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Want a tooth out? Tooth extraction: when it is needed, and how it is done

An extraction takes out a tooth that can no longer be kept, or has started doing harm, such as a tooth broken down to its root or a wisdom tooth that keeps getting infected, and it is done under local anaesthetic. But because it is your tooth and it does not come back, the examination and the x-ray decide first whether something can save it; if nothing can, it is carried out calmly, and you know what comes after.

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A thin terracotta line drawing on handmade paper: a molar lifting gently out of its place above the gum line, with olive sprigs around.

What an extraction is, when it really is the answer, and wisdom teeth

Most people who say “I want it out” arrive with pain, a broken tooth, or a wisdom tooth that has been giving them trouble. An extraction takes the whole tooth out, root and all, and leaves a gap that does not fill itself. That is why the first question at the examination is not “how do we take it out?” but “can it be kept?”. The decision to extract comes after it is clear that the tooth cannot be kept, or that having it there has started to harm what is around it, or when an orthodontic plan, after the examination, needs room that cannot be made another way.

Before you have it out: what might save your tooth

A tooth that hurts does not have to come out. Pain usually means there is inflammation or infection; it does not tell you whether the tooth can be kept. Depending on what the examination and the x-ray show, there are routes that can leave your tooth where it is; the most common are three:

A root canal. When the infection has reached the nerve, and the root and the bone around it still allow it. If the tooth can still be kept, a root canal removes the source of the infection and leaves your tooth in place on its own root.
A crown. When the tooth is weak or broken, but enough of it is left to hold on to.
A filling. When the decay has not reached the nerve yet, and the tooth is still strong.

How the choice between keeping a tooth and taking it out is made, and what you gain and lose on each road, is set out in Extraction or root canal: how it is decided.

When extraction really is the answer

When the tooth can no longer be kept. Not when it hurts, and not when the treatment would take longer. Or when having it there has started to harm what is around it, or when an orthodontic plan needs room that cannot be made another way:

A break that reaches the root. A fracture running below the gum and the bone, or a root cracked along its length: nothing clean is left to build on, and the bacteria in the mouth reach the break. In a limited number of cases, if enough root is left, there are ways to expose the break or bring the root up a little so the tooth can be kept. The examination decides whether your tooth is one of them.
Decay that has left nothing. Decay that has eaten the tooth down below the gum, with nothing left for a filling or a crown to hold on to.
Advanced gum and bone disease. Bone loss from advanced gum disease makes the tooth loose, and a tooth with no bone to hold it cannot be kept with a root canal.
Braces that need room. This is the one case on this list where the tooth itself may be healthy. Very crowded teeth need room to line up, and that room is made by light filing between the teeth, by gentle widening in a child, or by an extraction, so an extraction here is sometimes the way, not always. It is decided with the orthodontic plan, after the examination and the x-ray, not before.
A wisdom tooth doing harm. It keeps getting infected, or it or the molar beside it decays because it is hard to clean. More on it just below.

And wisdom teeth?

A wisdom tooth is a case of its own. The question there is not “can it be kept?” but what it looks like on the x-ray, how close it sits to the nerve, and how often it gets infected. And not every wisdom tooth has to come out:

It stays when it has come through and is causing no trouble: it does not get infected, you can clean it, and it does not harm the molar beside it. Then it is watched at your regular check-ups, and it is not taken out just because it is there. If it is buried or half under the gum and causing no trouble, the decision comes from the x-ray and the examination; it is not automatically an extraction.
It comes out when it causes trouble: the gum over it gets inflamed and swollen time after time, there is decay in it or in the molar beside it, food keeps catching around it and cannot be cleaned, or it presses on the molar beside it.

Wisdom teeth come through at all angles: fully through, half under the gum, or buried in bone. The x-ray shows where it sits and how close it is to the nerve, and that decides how it is removed, simple or surgical, and how we prepare for it.

And your children’s teeth? A baby tooth holds the space for the permanent tooth beneath it, so we treat and keep it whenever there is a way to. Extraction becomes the choice when the tooth can no longer be saved, or when the permanent tooth beneath it is ready to come through anyway. The decision comes from the examination and the x-ray, not from age alone. The details are on Children’s dentistry.

How an extraction is done, step by step

A simple extraction is usually done in one visit. Here are the steps as they are, with no minutes attached, because the timing for your case is something you find out at the examination.

