth. – Your tooth’s current status (infection, severely decayed or broken, etc…), the expected level of difficulty of your extraction procedure, oral surgeon vs. general dentist considerations.
• Considerations with providing your treatment. – Managing your special needs. Best choices for addressing all of your dental issues.
• Medical conditions and health concerns that may prevent your dentist from pulling your tooth on your first visit.
• Medicines you take that may prohibit having a same-day extraction.

1) Tooth-related issues that may prevent your having a same-day extraction.

a) Your tooth’s health status.

A severely decayed bicuspid that shows signs of associated infection. The tooth is relatively asymptomatic and has no associated swelling.

Low-grade infections like these pose no obstacle to extracting the tooth.

• Usually, but not always, the presence of infection does not constitute a reason why your dentist can’t go ahead and pull your tooth during your first appointment.
• But even in cases where it does, you still require their attention (the link above explains). So, don’t let this condition keep you from seeking an appointment or keeping it.

b) Case difficulty.

Even though you’ve been scheduled with your dentist, it won’t be until they’ve had a chance to actually examine your tooth that they’ll know precisely what dental services you’ll need.

• If you’re an established patient, your chart may contain suitable x-rays of your tooth from previous appointments that can give them an idea beforehand of what’s up. Possibly you’ve even had a prior discussion with your dentist about having the tooth out.
• Of course, if you’re a new patient, the dentist will be completely in the dark about your case specifics until they have had an opportunity to examine you.

Unexpected findings.

It may be that after completing their examination they will conclude that the level of treatment you require lies beyond what’s routine.

Scenario #1.

Possibly your dentist will find that your tooth is so deteriorated (broken, decayed, etc…) that it requires Surgical Extraction. If so, the amount of time that’s been set aside for your appointment may not be long enough for them to perform this procedure. And if not, your extraction will need to be rescheduled.

Scenario #2.

Or, your dentist may find that the level of expertise that’s needed to remove your tooth simply lies beyond what they can offer, and therefore your case is better handled by an oral surgeon. If so, a referral will need to be made.

FYI: This page explains how the level of Extraction difficulty of wisdom teeth can vary widely, from astoundingly easy to extremely complex. And, of course, a dentist won’t know where within this range their patient’s case lies until they have had an opportunity to examine them.

So, due to unknown issues such as this and the associated constraints they may pose, going ahead and removing your tooth during your initial visit simply may not be something that your dentist can offer.

2) Issues associated with treatment planning your case.

During your examination, your dentist may determine that your extraction procedure can be handled more beneficially for you if it’s rescheduled for a later date. Here are some examples of why.

Scenario #1.

A simple example is when the dentist’s examination identifies nearby teeth that need to be removed too. If so, rather than having two or more separate extraction appointments, it may make more sense to make plans for a single one where all of the teeth can be removed in one sitting.

After all, the postoperative Healing Timeline that takes place after having multiple teeth extracted is similar in duration as to when just having one pulled. So why spend more time recuperating than is necessary?

Example #2.

Another factor that may prevent having your tooth pulled during your initial visit is your desire for some type of Conscious Sedation with your procedure. Some methods require advance planning (our link explains) that will likely make having a same-day extraction impossible.

More so than with conditions related to your tooth or its extraction procedure, health-related issues (health history, medications taken) are probably more likely to create factors that make it impossible for your dentist to offer to remove your tooth during your first appointed visit.

3) Medical conditions and health concerns that may prevent having a same-day extraction.

Before they can even consider pulling your tooth, your dentist will first need to collect and evaluate your relevant medical information. Doing so is vital in helping to avoid complications from developing during your procedure or the healing process that follows.

There’s a wide range of medical conditions that may pose a risk or present a complication with having oral surgery. They include:

• Cardiovascular disease.
• Heart anomalies.
• Congestive heart failure.
• High blood pressure.
• Bleeding disorders.
• Hematological conditions.
• Liver disease.
• Hyperthyroidism.
• Renal disease.
• Adrenal insufficiency.
• Radiation treatments.
• Tuberculosis.
• Epilepsy.
• Diabetes mellitus.
• Previous problems with extractions.

FYI: We expand on the list above and provide details about its individual conditions on our page: Medical issues of concern with tooth extractions.

Different conditions will be managed in different ways.

Only your dentist can determine what factors associated with your medical condition pose a barrier to performing your extraction on the day of your appointment, and how they must be managed. Here are some examples:

• With some conditions, it’s customary that the patient’s medical doctor is consulted and their consent is granted before proceeding with their surgical treatment.

  If this permission can be obtained immediately (like by phone), then proceeding with the extraction during the person’s originally scheduled dental visit may be possible.

• If a patient’s medical condition is considered “controlled” it may be possible for their dentist to go ahead and perform their tooth extraction on their first visit.

  However, and like above, a need to confirm this fact with the patient’s medical doctor may cause some delay or cause reason to reschedule the extraction, especially if testing is needed to establish the patient’s current status.

• Having some medical conditions may dictate that some type of preoperative protocol needs to be followed so complications during the patient’s procedure or the healing process that follows are kept to a minimum.

  This may mean taking pretreatment medication or adhering to a specific preop routine (like dietary, rest, or appointment time of day restrictions). And if so, allowing for these arrangements may make it impossible for your dentist to remove your tooth at the time of your first scheduled appointment.

• With yet other medical conditions, a certain amount of time may need to have elapsed since your latest episode/event before conditions are considered safe enough for your extraction to be performed.

  With these types of situations, your extraction may need to be delayed for some days, weeks, or possibly even months, depending on the specific nature of your condition.

▲ Section references – Fragiskos, Hupp

4) Medicines that may prevent having a same-day extraction.

Like medical conditions, the medications you take may be the hitch that prevents your dentist from being able to perform your extraction the same day as your initial appointment. Compounds of concern can include prescription, over-the-counter, supplemental, and even herbal items.

In some cases, a history of having taken the compound may not necessarily preclude your still having your tooth pulled during your initial visit. However, the time that’s needed to arrive at this conclusion (like contacting and consulting with your physician) may make rescheduling the only choice that allows your dentist’s office to maintain their appointment schedule.

Medications and supplements that may necessitate delaying your extraction.

The list of compounds of concern of course includes blood thinners. Both those taken specifically for this purpose or those that interfere with the clotting process as a side effect. Unfortunately, this class of items includes a wide range of commonly used OTC medications, herbal compounds, and dietary supplements. So, their interference with having a same-day extraction isn’t entirely uncommon.

Other types of compounds will also be of interest to your dentist. For example, a history of taking bisphosphonates (used to treat bone diseases), systemic corticosteroids, immunosuppressive drugs, and cancer chemotherapeutic agents may all cause your dentist to pause in offering to perform your extraction procedure at the time of your first visit.

FYI – We expand on the above list of drugs and provide more detailed explanations about them on our page: Medications of concern with tooth extractions.