When a tooth cannot be preserved without risking your broader oral health, extraction becomes a prudent, preventive step. At the office of Paulussen Dental, we consider removal only after exploring conservative restorations and discussing all available options. Our approach is to weigh the immediate concern against long-term outcomes so you can make a confident, informed decision about your care.
Removal may be recommended to halt the spread of infection, to address severe structural damage, or to resolve problems that threaten adjacent teeth and gum tissue. In some cases—particularly with developing smiles or impacted third molars—extraction can actually simplify future treatment and support better function and alignment. Each recommendation is individualized to your dental and medical history.
We also consider the timing and sequencing of extractions; sometimes planning a staged approach or coordinating with other dental treatments—such as orthodontics or implant placement—produces the best functional and aesthetic outcome. Before proceeding, we review the rationale for extraction, alternative treatments, and what to expect during recovery so you can proceed with clarity and confidence.
Primary (baby) teeth that are not shedding or are damaged
Occasionally a primary tooth remains firmly in place and interferes with the normal eruption of the permanent tooth beneath it. This can happen when the root does not resorb as expected or when the baby tooth fuses with the jawbone. Removing the retained tooth can allow the permanent tooth to erupt properly and support normal dental development.
Permanent teeth with extensive decay that cannot be restored
Decay can progress from a small enamel defect into deeper structural compromise if untreated. When a tooth has lost too much healthy structure or when a root canal and restoration will not provide a predictable result, extraction may be the safest option to prevent ongoing infection or fracture.
Teeth that are fractured beyond repair
Cracks and fractures vary widely in severity and location. If the fracture extends into the root, involves multiple cusps, or leaves insufficient tooth structure to support a crown, removal becomes necessary to prevent pain, infection, or further damage to neighboring teeth.
Advanced periodontal disease that undermines tooth support
Periodontal disease can erode the bone and soft tissue that hold teeth in place. When support is lost to the point that a tooth is mobile or is damaging surrounding tissues, extraction can protect overall oral health and make future restorative work, such as implants or bridges, more predictable.
Impacted or problematic wisdom teeth
Third molars often lack room to erupt cleanly and can become impacted, decay-prone, or a source of crowding and infection. Removing troublesome wisdom teeth early—when appropriate—can reduce the risk of later complications and simplify long-term care.
Extractions to facilitate orthodontic treatment
In some orthodontic plans, removing select permanent teeth creates space to align the bite and achieve a more stable, functional result. When this approach is recommended, extraction is carefully coordinated with the orthodontic team to support the overall treatment goals.
Every extraction begins with a comprehensive review of your medical and dental history. We assess systemic health, current medications, and any factors that could affect healing or anesthesia. Clear communication about your health enables us to plan safely—whether that involves modifying medications, consulting with your physician, or arranging a specific perioperative protocol.
Diagnostic imaging is a critical part of the planning process. Digital radiographs let us visualize root form, bone levels, and the relationship of a tooth to nearby anatomic structures. This information determines whether a case is likely to be a straightforward removal or whether a surgical approach will be required. We will explain the imaging findings and the planned approach in plain terms before you consent to treatment.
We also use this visit to set expectations: what anesthetic or sedation options are available, how long the appointment will take, and what immediate aftercare looks like. Our goal is to minimize discomfort and reduce uncertainty so you arrive informed and relaxed.
A simple extraction is performed when the tooth is fully visible and roots are accessible. After numbing the area with local anesthesia, your provider gently loosens the tooth and removes it using forceps. The technique is designed to preserve surrounding bone and soft tissue, and most patients report that the procedure itself is no more uncomfortable than a routine filling when appropriate anesthesia is used.
We will discuss whether sutures are needed and provide instructions for immediate care. If anxiousness is a concern, sedation dentistry options—ranging from oral medications to nitrous oxide or deeper sedation—can be discussed and scheduled to make the experience more comfortable.
Surgical extractions are used for teeth that are broken at the gum line, fused to the bone, or impacted beneath the surface. These procedures may require a small incision, removal of a portion of bone, or sectioning the tooth into pieces for safe removal. Surgical cases are performed with local anesthesia and, when indicated, supplemental sedation to ensure patient comfort.
Complex cases are sometimes referred to an oral and maxillofacial surgeon for additional expertise. If a referral is recommended, we will coordinate care and share all relevant records to make the transition seamless and to maintain continuity of treatment.
