Should you have a tooth pulled? Tooth Extraction Costs, Risks, and FAQs

Whether you’re dealing with wisdom teeth, a cracked tooth you didn’t plan for, or a painful infection, the words “tooth extraction” can cause concern. Luckily, a tooth extraction doesn’t have to be a source of dread.

I want to help you understand the procedure, aftercare, and options involved. It’s important to be well-educated about tooth removals. Tooth extractions can be considered oral surgery, and you’d never walk into surgery unprepared!

While most patients don’t want a tooth removed, feeling confident and knowledgeable will improve your experience.

There are multiple kinds of extractions based on your situation. I’ll also walk you through your pain management options and give clear instructions for aftercare.

Opt for informed instead of overwhelmed. Saying goodbye to your tooth will be easier with this comprehensive guide.

What is a tooth extraction?

Let’s boil down this mysterious procedure. Simply put, in a tooth extraction, a tooth is pulled out of the socket in the bone where it rests.

There are two basic types of tooth extractions: a simple tooth extraction and a surgical tooth extraction. One or both can also factor into your wisdom tooth removal. Both extractions remove a tooth from the mouth, but there are some key differences to note.

In some cases, if you can see the tooth in the mouth, you may need only a simple extraction. If the tooth isn’t visible, the extraction will likely be surgical. However, hidden root structure can make even a visible tooth eligible for surgical extraction. If you have impacted wisdom teeth, those are judged at varying levels of impaction, which is why wisdom tooth surgery can involve a combination of simple and surgical extractions.

A simple extraction will loosen your tooth using an “elevator,” then pull it out once it’s properly dislodged from the surrounding bone. This surgery is, as its name implies, a more routine procedure and only requires a local anesthetic.

Most general dentists offer simple tooth extractions. The healing time, pain management, and swelling will likely be more mild with a simple extraction. If this is your diagnosis, you can relax.

A surgical extraction deals with a tooth that hasn’t erupted yet or one that may have broken off near the gumline. In this case, the tooth can’t be grasped and loosened the same way. A small cut will be made into your gum line so that your dentist can access, loosen, and remove the tooth. (1)

An oral surgeon could be needed for surgical extractions in some cases. Unfortunately, due to the more complex nature of this procedure, your downtime, swelling, and recovery may be a bit more extensive. Not to worry, though, great aftercare and proper rest help take the bite out of surgical extractions.

7 Common Reasons for Tooth Extraction

When you’re dealing with problems like cavities, gum disease, and more, how does your dentist make the choice to extract a tooth? In some cases, there are decisions that you must make together based on your individual situation, like if it’s better to get an extraction or a root canal.

Here are some of the major reasons your dentist may suggest you have a tooth pulled:

Overcrowding. The problem is simple: too many teeth, not enough space. Removing a tooth can free up space for better alignment. This may be necessary for orthodontic treatments, such as braces that shift teeth around inside the mouth.
Risky infections. In some cases, bad bacteria has spread into the tooth roots past what root canal therapy can treat.
Immune system considerations. Patients with weakened immune systems can have a harder time fighting tooth decay and infection. This can include those with transplants, HIV positive individuals, chemotherapy and radiation patients, and more. In such cases, opting for an extraction over a root canal is standard. (2)
Periodontal disease. In its more advanced stages, gum disease can loosen teeth within the mouth. These loose and weakened teeth will only continue to cause issues if not removed. (3)
Wisdom teeth. Third molars can grow in incorrectly, cause issues with crowding, develop cavities, and cause pain. These teeth also pose risk of infection, inflammation, or gum irritation. Typically this extraction is needed in the teens or early 20s. Here’s my ultimate guide to wisdom teeth. Resources like this can help you make an informed decision about what to do with these third molars.
A broken or damaged tooth. Depending on the level of damage, the dentist may recommend pulling the tooth instead of repairing it.
Overlap. A patient’s permanent teeth may start to come in before their “baby teeth” have fallen out. Since two rows of teeth is only ideal if you’re a shark, the dentist may remove the smaller teeth and make room for the permanent ones.

