The tooth extraction procedure. -

How dentists pull teeth- the steps, the instruments (forceps, elevators), procedure details. | What it's like to have a tooth removed (pain, pressure, noises). | Extraction classifications - Simple vs. Surgical.

This page contains an outline of the process that a dentist uses when they extract a tooth for a patient.

  • It explains the purpose of each of the steps of the procedure and how the dentist uses their instruments when performing them.
  • As added information, it also describes the routine sounds and sensations (both pain and non-pain related) that you'll have the potential to experience as your procedure is performed.


The more you know about tooth extractions, the easier yours will be.

The process of pulling your tooth is more likely to go quickly and uneventfully if you, as the patient, contribute toward it. The contribution you have to offer is cooperation.

Patient cooperation makes all of the difference.

Patients who moan, flinch and squirm at every routine, non-issue sound or sensation are simply making their procedure more difficult and drawn out.

They're taking their dentist's attention away from the process at hand, and instead making them focus on the management of their patient.

Learn what's normal, so you can signal if things aren't.
Be intelligent. Take the time to read through this page and learn what's to be expected during a tooth extraction, and what isn't.
That way if something out of the ordinary does occur you can promptly bring it to your dentist's attention. Establishing an "it hurts" signal. Otherwise, they'll have the luxury of just focusing on removing your tooth.

Taking this approach will help to ensure that having your tooth pulled will go as easily, quickly and smoothly as possible. Something both you and your dentist want.

Extracting teeth - The procedure.

A) Numbing your tooth.

As a first step, your dentist will need to anesthetize ("numb up") both your tooth and the bone and gum tissue that surround it.

A picture of a dentist giving a dental injection.
At this point in time, there is still no way for a dentist to predictably administer a local anesthetic except as an injection (a "shot").
We'll admit that receiving one may hurt a bit. But we'll also emphatically state that it doesn't always.

Here's more information about this subject. It may help to put your mind at ease: Will my dental injection hurt? Why some do.

Takeaways from this section.

As a test for numbness, a dentist will usually begin the extraction procedure by taking a semi-sharp dental instrument (often an elevator, see below) and pressing it on the gum tissue immediately surrounding your tooth.

The idea is that you should feel the pressure of this activity (that's normal during an extraction, see below) but there should be no sharp pain.

FYI: They're not just testing, they're also using this step to start to peel away (loosen and detach) the gum tissue from around your tooth.

As a second test, your dentist may use their fingers and push firmly on your tooth from side to side, just to make sure that that kind of pressure doesn't bother your tooth either.

Here's more details about how a dentist tests for numbness before pulling a tooth What to expect.


Can you pull your own tooth?

We anticipate that for most people, their inability to fully anesthetize (numb up) their tooth would be their biggest obstacle in attempting to perform an extraction by themselves. We discuss the idea of a DIY extraction approach more fully here. Is it possible?

B) The extraction process - What to expect.

The remainder of this page outlines the usual steps of the actual tooth extraction process. We describe it in terms of:

  • The general challenges that removing a tooth poses for a dentist.
  • The kinds of extraction instruments that are usually used (along with the manner in which they are used to work the tooth loose).
  • What the steps of the process are like for the patient, in terms of what they are likely to experience (feel, hear, etc...).


1) The overall game plan.

When a tooth is pulled, here's the situation that a dentist faces.

An illustration stating that a tooth is held in its socket by a ligament.

Ligament fibers attach to both the tooth and the bone.

  1. The root portion of the tooth is firmly encased in bone (its socket), and tightly held in place by its ligament (the fibrous tissue between the tooth and bone that binds the two together, see diagram).
  2. To remove the tooth, the dentist must both: 1) "Expand its socket" (widen and enlarge it, see next section) and 2) Separate it from the ligament that binds it in place.
  3. After working towards this goal, possibly using an assortment of instruments (described below), a point is finally reached where the tooth has been loosened up enough that it's free to come out.


Animation showing how rocking a tent stake back and forth enlarges its hole.

Rocking a tent stake back and forth "expands" its hole.

What does "expanding" the tooth's socket mean?

If you've ever tried to remove a tent stake that's been driven deeply into the ground, you know that you can't just pull the stake straight up and out.
Instead, you first have to rock it back and forth, repeatedly, so to widen (expand) the hole in which it's lodged. (See animation.)

Then, once the hole has been enlarged enough, the stake can be easily removed.

Animation showing how rocking a tooth back and forth enlarges its socket.

Rocking a tooth back and forth expands its socket.

Extractions are somewhat the same.
In the case of teeth, it turns out that the type of bone tissue that encases their root(s) is relatively spongy.
And due to this characteristic, when a dentist firmly rocks it back and forth against the walls of its socket, this bone compresses.
After repeated cycles of side-to-side pressure, the entire socket gradually increases in size (expands). (See animation.)

Finally, a point is reached where enough space has been created (and simultaneously the root's ligament torn away enough) that the tooth can be removed easily.

2) Your dentist will use these tools.

Dentists have a variety of tools they use to grasp and apply pressure to teeth. Some of them are pliers-like instruments called "extraction forceps." Others are specialized levers called "elevators."

a) Periosteal elevator or desmotome.

As used with routine (simple, non-surgical) extractions, the use of either a desmotome or pointed periosteal elevator is generally interchangeable.

These instruments are used to loosen up and detach the gum tissue that surrounds the tooth that's being removed. And also, to whatever extent possible, sever the tooth's periodontal ligament (the ligament that runs from tooth to bone and binds a tooth in its socket).

How the instrument is used.