Effective pain control is a priority from the moment you arrive. Local anesthesia reliably numbs the area around the tooth, rendering the procedure painless for most patients. For those who experience anxiety or who are undergoing more extensive surgical work, additional sedation options can be arranged to promote relaxation and reduce the memory of the appointment.
Sedation can range from minimal (where you remain fully awake but calm) to moderate (where you may have limited memory of the procedure). We tailor the level of sedation to the complexity of the extraction, your medical history, and your personal comfort needs. All sedation plans are discussed in detail ahead of time, including pre-procedure instructions and recovery expectations.
We also prioritize safety: monitoring during sedation, clear preoperative instructions about eating and medications, and post-sedation guidance to ensure a smooth recovery. If you have concerns about anesthesia or past reactions, please tell us during the consultation so we can adapt the plan accordingly.
Recovery after extraction focuses on protecting the clot, managing discomfort, and preventing infection. We provide clear, written post-operative instructions tailored to your procedure. Most patients find that following these guidelines—resting, avoiding actions that dislodge the clot, and taking medications as directed—supports predictable healing and a return to normal activities within a few days.
Bleeding is typically controlled with gauze pressure applied directly to the site. Expect light oozing for up to 24 hours; persistent heavy bleeding, increasing pain, fever, or unusual swelling should prompt a call to our office. We emphasize prevention of dry socket by avoiding actions that create suction in the mouth and by not smoking during the healing window.
Oral hygiene should be resumed gently; brushing nearby teeth and using a mild saltwater rinse after the first 24 hours helps maintain cleanliness without disturbing the healing site. We also advise on diet—soft, nutritious foods that are not overly hot—and provide specific guidance if you are taking antibiotics or prescription pain medication.
Control bleeding with directed pressure
Immediately after your extraction, bite on gauze as instructed to help form a stable clot. Change the gauze once the initial heavy bleeding subsides, and maintain gentle pressure until bleeding is minimal.
Protect numb tissues
Avoid chewing or touching the numb area until sensation returns to reduce the risk of accidental bites to lips, cheeks, or tongue.
Take medications as directed
If antibiotics or pain medications are prescribed, follow the schedule and dosage exactly. Over-the-counter non-aspirin analgesics can also be effective for managing discomfort; take pain relievers before the anesthetic fully wears off if advised.
Avoid disturbing the clot
Do not rinse vigorously, spit forcefully, or use a straw for the first 24–48 hours. These actions can dislodge the clot and lead to delayed healing or dry socket.
Manage swelling with brief cold applications
Short intervals of ice applied to the face can help reduce swelling during the first 24 hours. Use 10-minute on/10-minute off cycles rather than prolonged continuous application.
Refrain from tobacco use
Smoking and other tobacco products interfere with clot formation and soft tissue healing; avoid them for at least one week after the extraction.
Choose gentle, nourishing foods
Stick to soft, lukewarm foods for the first couple of days and stay well hydrated. Avoid carbonated and alcoholic beverages while you are healing and/or taking prescribed medications.
Maintain careful oral hygiene
Continue brushing your other teeth gently and use a warm saltwater rinse after 24 hours to refresh the mouth. Avoid vigorous rinsing that could dislodge healing tissue.
Attend follow-up appointments
If sutures were placed or if your case required surgical techniques, a follow-up visit may be scheduled to monitor healing and remove stitches if needed. Keeping this appointment helps ensure a smooth recovery.
If you notice persistent bleeding, worsening pain, unusual drainage, or a fever, contact our office for evaluation so we can address any complications promptly.
At Paulussen Dental, extractions are performed with an emphasis on preserving comfort, protecting surrounding tissues, and planning for a healthy long-term result. Our clinicians assess each case carefully and present options that align with your oral health goals—whether that means extraction alone or extraction followed by reconstruction with dentures, fixed bridges, or dental implants.
We take time to answer questions, explain the steps of care, and coordinate any necessary follow-up treatment. Our priority is to make the process understandable and as comfortable as possible, while keeping your broader oral health and future restorative needs in clear view.
If you would like more information about extractions, anesthesia options, or replacement solutions after a removal, please contact us to speak with a member of our team. We are happy to help you understand your options and plan the best course of care.
