If a tooth is causing significant pain for a patient and/or cannot be successfully restored, extraction is sometimes the only option. Wisdom teeth may be extracted to alleviate discomfort or prevent a future shift in the occlusal positioning of other teeth. Most tooth extractions are not painful because the dentist will apply a local anesthetic to the area surrounding the tooth before it is extracted. If a patient is anxious about undergoing a tooth extraction, the patient may opt for nitrous oxide (laughing gas) or even general anesthesia. The extraction alone should not be painful, but the patient may still feel pressure during the process. There may however be a manifestation of mild extraction site pain and/or swelling from inflammation in the days immediately following a tooth extraction.

Most tooth extractions can be done by general dentists. However, if a wisdom tooth is impacted or below the gums, it would be wise to refer the patient to an oral surgeon with additional specialty training in complex tooth extractions. The area near the extraction site will initially be numbed with a local anesthetic. Once the extraction site is numb, the dentist has an array of tools to extract the tooth. A dental elevator is initially used to go under the gum line and twisted around to loosen the area between the socket and jawbone where the tooth is anchored. Starting a tooth extraction with elevators will minimize the possibility that the tooth will break before it is extracted. The material surrounding the tooth is compressible, and once the tooth is loosened enough it will be lifted out of the socket. If it is not possible to remove the tooth using elevators alone, at some point the dentist will switch to using extraction forceps to complete the procedure successfully.

The extraction of impacted wisdom teeth is more complex, but the most pain a patient should feel during the actual procedure is a pinch from the injection before the extraction site is anesthetized. For a fully or partially impacted wisdom tooth, the oral surgeon will initially use a surgical knife to cut the gum tissue and access the tooth. Once the incision in the gum tissue is made, the oral surgeon will use a drill to remove any impeding jawbone structure and access the impacted tooth. Once the tooth is accessible, the process of extraction is undertaken. Before a wisdom tooth extraction is undertaken, a patient’s panoramic x-rays and/or CBCT scans should be comprehensively reviewed to minimize the possibility of paresthesia caused by damaging the inferior alveolar nerve. Once the extraction procedure has begun, if it is revealed that removing the full tooth raises the possibility of paresthesia, the oral surgeon may instead opt for a coronectomy and leave a portion of the tooth along with the root while removing the coronal part of the tooth causing discomfort to the patient. Damage to the inferior alveolar nerve may result in temporary or even permanent numbness in the lips and chin along with possible speech difficulties.

Following an extraction, the dentist or oral surgeon will remove any residual pathological tissue in the socket and irrigate the socket with saline solution to remove any remaining tooth or bone fragments. After a surgical extraction, it may even be necessary to place stitches to minimize the amount of bleeding. Once the extraction is complete, the patient will be instructed to bite down on gauze to create firm pressure around the extraction site until the bleeding is controlled. The dentist will often issue a prescription for ibuprofen or an opioid painkiller to negate the sensation of pain after the anesthetic dissipates. The patient may also be instructed to take a course of antibiotics following an extraction. If postoperative instructions are properly followed, the tooth extraction site should be fully healed within 2 to 3 weeks.