The pointed end of the tool is worked along each side of the tooth in the crevasse between it and its surrounding gum tissue in a downward motion. As the dentist pushes down they will also push the gums away from the tooth, thus detaching them.

Takeaways from this section.

As the actual start of the extraction process, this step also serves as a testing mechanism for your dentist. They'll start off gently with their instrument, asking you if you feel any discomfort.

  • If you do feel pain, they'll give you more anesthetic.
  • If all you feel is pressure, that's a good sign. That's what would be expected if the area has been numbed up successfully (so, so far so good).

    (A patient being able to discriminate between pressure and pain is an important aspect of their role in the extraction process. We discuss this issue below.)

Once your dentist knows that you are comfortable, they'll get more aggressive with the use of their instrument and complete their job.


b) Dental Elevators

Using an elevator to extract a tooth.

Animation illustrating how using a dental elevator can extract a tooth.

The wedging action of an elevator tends to loosen up and lift the tooth out.

To look at one of these instruments you might mistake it for a narrow screwdriver. That's because just like one, an elevator has a handle and then a specially designed "blade" or tip portion.

How they're used.

There are two general ways in which an elevator can be used to remove a tooth.
a) One is where the tip of the instrument is wedged into the ligament space between the tooth and its surrounding bone (as shown in our animation).
As the elevator is forced into and twisted around in this space, the tooth is in turn rocked around and pressed against the walls of its socket. This helps to both expand its shape and separate the tooth from its ligament.

As this work is continued, the tooth gradually becomes more and more mobile, with the downward motion of the elevator tending to lift the tooth up out of its socket.

b) The other method is one where the elevator is wedged in between the tooth and the crest of the surrounding bone. The bone serves as the fulcrum point as the elevator is used to apply upward pressure on the tooth, thus lifting it out of its socket.

In some cases, the dentist may be able to completely remove the tooth just using an elevator. If not, they will choose a point where they feel they have accomplished as much as they can and will then switch to using extraction forceps (see below) to complete the job.

Takeaways from this section.

A dentist will almost always start the extraction process using an elevator. They'll try to loosen up the tooth as much as possible before having to switch to using forceps (dental pliers).

A part of the reasoning behind this sequencing is that the possibility exists that the tooth may break once the pressure of the forceps is applied. If so, it may be more difficult to grasp and finally work free.

By using an elevator first, if the tooth does break, the dentist at least has the advantage that the portion that remains has already been loosened up some. And that can prove to be a significant asset.

As a side note, it's a pretty talented dentist who routinely removes teeth just using an elevator alone.


Extracting a tooth with forceps.

Animation illustrating the use of extraction forceps in removing a tooth.

Rocking the tooth back and forth with the forceps expands its socket.

c) Extraction Forceps

Forceps are dental instruments that look like specialized pliers. They are used to grasp and manipulate teeth during the extraction process.
A dentist will usually have a number of different ones on hand, each having a design that's tailored to:
  • The general shape of the tooth it's intended to remove, like large or small, or rounded or flat profile.

    The tooth's root configuration will also play a role (the dentist wants to be able to firmly grasp and apply pressure low down on the tooth). For example, the design will vary depending on whether it is 1, 2 or 3 rooted.

  • The location of the tooth in the mouth (such as front vs. back, or left vs. right side of the jaw).


How they're used.

A dentist will grasp a tooth with their forceps and then slowly yet firmly rock it back and forth (side-to-side) as much as it will. They may use quite a bit of force as they do this but it will be controlled and deliberate.

Because the bone that surrounds the roots of a tooth is compressible, this action will gradually expand the size of the tooth's socket. As it does, the range of the dentist's side-to-side motions will increase.

In addition to this rocking motion, the dentist will also rotate the tooth back and forth. This twisting action helps to rip and tear the tooth away from the ligament that binds it in place.

At some point, the socket will be enlarged enough, and the ligament torn away enough, that the tooth can be easily removed. As compared to the use of elevators, most teeth are ultimately taken out via the use of forceps.

Takeaways from this section.

You might be surprised to learn that dentists don't really "pull" teeth. Instead, when a dentist uses their forceps, at least initially, they don't so much pull out on the tooth as push in.

They know that just pulling out won't work because at this point the tooth's ligament is still mostly attached, and its socket hasn't been expanded enough yet.

What they want is for the force they create to be directed more so toward the root of the tooth, which will tend to act as a pivot location for the expansion of the socket's walls (see picture above).

Then yes, after the tooth is good and loose, the dentist will "pull" the tooth on out.

Section references - Wray


C) What you'll feel during your extraction.

[ We've updated our information and now have an entire page dedicated to the subject of what you might feel (pain, pressure) during your extraction process. What to expect.]


The local anesthetics that dentists use to "numb up" teeth are effective in inhibiting nerve fibers that transmit pain but not those that relay pressure sensations.

1) You will feel pressure.

That means you should expect to feel pressure during your extraction procedure (a slow steady force applied in a controlled and deliberate manner), and possibly even a whole lot of it.

But don't assume that if you do that that is an indication that you'll soon feel pain too because it doesn't. Remember, that sensation is transmitted by different nerve fibers and they have been put out of commission by the anesthetic ("shots") you have been given.

2) You shouldn't feel any pain.

Pain shouldn't be a significant factor during your procedure. But if you do feel some you should let your dentist know immediately so they can numb you up some more.

But be accurate in what you are reporting. More anesthetic will do nothing to take away the sensation of pressure. And in fact, the needless administration of additional quantities may place you at greater risk for complications during your procedure.

D) Expect that you might hear some startling noises.

