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All topics.  »All Tooth Extraction pages.  »Pulling infected teeth.

Can a dentist pull an infected tooth?

– Will the presence of infection delay your extraction procedure? | Treatment approaches used when swelling is present. | Are antibiotics needed when extracting infected teeth?

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If you have a tooth that’s been bothering you, you may be eager to have it removed as soon as possible. But if it’s infected, and especially if swelling is present, you may wonder if that will cause a delay in having it extracted?

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.

X-ray of a decayed bicuspid that shows signs of associated infection.

With this case, the patient was relatively asymptomatic.

Just to make things clear, we should point out that a large percentage of infected teeth probably seem just like regular teeth to many patients. That’s because they haven’t caused any noticeable swelling, and they may not even hurt.
This absence of symptoms (swelling and/or pain) is explained by the fact that the infection associated with these kinds of teeth is low grade and/or the pus produced is effectively vented off (drained).
And it probably comes as no surprise to anyone that dentists extract these kinds of asymptomatic infected teeth all of the time.
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.

With these types of cases, once again, a dentist knows that going ahead and proceeding with pulling the tooth now is a way of preventing the development of more serious, possibly severe, symptoms later on. So, once again, dentists pull these kinds of infected teeth all of the time. A stitch in time …

▲ 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.

That’s because doing so provides for more rapid pain relief, it removes the locus (source) of your infection immediately (which aids in preventing further spread of infection/swelling), and the empty tooth socket provides a pathway through which pus can drain from swollen tissues (hence the swelling that has occurred can start to resolve more rapidly).

▲ 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.

Animation illustrating localized swelling due to tooth abscess.

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.

This can include utilizing a “nerve block” (a technique where the nerve’s trunk is numbed at a point distant from where it enters the infected tooth or tissue). Or augmenting “infiltration” technique so the anesthetic is placed in a wider band around your tooth (in healthy tissues) rather than immediately next to it.

▲ 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.”

Our point here is that these methods are the usual and customary way dentists numb up these respective types of teeth. And therefore this study documents that achieving adequate anesthesia for the extraction of infected teeth, even when there is noticeable swelling, is routinely achievable.

▲ Section references – Martis

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

Generally, for routine 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.

Furthermore, going ahead and removing the infected tooth immediately helps to hasten the resolution of the patient’s condition and pain, and helps to minimize complications of the infection, like the need for surgical drainage, time off from work, or hospitalization.

▲ 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?

For routine cases involving healthy patients that have uncomplicated medical histories, no prior period of antibiotic therapy (hours, days) is needed before extracting their infected tooth.

▲ 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.

Picture of localized swelling directly adjacent to an infected tooth.

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.

This is especially true if the abscess is found to drain promptly via the tooth socket after the tooth has been extracted, or else can be successfully incised and drained.

▲ Section references – Hupp

 
Animation illustrating diffuse swelling associated with an infected tooth.

Diffuse swelling may not offer an opportunity for drainage.

Greater amounts of swelling.

The ability of swelling to spread into areas distant from the problem tooth or into deeper tissues implies that the patient’s natural defenses are incapable of controlling its advancement.
And especially in the case where the swelling that has formed is very diffuse and cannot be successfully incised and drained (because there’s no primary point where pus has accumulated), placing the patient on antibiotics following the removal of their infected tooth is usually considered necessary.

▲ 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.

No serious complications following the extractions occurred. (Thus confirming that infected teeth with associated swelling can be extracted without facilitating the spread of infection, without the use of prior antibiotic therapy, but with the aid of post-operative antibiotics.)

▲ 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?
Odontogenic infections (infections associated with teeth) typically respond well to these antibiotics: penicillin, amoxicillin, clindamycin, metronidazole. But the specific drug or drug combination chosen depends both on what is medically safe for the patient, and what proves to be effective in bringing down their infection when taken.

▲ 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.

Therefore, with these types of cases, only antibiotic therapy is possible. If a point is reached where the swelling finally becomes focused and can be drained (possibly aided by the use of moist-heat applications), that procedure is then performed.

▲ 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.)]

Especially when antibiotics are used alone, the course of the patient’s condition must be closely monitored. The extensive spread of the patient’s infection, which may occur rapidly, can pose a life-threatening situation. (For example, extensive swelling extending into the floor of the mouth and throat can occlude the person’s airway and significantly (fatally) inhibit their ability to breathe.)

▲ 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.

 
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Page details –Last update:  September 30, 2021Authored by  Animated-Teeth Staff Dentist

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 Page references sources: 

Fragiskos FD. Oral Surgery (Chapter: Odontogenic Infections)

Hupp J, et al. Contemporary Oral and Maxillofacial Surgery. Chapter: Principles of Management of Impacted Teeth.

Isik BK, et al. Acutely infected teeth: to extract or not to extract?

Johri A, et al. Should teeth be extracted immediately in the presence of acute infection?

Martis CS, et al. Extractions in the presence of acute infections.

All reference sources for topic Tooth Extractions.

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