Getting a Tooth Pulled: What to Expect

Just like any other procedure, knowing what to expect when you need a tooth extraction is key. This section will empower you to prepare for, relax during, and recover from your dental extraction.

Before the Procedure

Inform your dentist of medical history, any immune system complications, medications and supplements. Conditions that need further consideration include hypertension, osteoporosis, bisphosphonate use, bleeding issues, and anticoagulant use. (4, 5, 6)

Your dentist will take an x-ray to design the best treatment for your teeth. This can show your dentist many elements. S/he will be looking at how your wisdom teeth are growing in, for instance, and if they are impacted.

S/he’ll also check for possible infections or cysts, and observe your teeth’s relationship to your inferior alveolar nerve. This nerve essentially gives feeling to the entire bottom half of the mouth: jaw bone, lower lip, teeth, and chin. An x-ray ensures that your dentist has a fully informed picture of what’s happening in your mouth before they start any work.

Based on your medical history and x-ray, your dentist may prescribe a round of antibiotics before the surgery. A variety of reasons may prompt this. Factors include your immune system’s strength, the length of the surgery, infections or issues found in the x-ray, and your medical history. (7)

You can also discuss pain management options during your procedure during the planning stage with your dentist. Anesthesia options may be available and are often preferable for surgical extractions. You’ll take into consideration how many teeth are being pulled and what type of tooth extraction is being performed.

If you choose IV sedation, be sure to wear a short-sleeved shirt so your veins are accessible.

During the week before the procedure, be sure to let your dentist know if you have had a cold or nausea and vomiting. These can alter the anesthesia scheduled or even necessitate rescheduling.

The day of the surgery, make sure you have a ride scheduled if you’ll be undergoing any kind of sedation, and avoid smoking. If you’ll be sedated, be sure that your ride is also ready to help with your post-care instructions until you’ve recovered from the effects of the anesthesia. It’s not easy to remember details right after a tooth extraction.

During the Procedure

If you are receiving a simple extraction, you will likely only need local anesthesia injected directly into the mouth. This type of numbing is common for fillings and other routine dental work.

For a surgical extraction or wisdom tooth removal, you may need general anesthesia in addition to local anesthesia. To remove an impacted or broken tooth, your dentist will be cutting into gum tissue and potentially even the bone around the tooth.

In both instances, you should feel pressure, but not pain or pinching. If you experience any discomfort beyond the pressure your dentist describes, let them know right away.

Beyond anesthesia, your dentist may also use steroids in an IV to decrease post-procedure swelling.

Once the tooth is out and the extraction site is cleared, your dentist will assess if you need sutures (small stitches that help the gum heal). After this, the extraction procedure is finished.

After the Procedure (Recovery)

What level of pain should I expect after a tooth extraction?

As you can imagine, a surgical extraction may be a bit trickier to recover from than a simple one. It can also involve more complications. (8) However, both are manageable with proper medication and rest! Many simpler cases are manageable with simple NSAIDs (non-steroidal anti-inflammatory drugs) such as Advil, Motrin, and more.

Your dentist can give you guidance for managing your pain this way, but typically you will follow a schedule of taking these aids three to four times daily.

Avoid aspirin, as it can thin blood, increase, or continue bleeding. Ibuprofen (Advil) may also encourage bleeding, so ask your surgeon what s/he recommends.

More serious cases may merit a prescription for pain medication from your doctor. Be sure to read my thoughts on opioid pain medication to stay safe from any harmful side effects or potential addiction.

Personally, I urge patients to switch over to NSAIDs after the third day to reduce their risk of addiction—but always take your surgeon’s advice. No matter what type of pain medication works best for you, start taking it before the anesthesia wears off. Waiting too long can leave you in more pain than necessary.

As an aside—try not to take any of these medications for more than several days after your extraction, if that. Acetaminophen (Tylenol), in particular, can damage the liver when taken excessively. All over-the-counter medications like these have potential side effects, so your goal should be to take as little as you can for as short a period of time as you can manage.