As explained above, pulling teeth is a fairly physical process.

And in light of this fact, it should be no surprise to learn that you may hear a minor snap or breaking noise during your procedure. After all, hard tissues (teeth and bone) are involved.

The good news is that most of these events are just routine and nothing to get excited about. The two most common ones are bone fracture and root breakage.

An x-ray of a tooth's broken root tip still in its socket.

a) Broken tooth roots.

You may hear your tooth's root break during the extraction process. In fact this isn't necessarily an infrequent occurrence.
A study by Ahel determined that the level of force that resulted in tooth fracture was sometimes only slightly greater than that required for routine tooth removal.
  • Root fracture is the most common intraoperative (during procedure) complication, occurring in 9 to 20% of cases (Ahel).
  • A study by Bataineh placed the incidence of crown (the part of a tooth above the gum line) or root fracture at around 12% of cases.
  • Generally speaking, if a tooth fractures during its extraction process, it's most likely due to grasping/applying pressure to it too high up (on its crown as opposed to its root). That's why forceps are designed with tooth root morphology in mind. (Wray)

Section references - Ahel, Bataineh, Wray

These statistics suggest that if some kind of tooth fracture does occur, your dentist no doubt has had plenty of previous experience in dealing with it.

The consequences of having a root break can vary.

  • The piece may prove to be uncooperative and retrieving it may add a fair amount of time to your procedure.
  • In other cases, the part that's left has already loosened up somewhat and can be teased out relatively easily. (Remember our elevator Takeaway above?)


b) Bone fracture.

The type of bone tissue found in the center of the jawbone is relatively spongy. In comparison, its outer surface (the cortical plate) is relatively dense.

During an extraction, as pressure is applied to the tooth, the spongy bone that surrounds its root will compress. The denser cortical plate, however, is more brittle and if it receives enough of this pressure it may snap. As you'd expect, this is more likely to happen with larger teeth (molars) or those with longer roots (canines). (Wray)

In the vast majority of cases, this type of breakage is just a minor event (a "hairline" fracture has occurred). After the tooth has been removed, the dentist will simply compress the empty socket so the bone is squished back into place. The fracture can be expected to heal, uneventfully, along with the extraction site as a whole.

Section references - Wray

Picture of tooth sockets immediately after the extraction process.

Tooth sockets immediately after the extraction process.

E) Multiple tooth extractions.

In cases where more than one tooth will be pulled, the general process described above will simply be repeated for each one.

There may be some economies of scale involved for certain aspects of the procedure. For example, when removing multiple adjacent teeth, the dentist might detach the gum tissue from them all at the same time. And they might position their elevator so it loosens up the adjacent tooth simultaneously too.

Your dentist will choose a specific order.
Beyond the above considerations, each tooth will be taken out in turn. As a general rule, a dentist will typically remove lower teeth before upper ones, and back ones before front ones so to avoid the issue of bleeding obscuring their view.

Section references - Wray

F) "Closing" the extraction site.

Once your tooth has been removed, your dentist will begin the process of closing up your surgical site. This process frequently includes:

  • Gently curetting (scraping) the walls of the empty socket so to remove any residual infected or pathological tissue. This process is referred to as curettage and performing it can help to prevent subsequent cyst formation.
  • Irrigating (washing out) the socket with saline solution, so to remove any loose bone or tooth fragments that remain.
  • Inspecting for the presence of sharp bone edges. Any that are found will be trimmed off or filed down using a dental drill, bone cutting forceps (Rongeur forceps) or bone file.


  • When upper back teeth have been removed, evaluation of the socket for sinus cavity involvement (communication between the two).
  • Using finger pressure to compress the sides of the "expanded" socket. Doing so restores the shape of the jawbone and aids in controlling bleeding.
  • If your dentist is concerned about the possibility of prolonged bleeding, placing materials in the socket that assist with blood clot formation. Clotting aids.
  • Placing stitches. How it's done. This is most likely only needed after a "surgical" extraction (see below) or when several teeth in a row have been removed.
  • Placing folded gauze over your extraction site and then having you bite down on it so to create firm pressure.


What becomes of your tooth and its dental restoration?

Details ...

Once your extraction process has been completed, your tooth and its restoration are still yours, just like they were before your tooth was pulled. So, if you want either of them, all you have to do is ask.

If you don't, and your dentist thinks that there's any likelihood that the restoration has any value at all, you can rest assured that they'll add it to their collection of other dental work they've "inherited." Later on, they'll turn around and sell what they have to a scrap metals refiner.

Of course, you may not have any idea about which type of restorations have value and which ones don't. If not, read this page: What can the value of scrap dental restorations be How much?, and how to sell them.


G) Dismissing you at the end of your appointment.

Once your extraction procedure has been completed, there are still a few steps your dentist must do.

Controlling bleeding.

Your dentist will place one or more pieces of gauze over your wound and then ask you to bite down. The steady pressure you apply over the next hour will play an important role in helping to control the bleeding from it. (Be sure to follow these instructions. Nothing is more effective.)

Minimizing swelling.

If your dentist anticipates that much post-operative swelling will occur, they may give you an ice pack to apply to your face. That's because generally speaking, the sooner this is begun after the completion of your extraction the more effective this preventive will be. (More details about post-surgical swelling. What to expect. | How to manage.)

Postoperative instructions.

With both of the considerations above, your dentist will need to provide you with instructions (use their respective links for details). Beyond that, they'll also need to give you a separate, more comprehensive set of postoperative directions. Example list. These are extremely important in helping you to avoid complications and must be closely followed. They'll include a whole list of things to do and not to do, both during this first day and the days to follow.

