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. 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?

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.

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 DYI extraction approach more fully here.

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...).

Reference sources for our outline of the tooth extraction process - Fragiskos, Koerner, Wray

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 is able to routinely remove teeth just using an elevator.

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 can expect to feel (pain, pressure) during your extraction process.]


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.
  • Placing stitches. This is most likely 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, 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. (More details.)

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.)

Postoperative instructions.

With both of the above, your dentist will need to provide you with instructions (see "details" links above). They'll also need to give you a separate, more comprehensive list of postoperative directions. 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.

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, another person's assistance may be required for your trip and afterward. See this page for further details.


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.

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 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. (Use this link for details about this procedure.)

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 teeth that are so loose in their socket (gum disease is usually involved) that they offer little resistance to their extraction instruments.

And even with teeth that were anchored more firmly initially, a dentist may reach a point during the extraction process where just grasping the loose tooth with their fingers and twisting and rocking it back and forth several times (basically mimicking the motions they would normally make with their forceps), just gets the job finished the quickest.

Extracting your own tooth doesn't make the best idea.

However, even in cases where the physics of the extraction process seem possible to accomplish, there are a number of reasons why pulling your own tooth doesn't make a good idea. Here are several of them:

  • Do you know why the tooth has symptoms? - Removing a tooth is one thing. Understanding why the tooth has developed problems, and how that issue may affect you in other ways, is equally important.

    A dentist's diagnosis of your situation is needed. And dental x-rays are typically required to form that diagnosis.

  • You may have pre-operative factors that must be managed in regard to a pending extraction. (Active infection, medical issues, taking medicines, etc...)
  • The use of local anesthetic (dental "shots") is almost always needed for tooth extractions.

    In very, very rare cases (necrotic [dead] teeth with very advanced gum disease [gum recession]) packing topical anesthetic (like benzocaine gel) around the tooth may provide adequate anesthesia. But even then, probably not.

    One must really expect that in all cases, the application of topical anesthetic will be totally ineffective in numbing the nerve that runs to a tooth, and in numbing the bone tissue that surrounds its root.

  • The use of any type of tool to pull or work the tooth out would seem to be a recipe for disaster.

    In the hands of a novice, even the use of actual dental extraction instruments could easily result in tooth fracture or damage to neighboring teeth. The use of makeshift instruments would seem astoundingly fool hearty.

  • Removing the whole tooth is important. - It's easy to anticipate that a novice would have no ability to remove tooth fragments.

    The surface of a tooth's root can be expected to be smooth and rounded (no sharp edges). But a novice's ability to determine if the extracted tooth was entirely intact would be a point of question.

  • A novice would have no expertise in providing wound closure and post-operative care (controlling prolonged bleeding, providing pain control, etc...).

Our next page discusses extraction procedure pain. ▶



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.


I just got my tooth pulled 2 hours ago...I’m feeling a bit of pain, is that bad?


In all cases a patient should feel free to contact their dentist about any concerns that they have. Responding to your needs is a part of their obligation to you as a treatment provider.

It seems possible that what you are experiencing falls within the realm of usual. Here's what our pages state about post-op pain during the same day of an extraction.

Dialysis and dentist

Iam on dialysis and don't have a good immune system and was wondering if that makes a difference with how dentist work on my teeth.. I may have to have all my teeth pulled.


Your extraction process itself will be similar to what we describe, simply because that's the only way there is to remove teeth. What will likely be unique to your situation is the planning that takes place before and after your procedure.

For example, your extractions will probably be scheduled for a non-dialysis day ("blood thinners" used during dialysis might cause you to have extra bleeding). Extra post-op steps might be used also to help to minimize your potential for bleeding complications.

In cases where a patient is at increased risk for infection (has a compromised immune system), antibiotics might be prescribed before their extraction.

All of these issues will be sorted out at your initial examination when the planning for your extractions are made, so to make your procedure as risk-free and routine as possible. Good luck, we're sure you'll find you're in good hands.

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?


The stitches 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.

Bottom back tooth pulled

It’s been a week and I have exstream pain it feels like part of the tooth is still in the front is there any way to tell if it’s still in there it was infected when it was pulled and he had to drill to get it out took a very long time the pain is close to being as bad as before it was pulled


You need to call your dentist's office and let them know that you require attention. They'll figure things out, and take steps that will help to keep you more comfortable in the mean time.

You mention ".. had to drill to get it out took a very long time..."