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The examination and the x-rayThe doctor examines the tooth, its gum and the teeth beside it, and a digital x-ray in the clinic shows the roots, the bone around them, and how close they sit to the nerve in the lower jaw or the sinus in the upper jaw. Whether your case needs a more detailed image is decided at the examination. And the first question: can it be kept or not? If extraction is decided, you are told why, whether it is simple or surgical, and what comes after, before anything starts. The cost is discussed after the examination, and what changes it, simple or surgical and where a wisdom tooth sits, is explained on What decides the cost of your treatment.
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Tell us about your health and your medicinesEvery condition you have and every medicine you take, especially blood thinners, diabetes, blood pressure, medicines for the bones, and whether you are pregnant. And do not stop any medicine on your own: the doctor decides whether the plan needs adjusting, or coordination with your own doctor before the extraction.
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Local anaestheticThe area is numbed before we begin: you are told before the injection, not after it. The prick itself is short and you do feel it; then the area goes numb. If the fear is strong, there is laughing gas alongside the local anaesthetic, not instead of it: a small mask over the nose, and you stay awake and can talk. It is an option the doctor decides on at the examination, for your case, not over the phone.
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The extraction itselfOnce you are numb, you usually feel pressure and movement, not pain; if you feel pain, you raise your hand and we stop, and more anaesthetic is given if it is needed. And honestly: a few steps cannot be interrupted halfway; you know which before we begin, not in the middle. A tooth that is visible with straight roots comes out with a simple extraction. A tooth broken below the gum, or a wisdom tooth buried in bone, needs a surgical extraction with more steps: a small opening in the gum, sometimes dividing the tooth into pieces so it comes out with less pressure on the bone, and stitches if needed. Either way, the aim is to take the tooth out and leave the bone and gum around it as intact as possible.
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The gauze and the instructionsOnce the tooth is out, a piece of gauze is placed over the site, and you bite on it firmly so the bleeding stops and a clot can form to close the socket. You are told the instructions for the first few days, and you leave the clinic knowing what to do on the first day, and who to call if something comes up.
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Follow-upAfter a surgical extraction, or if your case needs it, a follow-up appointment is set for the doctor to see how the site is healing. And if the replacement for the tooth has not been decided yet, it is talked through then too.

After the extraction: the first few days, and what replaces the tooth

The first few days are what protect the site while it heals. The blood that clots in the socket is what closes it, and most of the instructions are there to keep it in place:

Bite on the gauze firmly, for as long as the doctor tells you. Light bleeding, or saliva tinged with blood on the first day, is expected.
No sucking, no straws, no spitting, and no smoking for the first stretch, and the doctor tells you how long. Any of these can pull the clot out of place, and that delays healing and hurts.
Soft, cool food. Until the numbness wears off, do not eat on the numb side, and do not drink anything hot, so you do not bite your cheek or tongue, or burn yourself, without feeling it. After that, for the first few days, soft food that is cool or lukewarm, on the other side.
Rinsing starts when the doctor tells you, not before, and gently. Brush the rest of your teeth as usual, and keep away from the extraction site for the first few days.
Some discomfort and mild swelling for the first few days are expected, and they settle with the days. And a suitable painkiller the doctor decides on, not something to pick up on your own.

Drag and see: the socket as it heals

An illustration. The blood that clots there is what protects the site while it heals, and that is why the instructions matter.

Some signs do not wait; they are listed under When to call.

And what replaces the tooth

After an extraction there is a gap, and it needs a decision. If it stays empty for a long time, the teeth beside it can lean into it over time, the tooth facing it may drift towards it, and the bone underneath shrinks little by little. You do not have to decide this week. Just do not leave it for years. There are three options:

An implant. A small root in the jawbone where the tooth stood, with a crown on top, not leaning on the teeth beside it. If it is on your mind, say so before the extraction, because the extraction is done differently when an implant is in the plan. The details are on Dental implants.
A bridge. A false tooth carried on two crowns over the teeth on either side of the gap. No surgery, but the two neighbours are trimmed.
A denture. A removable plate that rests on the gum and holds on to the teeth beside it.

The examination decides which suits your tooth and its place. Sometimes the gap does not need replacing at all, a wisdom tooth for instance. How an implant and a bridge differ in your daily life: Implant or bridge: what actually differs.

The downsides and the limits, before the advantages

You are told the limits of an extraction before its advantages, so you decide knowing exactly what you are deciding:

The tooth does not come back. This is the biggest downside, and it is why the decision to extract comes after it is clear the tooth cannot be kept, or that your treatment plan really needs it, not at the height of the pain.
It leaves a gap that needs a decision. Replace it or not, with what, and when. And the replacement is a road of its own, with its own steps and its own time (the section above).
A socket that does not heal as it should. Sometimes the blood clot comes out of place or does not form well, and the bone beneath it is exposed; this is what is called a “dry socket”. It shows as pain that grows a few days later instead of easing, sometimes with a bad taste or smell. It happens more in smokers and after a surgical extraction, and the instructions for the first few days make it less likely. If it happens, it is treated at the clinic: call.
Nerves and the sinus. In the lower back teeth, and with wisdom teeth especially, a nerve runs close to the roots, and rarely, numbness in the lip, chin or tongue can last; any numbness that stays after the anaesthetic wears off is reported the same day. In the upper back teeth, the roots sometimes sit close to the sinus. That is why the x-ray before an extraction is not a formality: it shows how close they are, and if that closeness changes anything in how the tooth is taken out or in the instructions afterwards, you are told before we begin.