Your trip home.

When you first get out of the dental chair after your extraction, you may find that you're a little unstable. If so, just ask to sit back down for a while until things return to normal.

The same goes for as you prepare to leave your dentist's office. If you need time to sit and adjust, or even ask for assistance, just do so. They fully expect that some patients will require more attention and aid after their procedure than others.

Can you drive yourself home after a tooth extraction?

Per your dentist's permission, in the vast majority of cases where just a local anesthetic has been used you should be able to drive yourself home after your appointment. If some type of sedative has also been administered (especially oral or IV ones), another person's assistance may be required for your trip and for some hours afterward.

For details about what's usually indicated with different sedation methods, see this page: Conscious sedation techniques. Needed precautions.

How long will your extraction take?

Most "simple" (see definition below) single-tooth extractions will take on the order of 20 to 40 minutes. We give a precise breakdown (type of tooth, procedure time, numbing time, etc...) on this page: How long does an extraction take? What to expect.

Not all extractions are "simple."

a) Simple extractions.

X-ray of two teeth, one of which will require a 'surgical' extraction, the other a 'simple' one.

Surgical (#1) and "Simple" (#2) extractions.

A vast majority of tooth extractions are completed using the simple mechanics described above. Specifically:
  • The minor expansion of the socket and adjacent bone.
  • Separation of the ligament that binds the tooth in its socket.
  • The uncomplicated removal of the tooth using extraction forceps.

Actually, there's a name (a classification) for these types of cases. They're literally termed "simple" extractions.

An example.

Removing tooth #2 in our picture will likely be a "simple" extraction. Although it's severely decayed, it's erupted and has a normal positioning. It can probably be teased out just using the techniques described above.

b) Surgical tooth extractions.

There can be situations where some aspect of a tooth, such as its positioning, shape, brittleness or deteriorated state complicates its removal. If so, a "surgical" extraction What is this? will be required. (As an example, the impacted tooth (#1) in our picture above will require "surgical" removal.)

Two interesting aspects of this process are:

  • The additional steps taken simply set the stage so the tooth can then be removed using the same basic principles explained above.
  • Despite the fact that the added steps are surgical in nature, using them may actually serve to decrease the overall level of trauma created by the extraction process.


Can you pull your own tooth?

Most humans no doubt have extracted one, and more likely several, of their own teeth. Of course, we're talking about rootless baby teeth. And that situation is quite a bit different than extracting a "permanent" tooth. ( Here's why baby teeth come out so easily.)

What about permanent teeth?

Every dentist has encountered some teeth that are so loose in their socket (gum disease is usually involved) that they offer little resistance to the extraction process.

However, even in cases where the physics of the extraction process seem as though they would be possible to accomplish (like with just finger pressure), there are a number of reasons why trying to remove a tooth on your own still doesn't make a good idea. We discuss the various issues involved in our blog post: Can you pull your own tooth? Should you?


Our next page discusses extraction procedure pain. What to expect.


 Page references sources: 

Ahel V, et al. Forces that fracture teeth during extraction with mandibular premolar and maxillary incisor forceps.

Bataineh AB, et. al. Patient’s pain perception during mandibular molar extraction with articaine: a comparison study between infiltration and inferior alveolar nerve block.

Fragiskos FD. Oral Surgery. (Chapter: Simple Tooth Extraction)

Koerner KR. Manual of Minor Oral Surgery for the General Dentist.

Wray D, et al. Textbook of General and Oral Surgery. (Chapter: Extraction Techniques.)

All reference sources for topic Tooth Extractions.


Tooth Extraction

I had ALL my tops and bottoms pulled at once. All he gave me was the freezing. Please get your pain meds into you before you go for procedure and if you don't agree with your dentist how many teeth need to come out, you would be better off getting that second opinion. The bad teeth that needed to come out went easy and I dont feel a thing .. the good ones that he took out he had to PRY AND DRILL with a lot of effort because they were healthy and functioning teeth. I got my dentures in right after, very very painful. Lots of bleeding, discuss stitches before and get lots of advice about food because I cant wait to eat my next meal I should have ate just before.

Our interpretation.

For those reading this comment, we'll interpret what is being said, add some additional points and link to where you can find more information on our site:

"All he gave me was the freezing." - The "freezing" part refers to the use of a local anesthetic (just typical dental "shots") to numb up her teeth. And then as stated, no additional sedation technique was used in conjunction with that for the procedure.

"get your pain meds into you before you go for procedure" - This implies that this person took a pain reliever preemptively (before her appointment), as a way of aiding with pain control (both during the procedure and post-op).

This technique may have a place but only after consulting with your dentist. Some types of pain relievers can disrupt the blood clotting process and thus their usage is contraindicated prior to an extraction.

"PRY AND DRILL" - The "pry" reference refers to the use of dental elevators during the extraction process. Doing so is routine (and described above). "AND DRILL" implies that to remove some teeth that either some bone tissue needed to be removed or the removal of the tooth was aided by "sectioning" it (cutting it into parts and removing each piece separately). We describe these techniques on our Surgical Extractions page.

"Lots of bleeding, discuss stitches ... advice about food ..." - Generally, a patient needs to follow two sets of post-operative instructions. Those that apply for the first 24 hours, and then a second set for the period after the first day and beyond.

Removing premolar teeths

Hey there.Im going to extract 4 premolar teeths(2 top and 2 bottom)and next week Im going to extract 2 teeths first one top and one bottom and Im nervous.Will it hurt when I extract my premolar teeths?


