Tooth Extraction – Remove Unhealthy Teeth

Tooth extraction is the procedure of removing a tooth from its socket in the bone. If a tooth is damaged by decay or cracked, repair with a filling, crown or another treatment will often be used. However, sometimes, there’s too much damage for the tooth to be repaired. In this case, the tooth needs to be extracted. A very loose tooth will also require extraction if it can’t be saved, even with a bone graft.

Other Reasons for Tooth Extraction

  • Some people have extra teeth that prevent new teeth from coming in.
  • Sometimes baby teeth don’t fall out out in time to let the permanent emerge.
  • People getting braces may need teeth to be extracted to make space for the teeth that are being shifted into position.
  • People who are getting radiation to the head and neck may need teeth in the area of radiation to be extracted.
  • People who are taking cancer drugs may develop infected teeth because these drugs cause the immune system to weaken. Infected teeth may require extraction.
  • Some teeth may need to be removed if they become infected after an organ transplant. People with organ transplants have a large risk of infection since their prescribed drugs weaken or suppress the immune system.
  • Wisdom teeth, or third molars, are typically extracted either before or after they come in. They commonly emerge during the early 20s or late teens. They need to be removed if they are causing pain, decayed, or infected. These teeth often become lodged in the jaw (impacted) and will not erupt. This can cause the gum to be irritated, causing pain and swelling. In this situation, the tooth needs to be extracted. If all four wisdom teeth need removal, they are usually removed at the same time.


An X-ray will be taken of the area to help plan the tooth removal. Your full medical and dental history and a list of all medications you take will be needed as well.

If you are having wisdom teeth removed, you may need a panoramic X-ray. This will take a picture of all of your teeth at the same time. It can reveal many things that assist with guiding the extraction:

  • The impact of your wisdom teeth on your adjacent teeth
  • The upper teeth’s relationship to the sinuses
  • The lower teeth’s relationship to a nerve in the jawbone that provides feeling to the  lower jaw, lower teeth, lower lip and chin. This nerve is called the inferior alveolar nerve.
  • Any infections, bone disease, or tumors that might be inside the mouth

In some cases, antibiotics will be prescribed for before and following surgery. This practice may vary depending on the patient’s condition, or the dentist’s opinion. Antibiotics are more likely be prescribed if:

  • There is an  infection during surgery
  • Your  immune system is depleted
  • You will have a long surgery
  • You have a specific medical condition

Following the extraction, someone needs to drive you home. Your doctor will provide you with post-surgery instructions. It is necessary that you follow them.

How It’s Performed

There are two kinds of tooth extractions:

  • A simple extraction is done on a tooth that is visible in the mouth. General dentists perform simple extractions often. During a simple extraction, the tooth will be loosened using an instrument called an elevator. Then, an instrument known as a forceps will be used to extract  the tooth.
  • A surgical extraction is more complex. This happens if a tooth has broken off at the gum line or if it has not emerged yet. Surgical extractions will usually be performed by oral surgeons, but general dentists will also perform them. The doctor makes a small incision into the gum and sometimes removal of some of the bone around the tooth or cutting the tooth in half is required in order to extract it.

Most simple extractions can be done with an injection (a local anesthetic). Sometimes you might receive drugs to help you relax. For a surgical extraction, you will receive a local anesthetic, anesthesia may be administered through a vein (intravenous).

If you are receiving conscious sedation, steroids and other medicines may also be distributed in your IV line. The steroids will help reduce pain and swelling after the procedure.

During a tooth extraction, patients should expect pressure, but not pain. If you experience any pain, you should tell your doctor.