How much time should I budget for recovery?

I’d advise limiting activity for the next one to two days. Oral surgery is still surgery. Give yourself a rest day or two to heal and let your mouth begin to heal. Be sure to avoid heavy exercise as well; the delicate clot in your extraction site will thank you for not getting your blood flowing.

Ok, so schedule a 2 day nap?

After the surgery, you may be tempted to immediately lay down, but think again. Firstly, you’ll want to take medication before dozing off. To stay ahead of the curve, take your first pain medication dose before the numbness wears off.

Secondly, keep your head up. I don’t only mean that as a cheery saying. Keep your head propped up when lying down or nap sitting up to prevent more bleeding.

Tooth Extraction Aftercare

Your dentist will update you with written aftercare instructions after your surgery. It’s important to follow them closely. This reduces your risk of dry socket and infection. That’s always a good thing!

Here are some great suggestions from my years of extracting teeth.

Keep It Up

I mentioned this once, but the best thing you can do for recovery after a tooth extraction is to keep your head elevated for three full days without lying flat. Try a pillow like this one for optimal recovery angles.

Oh My Gauze

Immediately after surgery, the dentist will cover the socket with gauze and ask you to bite down. As you apply bite pressure, a blood clot will form over the hole where your tooth once was. Think of it as a much more delicate scab.

The damp environment in the mouth uses this clot to heal instead. Be sure to us a gauze pad in the extraction site for 3-4 hours to ensure clotting. If the initial gauze becomes blood-soaked, feel free to change it for a clean one. This may be necessary every half hour or so.

It’s important to keep applying pressure. However, don’t chew, simply bite. Chewing on the gauze can wiggle the clot around, which will prolong bleeding. (9)

Tea Time

If three to four hours have passed and bleeding continues, try a dampened black tea bag onto the wound. The tannin chemicals in the tea will aid in clotting.

Ice Ice Baby

Often, the jaw may begin to swell after a few hours. You can moderate the inflammation by applying an ice pack intermittently for ten to 20 minutes. Be sure to put it on the same side as the tooth extraction.

The sooner you begin to ice, the better your chances of reducing the swelling.

Don’t Suck

Your blood clot is your temporary best friend as it protects your extraction site and nearby nerves. It’s also busy promoting healing in the bone and damaged tissue. Do not rinse your mouth, spit, or use a straw for 24 hours. These behaviors may dislodge the blood clot.

Basically, avoid anything that would create suction. If you do dislodge the clot, it can lead to a painful condition called dry socket. This happens when sensitive nerve endings are exposed to air, food, and the inside of the mouth.

Risky Business

There are a few conditions that increase the risk of dry socket: birth control use, more difficult tooth extractions, and poor oral hygiene. (10, 11) If you fall into one of these categories, be sure to talk to your dentist about how you can stay complication-free.

Spare the Site

Don’t forget to keep your mouth clean to avoid the risk of infection. Be sure to prevent plaque, tartar, and bad bacteria from getting near your precious pulp. But don’t touch that extraction site. Irritating it with a brush or mouthwash will delay your healing and potentially destroy your clot. Good hygiene is your friend during this time. (12)

Salt in the Wound

As I mentioned, avoid rinsing the mouth for the first 24 hours. After the first day, a very gentle salt rinse (no spitting!) can actually be beneficial. This will help keep your extraction site clean, with an added bonus of relieving pain and potentially helping stitches dissolve.

I recommend using one 8-ounce glass of water and adding Himalayan salt until the salt stops dissolving to create a supersaturated solution of salt water. Remember to be very gentle as you swish it around your mouth. You’ve probably gathered by now that dislodging the clot is not going to be fun, so be careful. (13)

Lights Out

Don’t smoke, no matter how intense the urge may be. It dramatically increases the time it will take your mouth to heal and creates the same clot-dislodging problems as a straw. (14)

Be a Softie

I’m sure you can imagine that chewing won’t be as fun in the initial day or two after surgery. Soft foods are your friends directly after an extraction. Try bone broth, coconut water, scrambled eggs, bananas, and avocados to avoid any pressure or pain while promoting healing.