From your question, it seems you haven't found our "do tooth extractions hurt?" page.

It'd be our guess that your fears are unwarranted. But as that page describes, it's your cooperation and communication with your dentist during the extraction process that goes a long way in helping to insure a pleasant experience. You should read it. Best of luck.

Hi I'm due to have an upper

Hi I'm due to have an upper back tooth removed due to abcess.( Luckily I'm in the unique position of have a virgin wisdom tooth in the perfect position to fill the gap).
I have a lot of sinus pain and am just interested how the dentist checks the sinus cavity after extraction. I didn't realise my sinus pain could be linked to the tooth.
Thanks for all the information. I feel prepared knowing exactly what to expect and how to manage my own aftercare


You state: "I didn't realise my sinus pain could be linked to the tooth."
It can actually work both ways. The bone that encases a tooth's roots and also serves as the floor of a sinus can be paper thin. So, if there is an infection in the sinus, it can affect the nerve that runs through this bone and on into a tooth, thus causing tooth pain. Or the reverse, byproducts from an infection emanating from a tooth can spread to the sinus cavity and affect it.

We're not so sure to what degree your dentist will "check" your sinus after your extraction (in terms of evaluating your original complaint). It seems they have found a clear problem with your tooth (an abcess) and that absolutely needs to be taken care of.

Since this problem lies in the region of your sinuses, it makes a logical assumption that it is also the cause of the problem with them. If it is, getting rid of the tooth (the source of the problem) will allow your body to resolve the sinus issue on its own (clear up the remnants of the infection). Only time will tell. It could be possible that another, purely sinus related, problem exists.

Other than that, there is a specific post-extraction sinus check that is routinely done by dentists after any upper back tooth is removed.

As mentioned before, the bone that encases a tooth's roots can be paper thin, and therefore when an upper tooth is removed this bone might be damaged. If so, a hole would exist between the patient's sinuses and their mouth (an oral-antral communication).

Small openings will usually close on their own during healing. With larger ones however, the dentist will want to close up the extraction site snugly so to aid with insuring this.

The way the opening is discovered at the time of the extraction is this: The dentist will hold the patient's nose close and then ask them to gently blow air into their nose. If air escapes via the tooth socket (creates bubbles), the dentist knows an oral antral communication exists.

Not disrupting this fragile bone (whether or not and outright opening exists) is why as a part of post-op instructions patients are told not to blow their nose, and to sneeze with their mouth open (both as a way of preventing excessive pressure in the sinuses, see link above).

Good luck with your procedure. We hope it resolves both of your problems.

Tooth Extraction

So I'm 11 and I'm getting my 19th molar taken because it has a infection and I was wondering how long would it take for the anesthesia to settle in and what are the tools used for the extraction


Good luck with your procedure. We anticipate that you'll find the process easier than you expect (we noticed that you placed your comment on our "extraction pain" page.)

This link: Time needed to numb a tooth for an extraction. will answer your first question. (The usual initial injection in preparation for extracting tooth #19 is an IANB.)

This link: The steps of the extraction process. explains the use of dental instruments during an extraction.

Partial plate

My dentist is going to extract a molar in a few days and then put in my partial this common practice?


Yes, that's not uncommon. Your dentist is trying to save you from having to go for a period of time without having a partial to wear. We discuss immediate partial dentures here.


Hi, my orthodontist told me that my upper jaw was too wide, so I have to take out my upper premolars to make space and then putting braces to tighten it.
Do you know at what point or when after the procedure they’re going to have to place my braces ?
Do the stitches disappear or are they here forever?


Any stitches that are placed will be removed or dissolve away on their own after a week or two. The space itself will be closed in, either fully or substantially, during your orthodontic treatment. Your braces can be placed fairly immediately, just a week or so after your extractions.

Tooth Extraction?

Tooth #20 has become a problem. It has cracked out the back and has a large filling which is loose. It has also had a root canal done a very long time ago. Many dentists have told me it should come out.

I am frightened out of my wits. I am so worried about the pain, possibility of swelling and bleeding. I truly do not know what to do with myself. Is there anyone out there that can help me? I have not eaten on that side of my mouth for over 9 months. I am located in Central NJ. A million thanks.

* Comment notes.


We just don't see anything in your narrative that suggests that the extraction procedure you require will be especially difficult or troublesome.

In regard to the process of having your tooth pulled, tooth #20 is a single rooted (lower left 2nd) premolar. It has a location that provides a dentist with great access and visibility, which should help the procedure to more smoothly and quickly.

In regard to pain and swelling, we would think you have more to be concerned about by leaving the tooth in place rather than having it out.

With the exception that there's a medical issue involved, we're unclear why you anticipate problems with controlling bleeding after the extraction.

Something you don't mention that you might consider is the use of sedation for your procedure. Doing so is frequently benefits both the patient and dentist.

As mentioned above, proceeding with your treatment almost certainly holds more benefits for you than not. Doing so will allow you to make decisions, rather than conditions with your tooth dictating the course of events. Good luck.


I went in for #30 and ended up to be determined I need a root canal..I can’t afford a root insurance.. So I’m leaning on an extraction of that this a big procedure?

* Comment notes.


No, extracting #30 (lower right first molar) doesn't have to be a big deal.

This tooth is relatively large and has two roots. So in comparison to most single-rooted teeth, it may take more force to it rock back and forth until its socket is expanded enough that it will come out.

While technically a posterior tooth, a first molar's position in the mouth is one where it's relatively easy to visualize and access. So that's a positive for your procedure.

Numbing it should be a routine matter for your dentist.