Difficult, traumatic extraction are more likely to result in dry socket formation. We wouldn't be surprised if you have developed one. Again, the solution lies with treatment from your dentist.

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. There are other complicating problems. I was hoping if the tooth is extracted, an implant, even a very small one, can be placed to close the space. My teeth are not straight. I was not a candidate for braces because the molar in back of tooth #20 is fused to my jawbone. 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.


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. (You state the filling is loose, if so, the root canal work is no longer protected by its seal, which is a common cause of root canal failure.)

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

You mention you'd like an implant placed as a replacement tooth. It might be possible to place it during your extraction procedure, thus avoiding a separate surgical process.

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, proceding 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.

Pre molar pulled

Yesterday i had my upper left 1st premolar pulled . I felt alot of pressure on the right upper molars during the process, is that normal? Also today, i'm getting a lot of pain in the left upper canine an 2nd premolar . The 2nd premolar and molar behind the extraction also feels longer than usual. What should i expect and do?


In all cases, you should contact your dentist's office if you have questions or need help. That's their obligation to you. They expect you to. Their knowing your case history and health history are important factors in determining where the needed solution lies.

"I felt alot of pressure on the right upper molars during the process, is that normal?"
Generally an event involving a tooth on one side of the mouth doesn't refer sensation to a tooth on the other side of the mouth because the nerves that run to the left and right teeth are independent of each other.

"i'm getting a lot of pain in the left upper canine an 2nd premolar"
It's common that extraction sites have pain associated with them.
As neighboring teeth, possibly these teeth were inadvertently traumatized as part of the extraction process and are sore for that reason.

"The 2nd premolar and molar behind the extraction also feels longer than usual."
This isn't the usual type of remark you hear from a patient.

You need to contact your dentist. In the case where their direct attention isn't possible, their recommendation about OTC pain relievers or their calling your pharmacy can usually provide a solution until they can. But as mentioned above, knowing your case and medical history would be important to know.

Infected Tooth

Fourteen years ago I had two top wisdom teeth extracted and one right side infected bottom one. The bottom one came out butting up against the molar next door. I would have occasional pain and the tooth got dark. After extraction of the bottom right I developed more pain and bad taste along with a dry socket. Socket was packed with a gauze of cloves and and site area seemed to be healed on the outside but not the inside, because I was still experiencing horrible taste and pain in that area. I also developed a hole behind that last molar where extracted wisdom tooth was. Had the area opened and cleaned two other times with a pathology report of infiltrated white blood cells and dead bone. Now I am going to have it opened up again and I have two decent dentist one is biological uses ozone and your own sterilized blood for clots and the other is a traditional oral surgeon who doesn't use any of that stuff but might might have more experience. Traditional dentist says that the periodontal ligament doesn't need to be taken out and the other dentist says that it does, especially because it harbors bacteria and is a food source to feed bacteria. I looked it up on line and there are many articles to support taking ligament out and scraping bone area at least 1 mm maybe more...depending on infection. Who is right on this? I could really use some input...I need to have this done right and every dentist has a different take. Thanks!


In regard to a 14-year problem, with two surgical attempts that failed to resolve it ...

There would be no question in our mind that we would have an oral surgeon treat our case. That is the highest level of authority in dentistry for this type of problem. (We're unclear if both of the dentists you mention are.) (With your having used the term "pathology report," we anticipate that some of the unsuccessful attempts were performed by an oral surgeon. Even so we would still have the most faith in that type of practitioner.)

In regard to removing the PDL post-extraction, we weren't really familiar with this (and can't imagine that in the vast majority of extractions performed by general dentists this is accomplished, especially if you're referring to removing 1mm of bone).

We Googled around. Here's a link to an oral surgery text book (Contemporary Oral and Maxillofacial Surgery, 2013). The linked portion of the book states: "The remnants of the periodontal ligament ... are in the best condition to provide for rapid healing. Vigorous curettage (scraping) of the socket wall merely produces additional injury and may delay healing."

Here's an abstract from published research (2002). The last line states that the findings of their study suggest that some of the cells that contribute to bone formation after an extraction come from the periodontal ligament.

The abstract for this highly cited research paper (1994) states (last line) that cells originating in the PDL transform into bone-forming cells during extraction socket healing.

We found some sources stating what you mention above. But the ones we found by no means came close to having the same level of accepted authority as the ones we've linked to.