A word of caution: Sugary foods will delay healing of your extraction site. While it might be tempting to live on ice cream, pudding, and jello while you’re on soft foods only, these will actually be worse overall.

Time Is On Your Side

It will take 1-2 weeks to see new tissue and bone growing in, but the area will eventually heal over. Your blood clot will dissolve when it’s ready and your extraction site will be less sensitive as time goes on. In the meantime, don’t poke objects or your tongue onto that precious extraction site.

Risks of Tooth Extraction

While tooth extractions happen around the world every day, they are not always 100% safe. There are a few complications and risks involved if you have a tooth extraction:

Jaw fracture: this is uncommon and usually seen in older patients with complications. Likelihood of fracture increases with lower bone density or osteoporosis.
Soreness in the jaw or mandibular joint: many injections, long procedures, or lots of pressure will cause a bit of stiffness.
Nearby damage: the teeth or any dental work could be damaged in a tooth extraction. You may see cracked fillings or teeth in extreme cases.
Sinus hole: a hole in the sinuses may open during extraction of a tooth in the upper back of the mouth. This will generally heal on its own after several weeks.
Continuing numbness: an irritated inferior alveolar nerve can leave your lower lip, chin, or jaw still tingling or numb. This may last 3-6 months in unusual cases. Extremely rarely, this may be permanent.
Dry socket: the painful exposure of nerve endings in the mouth.
Leftover roots: your dentist may leave the tip of your tooth’s root behind if it poses a major risk to extract.

Only 4.6% of patients experience complications after third molar extractions, but the side effects can be unpleasant. (15) As you can see, serious risks can arise from having a tooth extracted.

This is why I never recommend an extraction unless the patient actually needs one. Far too often, I see patients look at tooth extraction as a quick fix to a dental issue, but that’s far from the case.

Keeping a patient’s tooth is almost always the best choice. Root canals, crowns, and other measures are often preferable to removing the tooth. With this in mind, be sure to discuss your options before deciding on a tooth extraction.

It’s inadvisable to leave an empty extraction site in the mouth long-term, and dental implants, bridges, or dentures can be costly. Leaving the extraction site empty can lead to shifting teeth. This may necessitate orthodontics as your teeth move to fill the space.

Jaw bone under the extraction site may also weaken over time if no implant is added. (16) There is also evidence that more tooth extractions equal more overall health risks down the road. (17)

Call Your Dentist if You Have These Symptoms

Heavy bleeding or severe pain more than four hours after your procedure
Nausea or vomiting after your extraction
A fever and chills that could point to an infection
Redness, swelling, or excessive discharge from the extraction site (Some swelling is to be expected, but combined with other symptoms, it can be a sign that something has gone awry.)
Coughing, breathlessness, or chest pain
Bloody nasal discharge

Don’t panic. Most of these issues are infections treatable with antibiotics. In rare cases, they may be symptoms of something more serious, so do not wait to let your dentist know.

Any strange side effects, such as those listed above, are worth mentioning. Dental health is connected to overall health, so don’t try to explain away concerns after a procedure.

Average Cost of Tooth Extraction

The cost of your tooth extraction is determined by the type of dental treatment you need. The more involved the procedure, the higher the cost. Other considerations can also affect cost. Common factors include area of the country and experience level of your dental professional.

Simple Tooth Extraction Cost

A fully erupted tooth costs $187 on average to extract. This would be a case where the tooth has grown above the gumline and has no complications.

Surgical Tooth Extraction Cost

This is for more complicated case, like partially erupted teeth or impacted ones. Tooth impaction occurs when teeth do not erupt above the gumline. At this point, incisions and a more complex procedure are needed. The more intense nature of this extraction raises the price to a national average of $400.

Wisdom Tooth Extraction Cost

The cost of a wisdom tooth extraction depends on several factors. The largest determinant is going to be the number of teeth that need to be removed. Not everyone needs all four teeth extracted, and many people have less than this number. Genetic factors make these teeth hard to predict.