You might run through your situation through your mind again, just to make sure there's no way that saving your tooth is possible.

If not, where most people get themselves in trouble is they wait until the tooth starts hurting to finally have it out. Infection/swelling/pain associated with that event can complicate the extraction process.

first time tooth extraction

i wanna know is extracting a tooth that had previous root canal treatment more difficult than extracting a normal tooth?

* Comment notes.


A tooth that has had root canal treatment is generally considered to be more brittle than a live tooth, and as such more likely to fracture during the extraction procedure. However, if that type of event occurs, it may or may not add to the level of difficulty of removing it. It simply depends on the manner in which it has broken.

Tooth pulled tomorrow.

I am 13 and I'm getting my very last baby molar tooth pulled out and I am nervous and scared. And it's weird because that tooth is half out and half still in my gum according to the X Ray I got yesterday. I need advice please.

* Comment notes.


You're overlooking all of the things your comment states that are favorable for your procedure.

You state you are 13 yr. That is the normal age for this tooth to fall out on its own. Despite the fact that it hasn't, there certainly is a chance that the root of the tooth has already resorbed significantly, thus making the extraction less difficult than it would have been at any time previously.

What you say about the appearance of the tooth on the x-ray suggests the same thing (the tooth is 1/2 out and 1/2 in).
Just concentrate on being a cooperative patient and no doubt your tooth will be out in a flash.

Tooth root pull out.

I am 52 haven't been to dentist for a long time I went the other day as I have a tooth at the front broken of need to get the root out I so scared pls tell me what the worst that can happen

* Comment notes.


We're eternally disheartened by requests to discuss dentistry from the standpoint of "the worst that can happen." Instead, we'd be eager to point out some reasons why your procedure might be easier than expected.

You state it is a front tooth that needs to be removed.

1) Front teeth have single, often conical shaped, roots. That shape offers less of a challenge to remove than most back teeth.

2) Being a front tooth, your dentist will have great access and good visibility of the surgical site. This should make the outcome of the procedure more predictable and the procedure quicker than a comparible procedure for a back tooth.

3) While this would only be an issue for a front upper tooth, front teeth usually have less physical association with the sinuses than back teeth. This drastically reduces any chances of complications associated with them.

4) Front tooth extractions have a lower incidence of dry socket formation.

Patient cooperation means everything when a tooth extraction is performed. After discussing your apprehensions with your dentist, the two of you might consider using some form of conscious sedation technique to put you more at ease.


Wendy is kind of a xxxx in her responses and it’s hilarious. Good info here though. Big time.


Female age 43, got #17 removed 6 days ago. No flap, gum removal or incisions. No stitches after. Regular dentist numbed the area, and went at it with pliers and whatever else they use. Procedure took FOREVER with no progress. LOTS of yanking and pulling and pressure. He lost control 2 separate times and hit my top row of teeth. FINALLY, the tooth came out. Don't know if it came out whole or in one piece. I did not ask. Took at least 20 minutes. Clotting began immediately. There was not all that much blood. Gauze changed about 3 times. All bleeding stopped within half an hour. Little to no swelling in the last 6 days. HOWEVER....been having extreme pain in that side of mouth. Haven't eaten on that side all week. Eating on the OPPOSITE side triggers pain. Pain is also present when not chewing/finished chewing. It's there pretty much ALL the time on a varying scale between 6 to 9 or 7 to 10 (ten being terrible). It's not dry socket because I can see the socket. There are no other symptoms of dry socket either. Advil eases the pain. I do not take Advil everyday. When I do, it's only 1 or sometimes 2 tablets in a whole 24 hr period. I have done salt water rinses. They help a bit, but relief is not long lasting. I eat mashed foods and drink liquids. Anything "heavier" is not often and ONLY done on the OPPOSITE side of mouth. Can you tell me if this prolonged pain is normal and when will it stop? What is my time frame to be at a 4 or 2 or 0 pain level? Tooth #18 was also filled at this time as he said it had 2 small cavities. Haven't been back to see him because he has taken a leave of absence from the office 2 days after my procedure. There are other dentists there but I haven't gone in for a check-up.


As you probably realize, the normal course of events is that a tooth extraction site can be painful. And then after the time of the extraction, what pain is noticed gradually diminishes as days pass. And basically, if that's not what you are experiencing, you should be evaluated by a dentist.

You describe your extraction process as being difficult, and as such, one would have to assume that a comparatively greater amount of local tissue trauma was created, and therefore you would have more potential for experiencing pain than if the tooth's removal was simple and quick.

Other than that, however, without direct evaluation and direct questioning to rely on, a dentist would have a hard time making a guess at a diagnosis.

It's common and usual that a dentist makes arrangements for coverage of patient emergencies by colleagues when they need to be absent. You should take advantage of that. Every dentist (your usual one or their fill-in) knows and expects that some percentage of patients will require additional post-extraction evaluation and assistance.


This was my first time with this dentist and he insisted on doing this work even though I said I had an appointment with a specialist next month. I had simply went to his office for a new patient exam and check-up. I also told him to stop twice during the procedure. He said, NO. I also told him not to do #18 but he insisted on that too. After I had posted my initial query up above, I continued to read this site and learned that there should be some time spent on rocking the tooth side to side and back and forth in order to loosen the ligaments. I know for a fact that happened very minimally. After just a few motions, all he focused on was PULLING. I am not surprised I am in pain for this long. The area obviously underwent significant trauma. He was running around between THREE rooms and doing work on THREE DIFFERENT patients during my visit. The total time spent PULLING was about 20 to 25 minutes. He was cutting corners and saving his time because he was NOT focusing on ONE patient at a time. If he had common sense, time management skills and ethics, he would have cut some bone, or some gum or sectioned the tooth. He had no time for any of that and did not have time for stitches either. As I said, it was my first time there and this procedure WAS NOT PLANNED. He just wanted to make money that day (I heard him getting angry about another patient who had cancelled twice and hadn't shown up for her current appointment either). I hope this post helps others. It's ok to feel pain like this. You are not alone. Find a new dentist if the current one is an idiot. I know that's what I will be doing. Thanks for your advice and thanks for writing back Staff Dentist.