The most common reasons for tooth loss include advanced periodontal disease, extensive tooth decay, and facial trauma. According to statistics, gum disease is responsible for close to 70% of tooth loss in adults. Although less frequent than the preceding three reasons, it should also be noted that specific diseases, drugs, smoking, and poor nutrition contribute to the risk of tooth loss.
The Centers for Disease Control and Prevention report that in the United States, an average of 12 teeth (including the wisdom teeth) are lost by the age of 50. Also, 26% of adults between 65 and 74 years of age have lost all their teeth.
Every patient and every situation is different. However, when a tooth and the surrounding tissues are numbed with a local anesthetic, you should only expect to feel a bit of pressure, but no pain as the tooth is being loosened from the surrounding tissues and extracted. For patients who are apprehensive and for some surgical extractions, our office will discuss our options in dental sedation to provide further relaxation and reduce any sense of discomfort.
While it's normal to feel some tenderness and swelling following an extraction, the degree of these sensations can vary. It mostly depends on the complexity of the extraction and the body's response to the procedure. We'll recommend or prescribe the appropriate pain medication to help ensure your comfort and give you specific instructions for maximum effectiveness and safety.
Typically, the recovery period following a simple extraction is shorter than a surgical extraction. However, a patient's overall health, habits, the size and location of the tooth, and other variables can influence recovery and healing. To speed up the recovery and avoid any complications, patients must follow the given at-home instructions diligently. We'll carefully review what to expect following your procedure and go over your post-op instructions.
Smoking interferes with blood clot formation, which is an essential first step in the healing process. Blood clot formation not only provides a protective layer to cover the underlying exposed bone and nerve endings, but it also supports the growth of new tissue. Cigarette smoke also contains chemical toxins that can disrupt the healing process and lead to problems such as continued inflammation, infection, or dry socket.
In a very small percentage of cases, a condition known as dry socket can develop in the aftermath of a dental extraction. This painful condition can arise when the blood clot in the extraction site doesn't form properly or gets dislodged. With dry socket, you may experience throbbing pain and symptoms such as bad breath and an unpleasant taste in your mouth. As skilled providers of care, our office will provide immediate treatment to alleviate your discomfort and promote healing.
The last teeth in your mouth to develop, wisdom teeth often do not have enough room to fully erupt or may be positioned in the wrong direction. These issues can affect your dental health as well as overall wellbeing. While some individuals never develop all their wisdom teeth, and a few have sufficient space for them, there are many people with partially or fully impacted third molars. Our office will monitor the development, position, and health of your wisdom teeth and will advise you if and when extractions are indicated.
After a tooth is removed, bone-grafting material is sometimes placed in the socket to promote healing and encourage new bone development. This procedure is often performed to support the eventual and successful placement of a dental implant.
At the office of Paulussen Dental, we strive to make dental care affordable and accessible. Depending on the type or complexity of the extraction and other variables, the cost of the procedure can vary. Based on our diagnostic findings, our office will inform you of the healthiest choices in care, explain the fees, discuss insurance coverage, and explain your payment options.
Many dental plans offer some level of coverage for tooth extractions. We'll advise you if your plan covers the full cost of the procedure and if there is any out-of-pocket expense. Our business office will work with you to maximize your insurance benefits as much as possible while helping you minimize any out-of-pocket expenses.
Extraction is recommended when a tooth cannot be predictably preserved without jeopardizing surrounding teeth, gum tissue or overall oral health. Typical reasons include extensive decay that undermines structural integrity, severe fractures that extend below the gum line, advanced periodontal disease with loss of supporting bone, or persistent infection that does not respond to other treatments. Extractions are also used for retained primary teeth, severely impacted third molars and to create space for orthodontic movement.
Before recommending removal, we evaluate conservative restorative options and discuss alternatives with you so the decision is personalized and based on long-term outcomes. The goal is to protect overall oral function and prevent the spread of infection or damage to adjacent structures. When extraction is the best path, we explain the rationale, the planned approach and the expected follow-up care.
The distinction depends on how much of the tooth is visible and how the roots relate to bone and nearby anatomy. A simple extraction is possible when the tooth crown is fully accessible and can be removed with forceps following local anesthesia, while a surgical extraction is required for broken, impacted or ankylosed teeth that need an incision, bone removal or sectioning of the tooth for safe removal.