If your non-traditional dentist is a fresh DDS/MD oral surgeon grad, we stand corrected. But being older and more traditional, we're just not familiar with the alternative approach.

Gum coloration

I had a tooth removal and bone graft and almost 3 weeks later my gums around the site are turning dark. I called the dentist and they said not to worry. Should I be?


It's simply not possible that your dentist would mislead you on this type of issue (just imagine the liability issue involved).

If the explanation you received seems lacking, call back and ask for clarification (surely a staff member could act as intermediary). Also, make it clear that you are available for observation if they feel that is needed.

Getting full upper denture/lower partial

And I am scared to death! I've had (a few) one tooth extraction but not once!! And the dentures are immediate which seems weird.since I am having all of this done in one day and all they have done is take a scan of my mouth. I am paying in the $5K range so I guess it's the economy route, although my dentist did say he has discounted his services. I am glad to have found this site it has helped me understand a bit better how it's all done... Thanks!


Valerie, I hope your recovery is going well.

I am 67 and am considering dentures. Bad teeth since childhood, 15 crowns, some failing. Just had a molar extracted.

Could you share your thought on dentures? Most dentists oppose it. Wife and I both think dentists have a strong financial interest against dentures.

I would appreciate your thoughts on recovery from all those extractions AND how the dentures are working you for.

We hope you are doing well

Getting wisdom teeth extracted

Hi i am 24 and i’m getting my wisdom teeth extracted an the bottom left tooth is grown in side ways instead of up the other bottom right right tooth is impacted and the one top left is flat surface all four are infected and they have to be extracted in a hospital setting due to my medical issues but im really scared about getting a damaged nerve and i was wondering how likely is that, is it pretty rare?
Because I don’t know how i would live if a nerver got damaged. Im very scared as is and i will be under general anesthesia.


One would only imagine that you'll do great with your procedure.

You mention the term "hospital setting."
That implies, an oral surgeon will perform your work (as opposed to a less experienced and trained general dentist).

You also mention having "general anesthesia." That means patient cooperation will not be a factor and your surgeon will be able to solely focus on the process of removing your tooth as expertly as possible.

While always a possibility, you seem to have as many factors stacked in your favor as possible. Good luck.
Here is our page that explains dental paresthesia as related to tooth extractions. It contains a statistics section.

Tooth extraction

I had an upper molar removed 7 hours ago the dentist said at the time she was having difficulty extracting the tooth and had to ask her assistant to hold my head while she pushed and pulled eventually it came out successfully. 7 hours later I am suffering extreme pain worse than tooth ache is this normal?


As mentioned above on this page, your case might be an example where performing a surgical extraction might have resulted in creating less procedure trauma than performing it conventionally (the extraction procedure steps described on this page). But that is hindsight now.

With any extraction procedure, postoperative pain is common and not unexpected when it occurs. We discuss the issue of controlling postoperative pain during the first 24 hours here.

Rather than a website, seeking attention from your dentist makes the better plan. Dentists expect that emergencies will happen, especially with difficult extractions, and expect to hear from their patients if their assistance is needed. That is their obligation to you as your treatment provider.

oral surgery

Iam a dental student and my pt has small part of crown at level of gingiva #36 no root , which instrument can I use and why ? is Coupland straight elevator acting here or not ?????


Your description of a lower left 1st molar that exists only as a crown remnant (no root portion remains in the jawbone) seems curious.

One would expect that something like that could be pushed out using a straight (Coupland) elevator. Probably quite easily due to the fact that the remnant must only be retained in place by some sort of soft tissue attachment.

immediate denture or temporary snap-ons?

How soon after extraction do they need to be placed to stop tooth movement (in prep for future potential implant)? An oral surgeon is doing the procedure, not a prosthodontist, do I need to go to two offices in a day?


We're somewhat unclear about your question.
We think your situation is that you plan to have a tooth extracted. And you're curious about when some type of replacement tooth needs to be placed, so to keep the neighboring teeth from shifting (especially to the extent that would interfere with implant placement later on).

Historically, edentulous spaces (a location without a tooth) were allowed to persist for even 6 months to a year before finally being filled in with a completed dental implant (a new completed artificial tooth).

And while there probably is some degree of tooth shifting that takes place during this type of time frame, it's typically minimal enough that it's not problematic. Your dentist's thoughts would be the definitive opinion on this.