Pulling an adult loose tooth

Hello, I am 73yo. My left lateral incisor tooth number 22 has been becoming loose over the past year or more.

It has now come downward (toward the lower teeth) exceeding just over 1/4 of an inch, exposing much of the root, overlapping the lower teeth and is now extremely loose. There is no swelling, no bleeding, no pain, no infection, no odor and there are no fillings or cavities in this tooth. This tooth still has the same color and appears to be very alive and healthy. The gum pocket is shallow and tight. The surrounding gum tissue is nice and pink and rebounds pink immediately.

Upon wiggling, it has a forward motion (toward the lips) of over 1/2 inch. Side to side motion is excessive. Twisting motion is also considerable. No backward motion toward the palate (resistance encountered).

Since it had been getting much looser, I was going to have it pulled but current dental office closings (covid-19) has prevented that, and is not considered and emergency.

I think I can pull it on my own with twisting, pulling downward and outward - high tolerance to most moderate pain, don't take any meds, don't smoke, don't drink, healthy rancher/farmer.

Thoughts? Thank you.

This is a very informative website and all of the information in it is really appreciated.


(For anyone else reading, the tooth in question is an upper left lateral incisor. In the USA this would be referenced as tooth #10.)

It's not really possible to make any recommendation about what you should do. As preliminary ground work, a dentist would want a full patient health history, and an understanding of the tooth's situation as it exists now and what has apparently lead to its condition (direct observation and an x-ray would be valuable in determining these). Obviously, none of that is available via this forum.

Generally, self-extracting a tooth is hampered by the fact that the person has no way to profoundly numb up the tooth and tissues of the extraction site.

Pharmacies do sell "topical" (applied to skin surface) anesthetic products (a gel or liquid containing benzocaine) that are intended for oral use. But they will only numb up the surface of the skin, and do not penetrate in and numb up the bone and soft tissues surrounding the tooth or the tooth itself.

In some cases (like extremely mobile single-rooted teeth whose bone encasing them has been severely eroded away by gum disease (evidenced by gum recession), and where the extraction process is expected to be extremely brief), application of topical gel around the tooth and in the space between it and its gums might take enough of the edge off the process to make it tolerable.

It's just that since this is an unknown, and dentists have more effective/predictable methods to use (injecting local anesthetic), they typically use them as a first approach.

You state:
Upon wiggling, it has a forward motion (toward the lips) of over 1/2 inch. Side to side motion is excessive. Twisting motion is also considerable. No backward motion toward the palate (resistance encountered).

Assuming the tooth is fully intact, from this description a dentist would likely anticipate that the bone around the tooth has been compromised (eroded away) by some infection process [an endodontic (root canal) or periodontal (gum disease) condition. (an x-ray would aid in making this diagnosis).

However, pretty much nothing in your description seems to corroborate this impression. As stated above, it would be ideal to have an idea of why the problem exists.

The forward motion of your tooth suggests that much of the naturally thinner bone on the front side of the tooth has been lost (google "dental fenestration and dehiscence" and look at the images/pictures for an explanation).

You're right, if you google "anatomy of maxillary lateral incisor" and look at the pictures you'll see that this tooth typically has a single relatively straight conically shaped root (an x-ray would confirm this).

So between that shape and the fact that the tooth has a lot of mobility (implying that it's no longer fully encased by bone) one would assume that it's mostly soft tissue holding the tooth in place and therefore the dentist will especially twist the tooth back and forth to so to ultimately separate the tooth's ligament (this page describes that above). (Rocking the tooth back and forth "expands" the socket, see above, but in this case that doesn't seem to be a needed issue.)

Wikipedia (a reasonable enough resource) states that the length of the root of a maxillary lateral incisor usually runs on the order of 1.5 times the length of its crown. You state you see 1/4" of the root showing. From that, you can get an idea of much root is still holding the tooth in place.

Another problem with self-extraction is having someone (a dentist) available to handle post-operative issues.

For example, the gum tissue surrounding teeth that are very loose because of a history of some kind of associated infection will tend to bleed more so that healthy ones. Although, in the vast majority of cases following proper clot formation and management instructions is all that's needed.

FYI: We have a page that covers the type of instructions a dentist usually provides their patients (on the day of and 24-hours post-extraction, and beyond).
It seems likely that every dentist has probably had at least one patient mention to them that they extracted their own tooth (usually an extremely mobile lower front incisor that has been ravaged by gum disease). But that's not the norm and the points above bring out some of the reasons why self-extraction is difficult to suggest for someone.

Razor sharp, post-surgical fragment slicing under my tongue...??