Diagnostic imaging and a thorough clinical exam determine the likely category and complexity of the procedure. We discuss findings with you in plain language and outline whether additional sedation or referral to a specialist is advisable for the safest and most comfortable outcome.
Every extraction begins with a detailed review of your medical and dental history, including medications, systemic conditions and any previous anesthesia reactions. Digital radiographs or cone-beam CT (when indicated) are used to assess root shape, bone levels and proximity to nerves or sinuses, which influences surgical planning and risk management.
We may coordinate with your physician for patients on blood thinners or with other medical concerns to plan a safe perioperative approach. The preoperative visit is also when we explain anesthesia choices, estimated appointment length and immediate postoperative expectations so you can make an informed decision.
Local anesthesia is the foundation of pain control and reliably numbs the area so most patients feel no pain during the procedure. For patients with anxiety or those undergoing more complex surgical extractions, supplemental options such as nitrous oxide, oral sedation or deeper monitored sedation can be arranged to promote relaxation and reduce awareness of the procedure.
The appropriate level of sedation is chosen based on the complexity of the extraction, your medical history and your comfort preferences, and is discussed in detail before treatment. Safety is prioritized with monitoring during sedation, clear pre-procedure instructions and post-sedation recovery guidance to ensure a smooth experience.
Preparation includes providing a complete medical history and a list of current medications so we can identify factors that affect healing or anesthesia. You may be given specific instructions about eating, drinking, or adjusting certain medications before the appointment if sedation or medical conditions require special precautions.
If you plan to use sedation, arrange for a responsible adult to drive you home and follow any preoperative fasting instructions closely. Asking questions about the procedure, expected duration and recovery during the consultation helps set clear expectations and reduces anxiety on the day of treatment.
Initial recovery focuses on clot protection, pain control and minimizing swelling. You should expect some bleeding and light oozing for the first 24 hours, controlled with directed pressure using gauze, and mild to moderate discomfort that is manageable with prescribed or over-the-counter analgesics as recommended by your provider.
Swelling usually peaks within 24 to 48 hours and can be reduced with intermittent cold packs; gentle oral hygiene and soft, nutritious foods support healing. Avoid actions that create suction in the mouth, such as using a straw or smoking, during the critical initial healing period to reduce the risk of complications like dry socket.
Follow postoperative instructions closely: keep firm pressure on the extraction site as directed, avoid vigorous rinsing and spitting for the first 24–48 hours, and refrain from smoking or using tobacco products during the healing window. Maintain gentle oral hygiene around the site and begin warm saltwater rinses only after the first 24 hours to keep the area clean without disturbing the clot.
If antibiotics or specific wound-care measures are prescribed, take them exactly as directed to reduce infection risk. Contact the office promptly if you experience increasing pain, a foul taste or odor, persistent heavy bleeding or fever so we can evaluate and treat any complication early.
Referrals are recommended for cases that require advanced surgical expertise, complex anatomy, or when sedation beyond office capabilities is indicated. Examples include deeply impacted third molars near nerves or sinuses, teeth with unusual root anatomy, medically complex patients who need hospital-based monitoring, or cases where bone grafting or extensive reconstruction may be anticipated.
When a referral is advised, we coordinate care and transfer records to ensure continuity and a seamless experience for the patient. Collaboration with a specialist is intended to maximize safety and the likelihood of a predictable outcome for challenging cases.
Extractions can play a planned role in orthodontic treatment by creating space to align teeth and achieve a stable bite, and they are often coordinated closely with the orthodontic team. When extractions are performed with future restorations in mind, the timing and sequencing—such as staging extractions before implant placement or bridgework—are considered to preserve bone and support optimal functional and aesthetic results.
Our clinicians discuss restorative goals and long-term plans with you before proceeding so the extraction contributes to an overall treatment strategy rather than being an isolated step. This planning helps ensure predictable options for tooth replacement, alignment and long-term oral health.
After extraction, common replacement options include dental implants, fixed bridges and removable partial or full dentures, with the choice depending on oral health, bone volume and the patient’s functional needs. Implants are often recommended for their ability to preserve bone and restore near-natural function, while bridges and dentures provide predictable alternatives when implants are not suitable.
At Paulussen Dental we review replacement choices with you, explain the advantages and clinical requirements of each option, and coordinate sequencing so reconstruction proceeds safely after healing. Treatment planning considers long-term oral health, esthetics and the most reliable way to restore chewing function and smile appearance.