And the advantages

It removes the source of the pain or the infection, in the same sitting, when the tooth itself is the source.
One procedure, usually done in a single visit. A surgical extraction takes longer in the same sitting.
It protects what is around it. When the tooth can no longer be kept, or a wisdom tooth gets infected time after time, an extraction is sometimes what protects the bone and the teeth beside it.

When it is not right for now, or should wait

In these cases the answer is usually not “no”. It is “not now”, or “with a different arrangement”, and you hear what has to happen first:

Swelling or an active infection. Extracting through an active infection is harder. Sometimes the infection is treated first at one visit, and the extraction afterwards is usually easier. And do not start an antibiotic on your own: the doctor decides.
Blood thinners. Not a closed door in many cases, but the plan changes: arrangements for bleeding, and sometimes coordination with your own doctor beforehand. And do not stop them on your own, before the appointment or after it.
Diabetes that is not under control. High blood sugar slows healing and makes infection more likely. So an extraction that can wait, waits until your blood sugar is under control with your own doctor, and an urgent one is arranged around your case.
Pregnancy. Mention it on the first call. An urgent extraction, with pain or infection, does not wait, and it is done in coordination with your obstetrician. A planned one, such as a wisdom tooth already planned for removal that is quiet for now, or an extraction for braces, usually waits for a suitable time the doctor decides.
Medicines for the bones, or radiotherapy. Some medicines given for osteoporosis or alongside cancer treatment, and radiotherapy to the jaw area, change how bone heals. Not necessarily a closed door, but say so in your first sentence, and the doctor may need to speak with your own physician before deciding.

So, take it out now, or wait?

“Just pull it and be done” is something pain makes a lot of people say, and it is understandable. But a decision made at the height of the pain lets the pain decide for you, and an extraction cannot be undone. The examination decides whether your tooth can be kept, and if not, when it comes out and what has to happen first. What does not wait is strong pain, swelling and fever: with those, call today.

What to do from now, and when to call

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Hurting now?Book as soon as you can, and do not settle on an extraction while you are in pain: the earlier you come, the more room there is for the options that keep the tooth. Do not start an antibiotic on your own. What to do until the appointment: Toothache: what to do right now.
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Been told it has to come out, and want to be sure?You have every right to understand first. Book an examination and bring any x-ray you have.
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Have your list of medicines readyEvery medicine you take, any long-term condition, and whether you are pregnant, written down and ready for the first visit.
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If an implant is on your mindSay so before the extraction, wherever it is done, because the way the tooth comes out helps preserve the bone when an implant is in the plan.
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If you are in Amman for a whileIf you are only in Amman for a stretch, a posting, a contract, a semester, or you come and go, say so at the first visit. The extraction itself is usually done in one visit, but the decision before it and the replacement after it take time: the site needs its first few days to settle, and an implant heals on its own clock. So the order of things is built around your dates from the first visit, and it is fairer to hear that before you book flights than after. If this tooth has been x-rayed or treated abroad, bring whatever you have.
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Book the examinationIt decides whether your tooth can be kept, and if not, how it comes out and what comes after. And you decide after it, in your own time, with no pressure.

When to call

Most of what happens after an extraction is expected: some discomfort and mild swelling for the first few days. But some signs do not wait, whether the tooth is still in, or you had it out with us or anywhere else:

Call today: bleeding that does not stop with pressure on the gauze.
Call today: pain that grows after it had been easing.
Call today: swelling that grows instead of easing, or a fever.
Call today: a bad taste or smell from the extraction site, with pain.
Call today: numbness in the lip, chin or tongue that has stayed after the anaesthetic wore off.
Call today: strong pain in a tooth that has not been extracted, or pain that wakes you at night.
Call today: a tooth that hurts and has not been extracted yet, with swelling in the gum or the cheek, or a fever.

Call and we will find you the earliest slot, and tell you what to do until you arrive. Before any painkiller, ask the doctor first, so it suits your case. If the swelling has reached your eye, or it has become hard to swallow or breathe, that is a hospital emergency, not an appointment. If the clinic is closed and the bleeding will not stop with pressure, or the swelling is growing, or you have a high fever, go to the nearest hospital emergency department. Let us know as soon as we open. And if a tooth that has not been extracted is hurting right now: Toothache: what to do right now.

And who treats you?

The clinic has a team of dentists, Dr. Adnan Alakhras among them. At the first visit you hear the state of the tooth, its roots, its gum and the bone around it, and usually whether it can be kept at all, before you hear a word about extraction. Sometimes the answer needs a second x-ray. His qualifications are on his page: Read about the doctor and the clinic.