Hi, I had 6 surgical extractions about a month ago. Three on bottom left (17,18,19?) were pretty traumatized with the tug of war due to #18 being broken at the gum line. Things healed pretty quickly. Also overall experience was extremely positive compared to whatever it was that my disturbed brain thought it was going to be like. FOR SURE.......Amazing! Now I have this horrible bone sliver (it's bigger than that, but the slicing feel of it's thinness gives me the creeps) coming out of the inside of the left side where my tongue lays. So when I talk, eat, or really make any movement large or small, it is stabbing the left side underneath my tongue. Every few major stabs is actually a small slice. I ended up stuffing gauze next to it. I almost went to the ER, then tried to see if I could maybe wiggle and pull it out. It's very very tender underneath of it so I don't know what to do. Then I found you here so I'm asking out of desperation. PLEASE TELL ME THIS TOO SHALL PASS


There's not going to be much to say that isn't already written on this page about post-extraction bits and fragments.

Either the shard is small and you can wiggle it out on your own, possibly after a day or two of loosening it up. Or you'll require attention from your dentist (usually a routine part of their obligated post-extraction care). Yes, in some cases possibly an emergency care facility would offer to administer an anesthetic and remove the piece.

At least in theory, the bit should pass through, after all that is what your body it trying to accomplish. It's just that with larger fragments, the process you have to endure on your own may be prolonged. Seeking attention can cut this period short. It also provides an opportunity for evaluation, so it's confirmed that what you are experiencing falls within normal limits.

Placing the gauze as a buffer seems a good idea during waking hours.

Pharmacies do sell OTC anesthetic products. (Like used for baby teething pain. Benzocaine is a common active ingredient.) It wouldn't be expected that this type of product would fully numb your situation. But it might provide enough aid that you could get the bit out. (You'd need to check the label to confirm that the product is suitable for your use. And note in the instructions that it's not intended for prolonged usage.)

Dental phobia

A few years ago, I developed a dental phobia. I’ve tried different things to get over it, talked to my primary care doctors, even wrote a dentist that my doctor recommended (I asked for a consult but she never responded). I’ve had Sjogrens for over 20 years and in the last 5 years, the dry mouth has done a number on my teeth. Now I have a have a tooth that really hurts. I’m trying to wiggle it so hopefully, it will come out on it’s own. I know one way or another, I need to get over the dental phobia, but how?


In regard to input about dealing with your phobia, I have no expertise to contribute. As a possible source for support, I'll mention that I am aware of the website that has existed for years on end. This isn't an endorsement (I know essentially nothing about the content of their pages) but it might be a place to find some help.

In regard to your tooth and needed procedure:

1) You seem to imply that the tooth already has some mobility (it wiggles). This box on this page discusses how that's an asset to the extraction process. So, even right now, the outlook for your extraction is already positive.

2) On the off chance that you're not already aware of dental sedation methods, read this linked page. Pay special attention to the nitrous oxide/laughing gas section, since that can be such a simple method to use.

Beyond that, some dentists do practice "sleep" dentistry (Google: sleep, twilight, or sedation dentistry). That technique would equate with the "oral sedation" section of that page.

And then while only just mentioned on that page, sometimes dentistry is practiced in the hospital setting with the patient totally unconscious (although rather than just for a single procedure, a treatment plan is usually formulated so as much of the patient's dentistry can be performed as possible during a single session).

3) That last point is an important one. You discuss the situation where you anticipate you have a number of dental issues. And also that right now you have a pending dental emergency.

The emergency backs you into the corner where it takes precedent and will probably be the sole focus of a single appointment.

In contrast, when no emergency exists, you could schedule a examination/treatment planning appointment (where no dental (fearful) procedures are performed). Discuss with the dentist how the treatment plan should be tailored to accommodate your situation: fewest possible appointments, sedation if needed, possibly planning for a less extensive treatment approach rather than a more appointment-laden one, and taking into consideration how your Sjogrens syndrome will influence the long-term outcome of each possible treatment approach). Then, decide on a plan and let your dentist figure out how that work can be completed in as few appointments as possible.

This isn't to make light of how difficult this will be for you. But it seems the only way to minimize the amount of distress involved for you. The cards regarding your dental situation have already been dealt. Your opportunity lies in controlling how they are played. Best of luck.

Three teeth

I have three teeth there gonna pull in two weeks I’m scared to death!! One is number 19 there really isn’t a tooth anymore just two numbs that stick up on the side the rest of the tooth is gone and it’s gum how will they get this out? The next one is number 17 my back wisdom about a month ago it started breaking up and some of it is gone in the middle but there is not a lot of room at that tooth. The next one is 16 the top wisdom it’s all the way in and don’t bother me but she said it needs to come out cause it has a cavity! Please explain how they will get these teeth out busted up and said that it would be pulling and drilling! I can go to another dentist if I want out to sleep to have them out if she does them she will just give me the shots! Which is better to have done not put to sleep or put to sleep?


"Which is better to have done not put to sleep or put to sleep?"
This is less a question about performing the act of pulling your teeth vs. patient management. If not sedated, can you emotionally tolerate having the procedure performed? And can your dentist rely on you to be a cooperative patient? We discuss issues associated with sedation practices here.

In regard to your planned extractions, there certainly might be factors involved that are favorable for your procedures. Only your dentist could know.
1) If the roots of a tooth #16 are fused together (into a conical shape, like an ice cream cone), the tooth's removal can be exceedingly easy (one of the easiest of all teeth).
2) The remaining portion of a broken down and diseased tooth (like your #19) have often supraerupted (Google it). If so, less root length is still encased in the jawbone, thus favoring the removal process.
3) With your tooth #17, either of the above factors might possibly come into play. Short of seeing the tooth and its x-ray, it would be hard to know.
4) Dentists rely on the use of "elevators" to remove teeth they can't grasp with forceps.

It sounds like you need to talk to your dentist anyway (about considering sedation). So, ask them about the issues mentioned above too. Good luck.

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