When a tooth has to come out, and what happens next
We take a tooth out when keeping it would cost you more than losing it. That is a real judgement, not a default, and it is worth understanding how it is made — because the alternative to an extraction is usually a root canal and a crown, and that is often the better deal.
Reasons a tooth cannot be saved
- A crack running below the bone. There is nothing to seal against, so a restoration will leak and the tooth will keep hurting.
- Too little tooth left. A crown needs something to hold onto. Below a certain point there is nothing to build on.
- Advanced gum disease. The tooth may be sound and still be loose, because the bone holding it has gone. See periodontal treatment.
- Infection that will not resolve, including a re-treated root canal that has failed again.
- Impacted or crowded teeth, most often wisdom teeth, or teeth removed to create space for orthodontics.
Simple and surgical extractions
A simple extraction is for a tooth that is fully through and reachable with instruments; it is often over in a few minutes. A surgical extraction is needed when the tooth is broken at the gumline, impacted, or has curved roots — the tooth is exposed through a small opening and usually sectioned so it can come out in pieces. Sectioning sounds worse and is actually gentler, because it removes less bone.
The appointment
- X-ray and plan. Root shape and position relative to the nerve and the sinus decide the approach.
- Anaesthetic. Local as standard, with sedation available for anxious patients and complex cases.
- Removal. You feel firm pressure and movement, not pain. Tell us immediately if you feel anything sharp.
- Closing. The socket is cleaned, sometimes sutured, and you bite on gauze until a clot forms.
Healing, and the one thing to avoid
The blood clot in the socket is the healing. Everything in the aftercare exists to protect it: no straws, no smoking, no vigorous rinsing or spitting for the first few days, because suction pulls it out. Losing it causes dry socket — a deep ache spreading toward the ear around day three to five, and more painful than the extraction. It is easy to treat, so call us rather than waiting it out. Expect swelling to peak at 48 to 72 hours, soft food for a few days and a return to normal within a week or so.
Replacing the tooth
Decide this early, ideally before the extraction. The jawbone starts resorbing at the site within months, and the teeth either side begin to drift. A socket-preservation graft placed at the time of extraction keeps the site ready for an implant later and is far simpler than rebuilding the bone afterwards. Your options are an implant, a bridge, or a partial denture — compared side by side on options for replacing missing teeth. Back teeth count too, even when nobody can see the gap.
