Tooth extraction can be performed with local anesthesia if the
tooth is exposed and appears to be easily removable in one piece.
The dentist or oral surgeon uses an instrument called an elevator
to luxate, or loosen, the tooth; widen the space in the underlying
bone; and break the tiny elastic fibers that attach the tooth
to the bone. Once the tooth is dislocated from the bone, it can
be lifted and removed with forceps.
If the extraction is likely to be difficult, a general dentist
may refer the patient to an oral surgeon. Oral surgeons are specialists
who are trained to administer nitrous oxide (laughing gas), an
intravenous sedative, or a general anesthetic to relieve pain.
Extracting an impacted tooth or a tooth with curved roots typically
requires cutting through gum tissue to expose the tooth. It may
also require removing portions of bone to free the tooth. Some
teeth must be cut and removed in sections. The extraction site
may or may not require one or more stitches (sutures) to close
In some situations, tooth extractions may be temporarily postponed.
These situations include:
Infection that has progressed from the tooth into the bone.
Infections may complicate administering anesthesia. They can be
treated with antibiotics before the tooth is extracted.
Use of drugs that thin the blood (anticoagulants). These
medications include warfarin (Coumadin) and aspirin . The patient
should stop using these medications for three days prior to extraction.
People who have had any of the following procedures in the
previous six months: heart valve replacement, open heart surgery,
prosthetic joint replacement, or placement of a medical shunt.
These patients may be given antibiotics to reduce the risk of
bacterial infection spreading from the mouth to other parts of
Before extracting a tooth, the dentist will take the patient's
medical history, noting allergies and other prescription medications
that the patient is taking. A dental history is also recorded.
Particular attention is given to previous extractions and reactions
to anesthetics. The dentist may then prescribe antibiotics or
recommend stopping certain medications prior to the extraction.
The tooth is x rayed to determine its full shape and position,
especially if it is impacted.
Patients scheduled for deep anesthesia should wear loose clothing
with sleeves that are easily rolled up to allow the dentist to
place an intravenous line. They should not eat or drink anything
for at least six hours before the procedure. Arrangements should
be made for a friend or relative to drive them home after the