Can a dentist pull an infected tooth?

Extracting infected teeth.

What’s possible?

If you have a tooth that’s been bothering you, you may be eager to have it removed asap. But if it’s infected, and especially if swelling is present, you may wonder if that will cause a delay in having it extracted. This page can help you understand when that might be necessary.

Will a dentist pull an infected tooth?

Yes, dentists routinely do pull infected teeth. They do this all of the time.

That’s because they know that nothing will benefit you more (get you out of pain quicker and provide a quicker, more predictable resolution of your infection) than just going ahead and getting rid of the source of your problem, which is your tooth.

Note: The term “infected tooth” doesn’t necessarily equate with the phrase “swelling is present.”

A severely decayed bicuspid that shows signs of associated infection.

With this case, the patient was relatively asymptomatic.

Some teeth display more active symptoms.

Sometimes an infected tooth will start to cause some minimal level of swelling or pain may begin to become an issue.

▲ Section references – Isik

Will a dentist pull an infected tooth that has caused noticeable swelling?

Yes, even when visible swelling is present, going ahead and removing the infected tooth promptly is still the preferred plan.

▲ Section references – Johri

Of course, there are always considerations …

Just because tooth extraction, even in the presence of swelling, makes the preferred plan for infected teeth doesn’t mean that there aren’t issues that your dentist must consider on a case-by-case basis before offering to perform your procedure.

This includes factors associated with the tooth’s infection and the symptoms it creates. The patient’s health status is also of vital concern and can pose reasons to modify the treatment plan that’s utilized.

The remainder of this page discusses these types of factors. (With any examples given, it is assumed that the patient is a healthy individual that has an uncomplicated health history.)

What issues must be considered before extracting an infected tooth that has swelling?

Factors associated with swelling may cause concern or present an obstacle in removing an infected tooth immediately. As examples:

a) Swelling caused by infection may limit your dentist’s ability to access your tooth.

This is a simple enough reason to understand. It’s possible that the level of swelling stemming from an infected tooth makes it challenging or even impossible for the dentist to have the access or visibility they feel they must have to remove it. This can be especially true if the swelling restricts the patient’s ability to open as widely as usual.

With these types of cases, the swelling will need to be managed before the tooth can be extracted. (See below.)

b) Concerns about local anesthetic effectiveness.

Local anesthetics are the type of drugs dentists use to numb up teeth and oral tissues (by way of giving dental “shots”). And the chemistry of these compounds is such that they don’t work as effectively in swollen/inflamed tissues. Here’s why.

A well-defined area of swelling (pus accumulation).

If the swelling is just localized.

Isolated, well-defined areas of swelling may not pose much of an obstacle to numbing up your tooth and gums for your extraction. Your dentist just needs to come up with a way to numb up the applicable nerves at a point before they enter the affected tissues.

▲ Section references – Fragiskos

The presence of diffuse and/or extensive swelling can complicate this process. And if so, it may be that the patient’s infection must be managed (see below) before achieving adequate anesthesia is possible and their extraction process can be performed.

Proof that it’s usually possible to adequately numb up infected teeth.

While doing research for this page, we ran across a study by Martis (1975) that evaluated 1,376 tooth extractions performed in the presence of acute infection. 327 of these teeth (almost one-fourth) even had a coexisting “fascial space abscess” (as an example, the kind of tooth swelling that would be noticeable in a person’s face).

The paper’s “materials and methods” section, as more or less a side note, mentioned that “all patients were anesthetized with mandibular block for the mandibular (lower) teeth and local infiltration for the maxillary (upper) teeth.”

▲ Section references – Martis

c) Concerns about the extraction of infected teeth spreading infection.

Generally, for routine, uninvolved cases involving healthy people, the belief that pulling an infected tooth will lead to the spread of infection does not pose a significant concern and therefore does not constitute a reason to not go ahead and extract the patient’s infected tooth immediately.