Questions people ask

Does it hurt?

An extraction is done under local anaesthetic: the area is numbed before we begin, and you are told before the injection, not after it. The prick itself is short and you do feel it; then the area goes numb. Once you are numb, you usually feel pressure and movement, not pain; if you feel pain, you raise your hand and we stop, and more anaesthetic is given if it is needed. And honestly: a few steps cannot be interrupted halfway; you know which before we begin, not in the middle. Once the numbness wears off, some discomfort and mild swelling for the first few days are expected, and they settle with the days; if the pain starts growing instead of easing, call. Before any painkiller, ask the doctor first, so it suits your case. If it hurts badly now and the clinic is closed: what to do until morning. If fear itself is the problem, say so from the first moment and we will go at your pace, and laughing gas is an option the doctor decides on at the examination. When the visit is hard.

How long does it take?

The extraction itself is usually done in one visit, and a simple extraction is quicker than a surgical one, because a surgical extraction has more steps in the same sitting. If there is an active infection, it is sometimes treated first at one visit, and the extraction comes after. The timing for your case is discussed at the examination, as an expectation, not a promise. After the extraction, the site needs the first few days to settle, and if the tooth is to be replaced, that is a road of its own with its own time. If you are only in Amman for a stretch, say so before anything starts, and the visits are planned around your dates.

Are there payment plans?

Not at the moment. The doctor is looking into it, and wants a trustworthy partner before he commits to anything; the details are under Payment and insurance on What decides the cost of your treatment. What you can do now: book the examination, and the decision after it is yours. You will find out whether your tooth can be kept at all, and if not, whether the extraction is simple or surgical, and what comes after. The cost itself is discussed after the examination, not over the phone.

Can I have a tooth out while I am pregnant?

It is decided with the doctor, so mention it on the first call. An urgent extraction, with pain or infection, does not wait, and it is done in coordination with your obstetrician. An extraction that can wait, such as a wisdom tooth already planned for removal that is quiet for now, usually waits for a suitable time the doctor decides. X-rays and anaesthetic in pregnancy are talked through at the examination: an x-ray that can wait, waits, and one that is needed for a diagnosis is taken with the precautions the doctor decides for your case; the local anaesthetic and any painkiller are decided for your case and how far along you are; and laughing gas is postponed during pregnancy. The same rule is explained in Braces during pregnancy: what waits and what doesn’t.

Can I have a tooth out if I take blood thinners?

In many cases, yes, but the plan changes: arrangements for bleeding, and sometimes coordination with your own doctor before the extraction. And do not stop any medicine on your own, before the appointment or after it: anything arranged around your medicine is the doctor's decision, and he may need to speak with your own physician first. Mention every medicine you take at the first visit.

What should I avoid after an extraction?

For the first stretch after the extraction: no sucking, no straws, no spitting, no smoking, no rinsing until the doctor tells you, no eating on the numb side until the numbness wears off, and nothing hot. The reason is the same for all of them: the blood that clots in the socket is what protects it and lets it heal, and any of these can dislodge it. How long that stretch lasts, the doctor tells you on the day of the extraction. The details are under After the extraction.

Do I have to replace the tooth?

Usually yes, unless the doctor decides with you that this particular gap does not matter, a wisdom tooth for instance. A gap left empty for a long time can let the teeth beside it tilt over time, the tooth opposite drift down, and the bone recede. The replacement can be an implant, a bridge or a denture; the examination decides which suits your tooth and its place. It is worth talking through before the extraction, especially if an implant is on your mind, even if the final decision comes later. You do not have to decide this week. Just do not leave it for years. Implant or bridge: what actually differs.

We suggest only the treatment you need, we tell you why, and we protect your tooth before we think about extraction.

Your next step

The examination. You come in, you are examined, and you find out whether your tooth can be kept or not, and why. If extraction is the answer, you know how it is done, whether it is simple or surgical, and what replaces the tooth afterwards. Whether you live around the corner or are only in Amman for a while, you then decide in your own time, with no pressure.

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Pages that go with this one

Written by: RyanMedical review: Dr. Adnan Alakhras · pending approvalSources: The clinic's services as published: tooth extraction, wisdom tooth extraction, surgical extraction and treatment of dental infections under local anaesthetic; laughing gas for children and adults; and digital x-rays in the clinic · American Dental Association, patient page on tooth extraction · NHS, patient page on wisdom tooth removal · American College of Obstetricians and Gynecologists, guidance on oral health during pregnancy · Questions patients actually ask, in Amman and from abroad

This page explains extraction in general; it is not a diagnosis of your case. The decision is made at the examination and on the x-ray, and the cost is discussed after the examination.