When a tooth has to come out, it should come out gently.

Removing a tooth is the last option, not the first

We would rather save a tooth than pull it. A crown, a root canal, or periodontal treatment usually beats an extraction, because nothing replaces a natural root as well as the root you were born with.

There are situations where removal is genuinely the better decision:

• Decay that has destroyed too much tooth for a crown to hold
• A fracture running below the gumline, especially a vertical root fracture
• Advanced gum disease that has taken the bone supporting the tooth
• Infection that has not responded to root canal treatment
• Crowding, when an orthodontic plan requires space
• Wisdom teeth damaging the teeth in front of them

If a tooth can be saved, we will tell you what that takes and what it costs, and you decide. If it cannot, we will say so plainly rather than sinking your money into a tooth with a poor outlook.

Simple versus surgical extraction

A simple extraction is what happens when the tooth is fully erupted and accessible. We numb the area, loosen the tooth from the ligament holding it, and lift it out. There is firm pressure and a sound you hear more than feel. Most take a few minutes once you are numb.

A surgical extraction is needed when the tooth is broken at the gumline, has curved roots, or is still partly below the gum. We open the gum tissue, sometimes remove a little bone, and often section the tooth so each root comes out along its own path. Sectioning sounds worse than it is, and it is usually gentler on the surrounding bone than forcing a whole tooth out.

Both are done with local anesthetic. If any of this makes you tense, sedation is available, and nitrous oxide covers most people comfortably.

What recovery actually looks like, day by day

The first few hours. Bite firmly on the gauze for 30 to 45 minutes. A clot needs to form in the socket, and that clot is the foundation of healing. Some oozing is normal. Do not rinse, spit, or use a straw.

Day one. Swelling peaks late on day one into day two. Ice the outside of your face, 20 minutes on and 20 off. Eat soft and cool: yogurt, applesauce, smoothies with a spoon, lukewarm soup. Take pain relief before the numbness wears off rather than waiting.

Days two and three. The sorest stretch, and also where improvement starts. Begin gentle warm salt water rinses after 24 hours, letting the water fall out of your mouth rather than spitting. Bruising on the cheek or jaw is normal.

Days four through seven. Most people feel substantially better and are back on softer versions of normal food. Any stitches are usually dissolvable, and chewing on the other side is still smart.

Weeks two through six. The gum tissue closes over. Bone fills in underneath more slowly, over a few months, which matters if you are planning an implant.

Call us if pain increases after day three instead of decreasing, if swelling worsens after day three, if you have a fever, or if bleeding will not stop with pressure.

How to not get dry socket

Dry socket happens when the clot dislodges or dissolves early, exposing bone. It usually shows up on day three to five as a deep, throbbing ache that radiates toward the ear and is clearly worse than the day before. It is not dangerous, but it hurts, and it is largely preventable.

The rules are simple: no straws, no smoking or vaping, no spitting, and no vigorous rinsing for the first several days. Suction is the enemy, and smoking is by far the biggest risk factor.

If you think you have it, call. We can place a medicated dressing that usually brings relief quickly.

Decide how you will replace the tooth before you lose it

This is the part patients most often regret skipping, so we bring it up at the same visit we plan the extraction.

Once a tooth is gone, the bone that held its root has no job, and it thins over the following months and years. Neighboring teeth lean toward the space and the tooth above or below drifts down. A gap left for several years can become a bite problem involving several teeth, and it can mean you need a bone graft before an implant is possible.

Your options generally include a dental implant, which replaces the root itself, a bridge that borrows support from the teeth on either side, or a partial or full denture. Sometimes, particularly with a back molar that has no opposing tooth, leaving the space is reasonable.

Extraction fees at our Fort Smith office run $250 to $380 depending on whether it is simple or surgical. We verify your insurance before treatment, and CareCredit, Cherry, and Proceed Finance are available if you are combining removal and replacement.