What happens during a tooth extraction

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As extract a tooth is the term used to describe the removal of a tooth (tooth extraction, exodontics) without further surgical measures. Often, tooth damage after inflammation or accidents is the reason. Read everything you need to know about tooth extraction, when to do it and what the risks are.

What is the tooth pull?

Tooth extraction is an ancient treatment method. There are already records of pulling teeth from the first century of our era.

A distinction is made between simple tooth extraction and surgical tooth extraction. The latter is only done in complicated cases, such as the removal of wisdom teeth. The cost of pulling the tooth is covered by your health insurance.

When do you have to pull a tooth?

Basically, the so-called preservation principle applies to tooth extraction: A tooth should only be extracted if it can no longer be preserved with all other methods (such as root canal treatment or root tip resection) or if preservation would not make sense or would be harmful.

There are several reasons (indications) for pulling the tooth:

Loose or damaged tooth

If a tooth is damaged in an accident to such an extent that it can no longer be preserved, or if it is severely attacked by tooth decay or periodontitis, for example, it must be extracted.

Lack of space

Congenital misalignments of the jaw can cause crowding of the teeth. Here, by extracting healthy teeth, space can be created again for the remaining teeth. Mostly the so-called "extraction therapy according to Hotz" is used.


In certain circumstances, teeth are pulled preventively - to prevent these teeth from becoming infected and worsening an existing disease or making treatment more difficult. This applies, for example, to the following cases:

  • Organ transplants: Tooth germs can cause rejection of the transplant here
  • Chemotherapy or radiation therapy: protection against radiation-induced tooth damage (osteoradionecrosis)
  • Heart valve replacement: Tooth extraction prevents inflammation of the inner lining of the heart (endocarditis), which is often caused by tooth germs

Tooth extraction is usually not possible in patients who are not allowed to operate because of a disease. These include, for example, the following clinical pictures:

  • severe cardiovascular disease
  • suppressed immune system (immunosuppression)
  • Bleeding tendency
  • acute inflammation or tumors in the surgical area
  • Allergy or intolerance to the narcotic agent used (local anesthetic)

How does the tooth pull?

Your dentist will first explain the procedure to you. He will inform you about possible alternatives, the process of tooth extraction, any complications and the subsequent care. In addition, the dentist will ask you about your age, underlying illnesses, medication intake or possible allergies.

He then examines the affected tooth and the condition of the rest of the dentition in detail. An x-ray of your teeth will also be taken. The dentist may give anxious patients a sedative for further treatment.

Anesthetic pulling the tooth

Pain can be relieved well with local anesthesia. To do this, the dentist - after local disinfection of the oral mucosa - injects an anesthetic into the tissue near the tooth (usually lidocaine or articaine). The anesthetic effect is additionally improved by adding a blood vessel constricting agent (vasoconstrictor).

Tooth extraction process

To pull a tooth, the dentist uses different levers and pliers - depending on whether the tooth is already loose or still firmly anchored. If the dentist uses a scalpel, the oral cavity should first be thoroughly disinfected and the area covered with sterile cloths.

Once the tooth has been removed, the wound is closed. In most cases, firmly pressing the gap between the teeth with a swab is sufficient. Suturing the wound is usually only necessary after removing the operative tooth.

What are the risks of pulling a tooth?

In the vast majority of cases, tooth extraction is uncomplicated - 90 percent of interventions are successfully completed within five minutes. Despite everything, complications can arise. These include:

  • accidental injection of the anesthetic into a blood vessel (risk of serious side effects)
  • Fracture of the tooth crown or root
  • Swelling or bruising
  • Injury to adjacent structures, such as neighboring teeth or nerves
  • Opening of the maxillary sinus
  • Inhalation or ingestion of parts of teeth
  • Infection or bleeding

Inflammation of the lining of the heart (endocarditis)

Interventions in the oral cavity can trigger inflammation of the inner lining of the heart. This is especially true for people with congenital heart defects or patients with heart valve replacement. As a preventive measure, these “risk patients” are given so-called endocarditis prophylaxis - antibiotics before the dental procedure, which reduces the risk of infection.

What should I watch out for after pulling the tooth?

  • After pulling the tooth, you should take it easy and avoid physical exertion.
  • You can eat and drink again as soon as the anesthesia has worn off. Be careful with the affected tooth area (for example, chew your food in your left cheek if a tooth has been extracted on your right).
  • You should refrain from smoking, coffee and alcohol until the day after pulling the tooth.
  • The dentist treats pain with mild pain relievers. Cooling is also often perceived as beneficial. In addition, an ice pack wrapped in a cloth and placed on the outside (cheek) can counteract swelling of the affected tissue. However, some patients find the application of heat more comfortable.

If the pain persists a few days after the tooth was pulled, the swelling does not decrease and / or the bleeding increases, you should visit your dentist again.

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