Historic opinion.

Most sources (textbooks, scientific papers, etc…) that discuss this issue explain how the opinion of the dental community has vacillated over the last 100 years.

Fortunately, nowadays, current practices are more likely guided by empirical findings from research studies. And they show that the removal of an infected tooth does not pose a significant risk of spreading infection.

▲ Section references – Hupp

When swelling is present, various protocols are used –

The following sections explain various protocols that are typically used when extracting infected teeth and managing their accompanying infection/swelling.

1) When removing an infected tooth, does the patient need to be placed on antibiotics first?

▲ Section references – Hupp

2) Does a person need to be placed on antibiotics after having an infected tooth pulled?

The need for a patient to be placed on antibiotics after having their tooth removed varies according to the specifics of the infection/swelling that existed at the time of their extraction, and then at the completion of their procedure.

Localized swelling directly adjacent to an infected tooth.

Minor levels of swelling.

In cases where little to no swelling is present, or else an abscess has formed (an area of swelling containing accumulated pus) but it’s well-localized and limited to an area inside the mouth and directly adjacent to the tooth, usually no following antibiotic therapy is needed.

▲ Section references – Hupp

Diffuse swelling may not offer an opportunity for drainage.

Greater amounts of swelling.

▲ Section references – Hupp

Research study.

The study cited above (Martis 1975) in part evaluated the implementation of this exact kind of scenario. 327 of the infected teeth removed for subjects had associated secondary “fascial space abscesses” (meaning a focus of swelling at least somewhat distant from the infected tooth).

Each patient’s extraction process included drainage of their secondary abscess. Their treatment was then followed with a course of antibiotics for at least 3 days.

▲ Section references – Martis

3) What about cases where an infected tooth with swelling can’t be immediately extracted?

As suggested above, there can be instances where symptoms associated with a tooth’s infection make it impossible or inadvisable to go ahead and extract the tooth. If so, what can be done?

i) Incision and drainage plus antibiotics.

Even if the tooth can’t be extracted, the hope is that conditions exist where the swelling that has formed can be incised and drained. This treatment is then followed by a course of antibiotics.

Then, once the infection has subsided to the point where the tooth can be extracted, its procedure is performed.

What antibiotics are used?

▲ Section references – Hupp

[Any antibiotics that are prescribed should be taken according to your dentist’s directions. If you encounter problems (including the development of a rash or itching sensation), you should report them to your dentist or physician immediately.]

It’s common that the patient’s antibiotic therapy is continued for as many as 7 to 10 days. Their extraction procedure is typically performed somewhere during the latter half of that time window.

ii) Antibiotics alone.

There can be times when instead of a well-formed abscess, the swelling that has occurred is diffuse throughout a region of tissue (like the patient’s cheeks and face). If so, there is no focal point of pus that can be incised and drained, and therefore the swelling can’t be surgically treated.

▲ Section references – Fragiskos

Antibiotic therapy alone is never your dentist’s preferred choice.

It’s important to note that the use of antibiotics alone will not reliably prevent dental infections from worsening. And for that reason, it’s never your dentist’s preferred treatment approach if other options exist.

[Surgical intervention (in preferred order: extraction of the infected tooth and abscess draining > extraction alone > just abscess draining alone, with each option accompanied with postop antibiotics if indicated) provides a more predictable outcome.)]

▲ Section references – Hupp, Fragiskos

d) The patient’s medical status.

Only your dentist can decide.

In all cases, whether or not to proceed with pulling your infected tooth will be a judgment call made by your dentist. There are no hard and fast rules. (Note: The common guidelines we discuss above generally apply to healthy individuals who have an uncomplicated health history.)

In addition to all of the factors we have discussed above, the patient’s current medical status is also of utmost concern. And especially when infection with swelling is involved, the patient’s ability to combat and contain that process must be weighed by the treating dentist and their treatment plan adjusted accordingly.