How soon can a problem tooth be removed?

If you have a tooth that’s been bothering you and you’re eager to have it out, you might find yourself asking: Once your appointment is scheduled, can your dentist extract the tooth during your initial visit, or will the procedure need to wait for a follow-up appointment?

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

Your dentist will have a checklist of factors that they’ll run through their mind when making their determination. Issues that they must evaluate and consider include:

• Factors dictated by your tooth and its condition. – Is the tooth infected, severely decayed or broken, etc…? / What’s the expected level of difficulty of the extraction procedure? Is a referral to an oral surgeon needed?
• Considerations with providing your treatment. – How is your case best treatment planned? / Do you have special needs that must be managed?
• Medical conditions and health concerns that may prevent your dentist from pulling your tooth on your first visit.
• Medicines you take or have recently taken that may prohibit performing a same-day extraction.

This guide explores each of these areas of concern. Understanding them will help you set realistic expectations for your appointment and learn about key factors that may keep you from having a same-day extraction— and how to avoid them.

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

a) Your tooth’s health status may necessitate a delay.

For the most part, there are relatively few complications associated with the current health status of a tooth that will prevent a dentist from going ahead and pulling it during the patient’s initial visit.

What about infection?

One concern that patients often have is the issue of infected teeth. We now cover this subject in detail on a separate page: Common guidelines about pulling infected teeth. Jump

However, in short …

• Usually the presence of infection does not constitute a reason why your dentist can’t go ahead and pull your tooth during your first appointment. These cases can generally be characterized as situations where the infection is localized, not spreading, and the patient is otherwise healthy.
• But even in situations where these limitations are not met, keep in mind that you/your tooth still require the attention of your dentist (the link above explains why and what they’ll do). So, don’t let your apprehensions keep you from making an appointment and keeping it.

Case examples where infection is present but an extraction can usually be performed.

• Symptoms: Swelling and tenderness near one tooth. A small gum boil that leaks pus is present near the tooth.
• Symptoms: Toothache, localized gum swelling, sensitivity to chewing, but no fever, no facial swelling, no difficulty opening the mouth.
• Symptoms: Pain on biting, tenderness when tapping on the tooth. Clear evidence of tooth infection on X-ray (see image below) but only minor localized swelling (as in preceding example).

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.

b) Your case’s level of difficulty may necessitate rescheduling.

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.
• 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 your tooth and take needed X-rays.

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.

Case examples where your tooth extraction can’t be performed during the same appointment.

Scenario #1

Your dentist may determine that your tooth 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.

Your dentist may determine that the level of expertise that’s needed to remove your tooth lies beyond their abilities and therefore your case should be handled by an oral surgeon. If so, a referral and its associated delay will be required.

What tooth factors might necessitate this kind of delay?

• The tooth may have experienced changes that complicate the extraction process. This includes teeth that have fractured or broken, have extensive decay, or are weakened as a result of root canal treatment.
• The tooth’s anatomy itself may pose challenges for the extraction process. This includes teeth that have long or curved roots, roots that lie in close proximity to nerves or sinuses, partially erupted teeth, etc… This page provides a fuller explanation about how tooth characteristics can affect extraction difficulty.

For any of the above reasons, your dentist may feel that they cannot offer a same-day extraction and instead your case must be rescheduled, either with them or an oral surgeon.

2) Treatment planning considerations may make postponing your extraction more advantageous.

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.

Case examples where postponing your extraction may make the more favorable plan.

Example #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 healing timeline following multiple extractions is usually about the same as it is for just a single tooth. So why spend more time recovering than necessary?

Example #2.

A common 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.

Example #3.

For front-tooth extractions, your dentist can probably offer a plan where some type of artificial tooth is placed on same day your tooth is removed. Doing so may require preparation on their part, or simply more chairtime than you have been scheduled for. If so, your extraction will need to be delayed.

More so than with conditions related to your tooth or its extraction procedure, health-based issues (primarily your health history and medications taken) are 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 and the healing process that follows.

There’s a wide range of medical conditions that may pose risks for oral surgery. Some of them are:

• 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 each condition on our page: Medical issues of concern with tooth extractions. Jump

Different conditions will need to 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.

Case examples where medical complications necessitate delaying your extraction procedure.

• With many conditions, it’s necessary that the patient’s medical doctor is consulted and their consent is given 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.

• Some medical conditions dictate that some type of preoperative protocol must 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.

Examples of medications and supplements that may necessitate delaying your extraction.

Any listing of compounds of concern will of course include blood thinners. Both those taken specifically for this purpose or those that interfere with the clotting process as a side effect.

Unfortunately, this group 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.

Some final thoughts.

Whether your dentist can remove a problem tooth during your first appointment will depend on several factors — from the tooth’s condition and the complexity of its extraction, to your overall health and the medications you take.

In many cases, same-day extraction is possible. But sometimes rescheduling or referral is the safer and more predictable option. And hopefully you’ll understand, that always makes the best plan for you.