This article is general information for our patients, not a diagnosis. If something in your mouth hurts, changes, or worries you, have it examined.
Having a tooth out is a routine procedure done under local freezing, and usually more straightforward than people fear. If you’re wondering whether the tooth can be kept instead, whether to save a tooth or take it out explains how I weigh that call.
Whether a tooth needs to come out, how, and what your risks are comes from your history, the exam and the X-ray (sometimes a 3D scan), read together. Any one alone can point the wrong way.
What happens when a tooth comes out
An extraction is the removal of a tooth from its socket: we numb the area, gently widen the socket and ease the tooth free, so what you feel is firm pressure and rocking, not cutting. Most simple extractions take only a few minutes.
Some teeth lift out whole and quickly. Others, such as badly broken-down teeth, curved roots, or wisdom teeth that are still partly buried, may need a “surgical” extraction. That means lifting the gum a little, sometimes removing a small amount of bone or dividing the tooth. It’s done under the same freezing and is often gentler on the bone than forcing a stubborn tooth. The X-ray usually shows which approach is needed, and I’ll talk you through it first.
Will I be awake, and will it hurt?
You stay awake for most extractions, but the area is fully frozen, so you feel pressure rather than sharp pain. The freezing (local anaesthetic) blocks the nerve to that tooth and gum. You’ll still feel pushing, pulling and the sounds of it. Feel anything sharp at any point? Lift your hand and I’ll add more.
If dentistry genuinely stresses you, say so before we begin. We work at your pace, tell you what is about to happen before it happens, and stop the moment you raise a hand.
Looking after the socket afterward
For the first 24 hours, the job is to protect the blood clot in the socket, because it’s the foundation your gum and bone heal over.
The first 24 hours
- Bite on the gauze for a full 30 minutes by the clock, with no peeking and no spitting. Still oozing? Fresh gauze, bite another 30.
- Rest, head up. Use an extra pillow that night; skip the gym, heavy lifting and hot baths.
- Leave the area alone. No rinsing, swishing or poking the socket. No smoking, vaping, alcohol or straws: suction can pull the clot straight out.
- Eat soft and lukewarm. Yogurt, scrambled eggs, mashed potatoes, lukewarm soup, a spooned smoothie. Chew on the other side.
- Ease discomfort early. A standard over-the-counter painkiller usually settles the soreness as the freezing fades; ask your pharmacist which one suits you, particularly if you take other medicines or live with something like ulcers or asthma.
Days 2 to 7
- Start gentle salt-water rinses. From the next day, rinse with warm salt water a few times daily and after meals, letting it fall out rather than swishing.
- Brush as normal, just gently around the socket.
- Watch which way the pain is heading. Ordinary healing eases a little each day. Pain that climbs instead, often with a foul taste, can mean a dry socket (below). Phone us about that pattern.
- Expect steady improvement. Most people feel much better within a week; a surgical site or a wisdom tooth can take longer.
What can go wrong
Most extractions heal without trouble, but bleeding, swelling, infection, dry socket and, less often, nerve or sinus problems can happen. If anything below sounds like you, call and let us look.
| What tends to be normal healing | What’s worth a call |
|---|---|
| Oozing for a few hours; soreness as the freezing fades | Bleeding that soaks through gauze after 30 minutes of firm pressure |
| Swelling and bruising peaking around day 2 to 3, then easing | Swelling that spreads or keeps growing after day 3 |
| Steady improvement over the first week | Pain that gets worse after day 3, often with a foul taste |
| A small numb patch that fades as the freezing wears off | Numbness in the lip or tongue that hasn’t begun to fade within 1 to 2 weeks |
Bleeding. A little oozing for a few hours is expected. A second burst can come hours later as the freezing, which also tightens the blood vessels, wears off. Same fix: sit up, fold clean gauze into a firm pad, bite on the socket for 30 minutes. If it keeps soaking through, call us.
Swelling and bruising. Common after surgical extractions and lower wisdom teeth, peaking around day 2 or 3. A cold pack on the cheek, 15 minutes on and 15 off, helps on the first day. Some jaw stiffness can follow and usually eases over several days.
Infection. Less common, and it tends to show up later, around days 5 to 10, with increasing swelling, a bad taste or pus, sometimes a fever. It needs a look.
Dry socket. If the protective clot is lost too early, the bone underneath is left exposed. The result tends to be a deep, throbbing ache, often spreading to the ear, that starts around day 2 to 5, is usually worst near day 3, and brings a foul taste. It follows roughly 2 to 5 of every 100 routine extractions, and as many as about 25 to 30 in 100 after a surgical lower wisdom tooth. Smoking is the biggest risk you can control: smokers get it several times more often. It isn’t a true infection, it settles over a week or two, and a soothing dressing usually brings quick relief. More in dry socket — what it feels like and how we treat it.