Another major factor is if any of the teeth are impacted. This can occur on top or bottom, and an impacted wisdom tooth will need surgical extraction.

Removing one non-impacted wisdom tooth can cost $140 on average, while an impacted wisdom tooth can run roughly $400. However, many dentists offer discounts for removing all four teeth at the same time.

Including anesthetic costs, the American average cost for wisdom teeth removal hovers around $1,900.

Wisdom teeth patients will also likely need an exam, averaging around $200, to determine treatment. X-rays may also be necessary to determine where the third molars are in the mouth. These cost an average of $105 around the country.

The cost of an extraction on its own can look minor next to larger costs like root canals and crowns. Initially, it is cheaper.

However, as I’ve mentioned, a tooth extraction should typically be followed up with additional treatment. This aftercare has its own pros, pitfalls, and costs.

The next section breaks down follow up costs for patients after tooth extractions.

If you’re feeling anxious at these numbers, you should know that there are many options. Yes, even for those with financial concerns or no dental insurance. Here are my seven cost-friendly options for getting dental work on a budget. Removal of a tooth isn’t impossible to afford.

Orthodontics After Tooth Extraction

Great news for patients with overcrowded mouths: you may be off the hook unless your dentist recommends measures to align your teeth. For all other instances, you will almost invariably need more treatment after extraction.

The American Academy of Periodontology has found that failure to address the space where your tooth once was can lead to shifting teeth, bite issues, and more. Here are a few of the most common options:

Dental Implants

Often, the most likely candidate is a dental implant, or a new false tooth implanted into your mouth. Once your bone has had time to heal, usually 6-12 weeks, the implant process can begin.

Typically, this process takes 2-3 visits and can run from $3,000-$5,000.

Bridges

Bridges consist of 1 or more implants, anchored onto adjacent teeth with crowns. This can be a good option if more than one tooth neighboring tooth was pulled.

Bridges are priced based on the number of teeth affected. Therefore, they can range between $1,200 and $2,400 on average.

Braces

With all this new space in your mouth, you may need orthodontic care.

If this is the case, your cost can vary considerably, from $3,000 to $13,000. The type of braces you choose and your insurance will affect where you fall within this range.

As you can see, though extractions may cost less upfront, your follow up options are no small matter. Talk with your dentist to see what type of treatment is best for your teeth, your budget, and your future.

Wisdom Tooth Surgery vs. Tooth Extraction

Wisdom tooth surgery has a few key differences from other tooth extractions. A typical tooth extraction is a more extreme measure often used as a last resort. Wisdom tooth extraction is necessary for most patients and much more common.

Lower wisdom teeth are among the most likely candidates for dry socket, and the recovery time can be longer due to the larger number of teeth removed.

Finally, there is no need for implants or replacements in wisdom teeth extraction. Wisdom tooth extraction generally doesn’t affect the alignment in the rest of your mouth. Here are my top tips for faster recovery from your wisdom tooth extraction.

Bone Graft

If you’re going to get an implant, dental bridge, or denture after your extraction, talk to your surgeon about bone grafting. This is a fairly new standard of care that many people forget to discuss when talking about extraction.

When a tooth is removed, the alveolar bone it was attached to naturally tries to close in on itself. In doing so, there can be bone loss, which can make procedures to replace that tooth more difficult (and expensive) down the road.

Research shows that doing a bone graft very soon after a tooth extraction greatly improved the quality of bone and alveolar ridge during healing. (18) In my experience, bone grafting is a beneficial standard of care in nearly every case.

While a bone graft will increase the cost of your tooth extraction, it will be a better option financially (and physically) than waiting. Speak with your dentist or oral surgeon about this procedure when planning to have a tooth pulled.

Tooth Extraction FAQs

Is it safer to get an extraction or a root canal?

A: This question always gives me pause. In almost every case, it’s preferable to save a patient’s tooth if possible. Perhaps this rush toward extraction is due to the spread of misinformation about root canals, especially in recent documentaries.