To shorten how long the space goes without a completed tooth, nowadays:
1) Implants are sometimes placed immediately following a tooth's extraction (same visit). Then 4 to 6 months of healing are allowed before the artificial tooth is placed on the implant.
2) In cases where an implant is placed immediately following the tooth's extraction, it may be possible to "load" the implant then too (its artificial tooth placed on it immediately).

In your case, it's not so clear that you've yet consulted about having your tooth replaced. Nor is it clear that your oral surgeon knows you plan to have an implant placed. Having made plans prior to your extraction may make one of the two options above possible (they both involve special considerations), thus shortening the period you have to go without a tooth.

In the case of #2 above, yes, you would typically have an appointment with your dentist (to have the tooth put on the implant that the oral surgeon placed) within 48 hours of the implant's placement.

Tooth extraction

The dentist didn't rock the too but kept pushing down that cause so mush pain and he and his assistant said the had to push down on the tooth. The top of the tooth had broke at the gum line and shot down the back of my throat. I have never had a dentist continual push down on a tooth to extract. Twisting or rocking was what others did. I now wonder if he was enjoying giving me so much pain. Even when I wiggled or asked him to stop in pain he didn't stop. It was a bottom front mollar and he gave me a shot in the top of the roof of my mouth. Therewas shots he said for the root and half my mouth felt numb untill he did the pushing down. It is possible he was the type who enjoyed seeing people in pain. This was my first time with him


Without any first hand information, it's difficult for us to say much. But from what you report, we can state that in regard to a lower first molar:

It's hard to understand why an injection in the roof of your mouth (hard or soft palate) would be needed. No nerve affected by an injection in that area would have a direct connection with a lower first molar.

There is an injection technique named the "Gow Gates" injection that can be used to numb up lower teeth (look on YouTube). It's given at a level higher up than one might think is associated with lower molars. Possibly the use of that method is what you are referring to.

You describe a tooth that was broken flat with the gum line. Especially in cases where the exposed aspect of the tooth is soft and mushy from decay, the options the dentist has in regard to instrument choice and their method of use might be different than with some of your previous (more intact teeth) extractions, thus explaining the differences that you noticed.

There typically is some aspect of pushing in involved with the extraction process. But you're also right, twisting and rocking motions are typical prominent actions too. However, we'd be unclear as to what degree the dentist's instruments were able to firmly grasp the tooth to do so.

It seems the dentist should have stopped and investigated the use of additional injections so to resolve the pain you noticed. But with no first hand knowledge, it's difficult to state much more than that.

5 months pregnant with pus pocket, do i need a tooth extraction?

I am 25 weeks pregnant and have a problem with my tooth#25. It has a pus pocket in the back and keeps having pus daily for the past 3 months. My dentist first thought it was from the pregnancy and ignored it. Then when it continued he said we should maybe do a root canal but all the Xrays showed no infection of the tooth and the cold test showed the nerve is alive and tooth vital. A Periodontist recommended removing this tooth because the gum pocket is 9mm and he said nothing can get this deep to clean the bacteria. My dentist then said NO, let's try to save the tooth. So he recommended starting and trying a Perio Protect which I have been using for almost 10 days now and it is not helping. It keeps having pus and starting to feel some pressure in the tooth or the pocket with light pain and I am freaking out of the infection as I am pregnant. We keep doing teeth cleaning and nothing helps. It's been a nightmare without a solution.
My question is should I remove this tooth, would that help? How dangerous is while I am pregnant. Also, I never ever take any antibiotics or meds in the past 20 years of my life. Is there a way to avoid the antibiotics, is it risky. What if they remove the tooth and the puss still comes out? I am so scared and really don't know what to do. Any advice or thoughts?
Thank you


We can't comment on your specific case (since we have no firsthand information) but in general terms:

1) Your periodontist specializes in treating conditions like yours. If they consider the tooth hopless, that's an opinion to give some weight to.

2) It's commendable that your dentist wants you to retain the tooth but we can't imagine a scenario where the Perio Protect device alone would serve as a cure for your tooth's condition (their website suggests the same). And your periodontist has already stated that the space below the gum line can't be adequately cleansed (the fundamental need in treating your tooth's condition). As such, one might expect that you'd continue to have symptoms.

3) Your condition is due to bacterial accumulation on and around the tooth's root surface deep below the gum line. If the tooth is extracted, the source of the problem will no longer exist. There's no reason not to expect that the condition will resolve. (That assumes no neighboring tooth has been affected. Your periodontist would have mentioned if any had.)

