Surgical extractions and oral surgery

Removal of teeth that cannot be saved, including impacted wisdom teeth and roots that need a surgical approach, along with minor procedures on the gum and jaw.

What it is

Extraction is the last option, not the first. A tooth is removed when it cannot be restored, when infection cannot be cleared, when it is so loose from gum disease that nothing holds it, or when an impacted tooth is damaging the one next to it.

A simple extraction loosens the tooth and lifts it out. A surgical extraction is needed when the tooth is broken at the gum line, the roots are curved, or it has not come through — the gum is lifted, a small amount of bone may be removed, and the tooth is often divided into sections so that each comes out along its own path. Sectioning sounds worse and is usually gentler, because it avoids forcing.

Wisdom teeth are the common case. Many cause no trouble and are best left alone; the evidence does not support removing them simply because they are there. They do need removing when they cause repeated infection of the overlying gum, decay in themselves or in the tooth in front, or a cyst.

Every extraction is planned around what lies nearby — the nerve in the lower jaw, the sinus above the upper back teeth. That is what X-rays and, for difficult lower wisdom teeth, a 3D scan are for. Knowing the risks in advance is how they are avoided and how you can give genuine consent.

You may need this if…

• A tooth broken down too far to restore
• Severe infection that cannot be cleared
• A tooth very loose from advanced gum disease
• Repeated painful swelling around a partly erupted wisdom tooth
• An impacted tooth damaging the one beside it
• Retained roots left from an old extraction

What happens, step by step

1. Assessment

   Examination and X-rays, and a 3D scan for difficult lower wisdom teeth where the nerve position matters. Medical history and medication reviewed — blood thinners and some bone medications change the plan.

2. Consent

   What is being done, what the risks are for your particular tooth, and what the alternatives are, explained before the day where possible.

3. Numbing

   Local anaesthetic, tested before starting. You should feel pressure and movement, not pain — and say so if you do.

4. The procedure

   The tooth removed whole or in sections, with the gum raised where needed. Stitches, usually dissolving, if the gum was opened.

5. Haemostasis

   Bleeding stopped before you leave, and you are not sent away until it has.

6. Aftercare and review

   Written instructions, medication where needed, and a review to check healing and remove any non-dissolving stitches.

Looking after it afterwards

• Bite firmly on the gauze for 30 minutes; do not keep checking.
• No rinsing, spitting, smoking or straws for 24 hours — this is what dislodges the clot and causes a dry socket.
• Cold compress on the outside for the first day; warm salt rinses from the day after.
• Soft, cool food. Keep drinking.
• Take the painkillers before the anaesthetic wears off rather than after.
• Call if bleeding will not stop, if swelling worsens after day three, or if severe pain starts three to four days later.

Questions people actually ask

This page is general information about surgical extractions and oral surgery. It is not advice about your own mouth — for that you need to be examined.