Following The Procedure

  • Your doctor will provide you with detailed instructions on how to prepare and what you should expect before and after your surgery. If you have any questions, be sure to ask them before leaving the office.
  • You can expect some slight discomfort even after simple extractions. Your doctor will likely prescribe pain medication but you can take over-the-counter drugs such as ibuprofen, Advil, Motrin and others. Take the dose recommended by your doctor.
  • Surgical extractions typically cause pain after the procedure. The amount of discomfort and duration depends on the difficulty of the extraction. Most pain subsides after a couple of days.
  • A cut in the mouth will often bleed more than a cut on the skin because it can’t dry over and scab. After the procedure, your dentist will instruct you to bite on a piece of gauze for 20 to 30 minutes. This lets the blood clot. Gradually, the bleeding should stop after the following day. You should not disturb the clot that is formed on the wound.
  • You can apply ice packs and/or warm compresses  in order to reduce swelling..
  • Eat cool or soft food for the next few days. Once you feel comfortable, you can try eating other foods.
  • You can rinse your mouth with warm salt water gently, starting 24 hours following the surgery, this can assist with keeping the site clean.
  • If you need stitches, your doctor will likely use the dissolving kind. This will take from one to two weeks. Rinsing with warm salt water will help stitches dissolve. Some stitches require removal by the dentist or surgeon.
  • You should not smoke, use a straw or spit after surgery. Doing this can remove the blood clot from the area where the tooth was. Do not smoke on the day of surgery or for 24 to 72 hours following your tooth removal.

Risks of Tooth Extraction

A problem known as a dry socket develops in about 3% to 4% of all extractions. This occurs when a blood clot is not formed in the hole or if it breaks down too soon.

In a dry socket, the underlying bone is exposed to the oral environment. This can be very painful and can cause a bad taste or odor. Dry sockets typically start to cause pain the third day after surgery.

Dry socket occurs up to 30% of the time when impacted teeth are removed. Difficult extractions can also increase the odds of a dry socket. Smoking on the day of surgery also increases the risk. Smokers and women who are taking birth control pills have higher odds of getting a dry socket. A dry socket needs to be treated with a medicated dressing to stop the pain and promote healing.

Infection can take place following an extraction. However, you likely won’t develop an infection if you have a healthy immune system.

Other potential problems are:

  • Accidental damage to nearby teeth, like cracking of fillings
  • An incomplete extraction, where a tooth root remains in the jaw — Your dentist will usually remove the root to avoid infection, but sometimes it is less of a risk to leave a small root tip in place.
  • A fractured jaw from the pressure applied to the jaw during tooth removal — This occurs more often in older people with osteoporosis (thinning) in the jaw bone.
  • The sinus is punctured during extraction of an upper back tooth (molar) — A small hole will usually will heal by itself in a few weeks. If not, more surgery may be required.
  • Jaw muscles and/or jaw joint soreness — Opening your mouth wide may be difficult. This can happen because of the injections, holding your mouth open and/or lots of pressure on your jaw.
  • Numbness in the lower lip and chin lasting for a long period of time — This is an rare issue. This is due to injury to the inferior alveolar nerve in the lower jaw. Complete healing can take three to six months. In rare cases, the numbness may be permanent.

When You Should Call a Professional

Get in touch with your oral surgeon or dentist if:

  • The swelling worsens.
  • You get a fever, chills or redness
  • You have trouble swallowing
  • There is bleeding in the area that will not stop
  • The area continues bleeding or oozing after the first full day
  • Your tongue, chin or lip is numb for longer than 3 to 4 hours after the procedure
  • The extraction site becomes extremely painful — This can be an indication of a dry socket.

If there is an infection present, your dentist usually will prescribe antibiotics.

Get a safe tooth extraction procedure from Dr. Ahmed in the Bay Area. Schedule an appointment at his professional dental practice in Oakland, CA, just fifteen minutes from Alameda and Berkeley.


Committed to Exceptional Dental Care

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Zahid H. Ahmed, DDS, FICOI, FAGD

Dr. Zahid Ahmed combines current advances in dentistry with holistic health to bring patients the best possible dental care. His goal is to provide patients with personalized service, creating lasting relationships based on trust and expertise.

Dr. Ahmed received his DDS from the University of Michigan School of Dentistry. He has worked as an Assistant Clinical Professor at UCSF and maintains a position as Clinical Instructor at Stanford University. He is recognized as a Fellow in both the Academy of General Dentistry (FAGD) and the International Congress of Oral Implantologists (FICOI). He believes continuous learning in dentistry allows him to stay current, and provide the best possible dental care for his patients.

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