A root canal will never be 100% clean, but having multiple teeth pulled can be a harbinger of larger issues. So, it’s best to just do your research, chat with your dentist, and decide what’s best for your needs. At the end of the day, root canaled teeth have a longer lifespan than implants after extraction. (19)

What type of dental specialist performs tooth extractions?

A: An oral surgeon is a specialist that can perform extractions. There are a few reasons to seek out this type of specialized treatment. Common ones are cracked teeth needing to be removed, impacted extractions, or dentist referrals. Oral surgeons are highly qualified to deal with a complex tooth extraction and any ensuing complications.

Residencies for oral surgeons require students to perform thousands of extractions before they even graduate. In fact, the average oral surgeon has studied for 12-14 years before certification. (20) Rest assured, you’re in experienced hands. If it looks like your extraction could be difficult, an oral surgeon is a great route.

It’s been 5 days since my tooth extraction and I’m still hurting. Is this typical?

A: There are many factors that could cause mild pain five days after surgery. My first question would be if you are taking your pain medication and antibiotics as directed. Is your clot still in place, and have you followed your aftercare instructions? Failure to protect your clot or follow directions can lead to discomfort.

I’d also ask how what type of tooth extraction was performed. For wisdom teeth, mild discomfort for one or even two weeks is fairly normal. Please note that severe pain is a different symptom altogether, and can indicate infection or dry socket. Check the section titled “Call Your Dentist If You Have These Symptoms” for more information.

The bottom line? Your pain should be decreasing over time.

I have a cavity! Is my tooth doomed? Will I need an extraction?

A: If you’ve been diagnosed with a small cavity, you may be surprised to learn that you can take natural steps to heal your minor cavity naturally. Even if you do need a filling, you can take preventative care of your mouth. This helps to avoid future work, including extractions. When you take proactive care of your oral health, your whole body benefits—and so does your wallet.

Is tooth extraction painful?

A: During the procedure, you should feel nothing more than pressure. Any pain should be immediately reported to the dentist performing the extraction.

If aftercare directions are followed closely, a tooth extraction should be mostly pain-free. In one study, patients receiving simple extractions said the procedure had very little effect on their quality of life. (21)

What are the side effects of removing teeth?

A: Patients missing most or all of their teeth are found to be at a greater risk of poor nutrition, plaque in their coronary artery, asthma, and diabetes. (22) Periodontal disease leading to tooth loss can also affect other areas of health. (23) However, implants can help with many of the alignment and jawbone issues caused by missing teeth.

What is the best painkiller for tooth extraction?

A: Many people find 400 milligrams of ibuprofen to be effective at managing pain after a simple extraction. (24) I’d recommend taking this dosage three to four times a day, as it can also reduce your swelling.

If your dentist prescribed an opioid pain reliever, try to limit your consumption. Each day you remain on opioid pills drastically increases your chances of addiction.

My tooth really hurts. How do I know if it’s an extraction emergency?

A: There are a few situations where this may be a true emergency. One is extensive bleeding in your mouth that is not caused by brushing your teeth. Also, if an abscess (swollen pocket filled with pus) appears, it could be a dangerous sign.

Almost all other signs other than trauma to the teeth or face should be seen by a dentist as soon as possible during normal business hours. (25)

Key Takeaways: Tooth Extraction

Three possibilities exist for tooth extraction: simple extraction, surgical extraction, and wisdom tooth removal. The location and needs of the tooth determine which type of extraction will be needed.

You can expect a pain-free procedure during tooth extraction, but the importance of aftercare cannot be overstated.

Do everything possible to care for the blood clot as it heals the bone and tissue underneath. Rest, ice, eat soft foods, and follow all directions as you wait for the wound to close.

While extractions are affordable, the implants and orthodontics needed afterward can be costly. Try to preserve the natural tooth when possible. Root canals are no more dangerous than extractions, and evidence shows multiple extractions (other than wisdom teeth) heighten your chance for other disease.

If you have a more serious extraction need, an oral surgeon will be happy and qualified to help.

25 References

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