4) IF your case requires antibiotics (only your dentist can decide), there are several kinds that are safe to use during pregnancy.

5) Due to the different tooth numbering systems used, we don't know if your mention of tooth #25 is a lower right central incisor or an upper left 2nd bicuspid. Either way, the 9mm periodontal pocket should help to make the extraction process easier than usual. Teeth are routinely extracted during pregnancy.

(Here's a link to our limited content about extractions and pregnancy.)

In terms of what to do, let your dentist know you are having continued problems and your situation requires attention.

Thank you

Thank you so much for your kind reply.
My tooth #25 is my front bottom tooth and I would have to be without a tooth until my baby is born but I understand that this might be my only option.
Sorry to ask but my dentist never listens to me. Is it crazy to try to take the tooth without anesthesia considering it has mobility +1 according to the periodontist or that's too crazy?
Also considering that there's pus with bacteria around the tooth is there a chance that extracting the tooth can spread the bacteria into my bloodstream? Or once the tooth is extracted the pus would be clean and won't come back? All my concerns are for the safety of my baby.
Sorry for all my questions and I appreciate your information.


Without knowing specifics of your case, all we can say is that handling extractions during pregnancy is typically routine, without undue concern for the mother or child (in regard to the drugs used, consequences of the procedure, etc...). In your case, one would expect the extraction itself would be exceedingly easy and quick.

In some instances (mostly depending on the patient's bite and sturdiness of the neighboring teeth), it may be possible to extract the tooth, cut off the tooth's root, and then using dental bonding, bond the half-tooth back into it's space (it's bonded to the teeth on either side of the space).

That's not a permanent solution, but if the patient is careful to to bite too heavily on it, it may serve as a cheap, easy way to temporarily provide the patient with improved appearance for some months until a more permanent solution can be performed. (The bonding can be buffed off the neighboring teeth later on without causing harm to them when the 1/2 tooth is removed.)


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


No, removing #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 root canal treatment and a crown is possible for your tooth.

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.


Previously root canal tooth with crown. Crown has come off twice! Swallowed the most recent one! I have decided to get it extracted and get an implant but I do not like pain....who does? I read everything here and I am nervous!!


For anyone else reading, it wouldn't be customary to extract a tooth only because it's crown keeps coming off. In MG's case, there must be shortcomings associated with the tooth that prevents their dentist from having the option of being able to improve the retention form (shape) of the tooth and making a new crown.

MG, Your tooth doesn't have a nerve in it. And you don't mention any infection associated with the tooth. As such, numbing things up for your extraction should be very straightforward. Not necessarily much different than when your root canal work was done.

And hopefully your case is one where your implant can be placed during the same appointment when your tooth is extracted, thus saving you experiencing a second surgical procedure.

Ulcer afer extraction?

Hi, had 1st big molar top right side removed 7 days ago, top part had broken off months ago losing about 30% of it and decayed down to roots so was no saving it. Dentist twisted like crazy and top part cracked into pieces - felt like my front teeth were coming loose but they seem ok now. They drilled and pulled out the 3 roots. No major pain in socket, some pain in neighboring teeth. But noticed same day pain on palette side of tooth hole (and gum side but nothing visible there), continuing from the hole, where the gauze was resting on, about 1/4 inch long not very wide. Started as white layer which came off days later, like an ulcer. Now its like a hole of its own, extended from the tooth hole only smaller not as deep but makes it impossible to eat solid food due to pain as it touches that area. No throbbing pain, but should I be worried about an infection, and what do you think it was caused by? I read something about bad injection technique causing ulcers, or maybe drilling roots or tool ripped it up? So far just using salt water rinse. Sinus on that side seems to be a little painful now and then too. Thanks.


It's not really possible for a forum like this to be able to respond with any type of qualified answer. You need to touch base with your dentist so they can examine you and determine what level of care you require.

One could assume that any of the sources of trauma you mention might have been the cause or trigger for the ulcer's formation. Also, this case report seems reminiscent of how you characterize your lesion : Canker sore following extraction. Only your dentist will be able to figure things out.

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.

* Comments marked with an asterisk have either been edited for brevity/clarity, or have been moved to a page that's better aligned with their subject matter, or both. If relocated, the comment and its associated replies retain their original datestamps, which may affect the chronology of the page's comments section.

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