Sinus opening (upper back teeth). The roots of upper molars sit close to the sinus. Occasionally removing one leaves a small opening; signs include air or liquid passing from the socket to your nose, or a salty taste. I check for this and, if needed, place a stitch and give “sinus precautions”: no hard nose-blowing, sneeze with your mouth open, no straws for two weeks. Small openings usually close on their own.
Nerve problems (lower wisdom teeth). Two nerves run close to the lower wisdom teeth, one feeding the lower lip and chin, the other the side of the tongue. Removing a tooth that sits against one can leave a patch of numbness or tingling. For most people this recovers over weeks to months; lasting numbness is rare (well under 1 in 100), and the risk rises when the X-ray shows tooth and nerve touching. Then I look closer, sometimes with a 3D scan, and may suggest an oral surgeon, or leaving the deepest root tips near the nerve.
Blood thinners and bone medicines
Usually you keep taking them — never stop a prescribed blood thinner or bone medicine on your own; tell us what you take and we’ll plan around it safely. Stopping a blood thinner without your doctor’s say-so can raise your risk of a clot, stroke or heart attack, which almost always outweighs the bleeding we can manage in the chair.
| Tell us if you take | Examples | Why it matters |
|---|---|---|
| Blood thinners | warfarin (Coumadin), apixaban (Eliquis), rivaroxaban (Xarelto), dabigatran (Pradaxa), clopidogrel (Plavix), daily aspirin | They raise bleeding risk. We usually keep you on them and use extra local measures (packing, a stitch, a clot-protecting mouthwash) |
| Bone-strengthening drugs | alendronate (Fosamax), risedronate (Actonel), zoledronic acid (Aclasta/Zometa), denosumab (Prolia) | A small but real risk of a jaw-healing problem; we may check with your doctor first |
| Drugs that slow healing or weaken infection defences | steroids, chemotherapy, anti-rejection medicines after a transplant | Healing can be slower and infection more likely, which changes the plan |
| Recent or planned cancer treatment | radiation to the head or neck, bone drugs given by vein (IV) | Higher risk of healing problems; the timing of any extraction needs care |
If you take warfarin, we often check a recent blood test (the INR, which shows how “thin” your blood is) and proceed without stopping it when the result is in a safe range. For newer thinners we sometimes just adjust a dose’s timing. Either way, you don’t leave until the bleeding is controlled.
Drugs for osteoporosis or some cancers slow the jaw’s natural ability to renew itself, and rarely a socket can struggle to heal, a condition called MRONJ (medication-related osteonecrosis of the jaw). For a weekly osteoporosis tablet that risk tends to be very low, no more than about 1 in 1,000; for cancer patients on IV bone drugs it’s closer to 1 in 100. Leaving an infected tooth carries its own risk, so this is a reason to tell us, not to avoid a needed extraction.
What happens to the bone afterward
Once a tooth is gone, the bone that held it slowly shrinks, most in the first year, which is why we raise replacement early. The socket fills with a clot in the first day, soft tissue over a couple of weeks, then new bone over the following months. The ridge also narrows and lowers: after a back tooth it can lose up to half its width in the first year, about two-thirds of that in the first three months.
The choices that preserve bone are easiest early, so it helps to know your options for replacing a missing tooth, from doing nothing to a bridge, denture or implant. If a denture is likely, dentures and the Canadian Dental Care Plan covers how the plan handles them.
Does the CDCP cover extractions?
It can, but it depends on your eligibility and your plan year. Extractions fall within the kinds of treatment the Canadian Dental Care Plan is built to help with, but whether yours is covered — and how much — comes down to your eligibility, the current plan year, and whether the plan wants the treatment pre-approved first. Rather than guess, call us at 705-721-9229 with your details and our team will check what applies and handle the paperwork with the CDCP on your behalf. For the bigger picture on who qualifies and how the plan works, see our guide to the Canadian Dental Care Plan. We also offer direct billing and accept the CDCP here in Barrie.
When to call us
Two slower signs deserve a call too: liquid or air moving between an upper socket and your nose, or numbness in your lip or tongue that hasn’t begun to fade within 1 to 2 weeks. Neither is a middle-of-the-night emergency, but both need a look. This guide is part of our Adult Patient Information library.
If a tooth is troubling you, or you’ve been told one needs to come out, reach our Barrie practice at 705-721-9229 or book online; online booking covers new patient visits and emergency examinations. For anything else, reach us through our contact page.
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