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Complicated Tooth Extractions

A tooth extraction is complicated, if it requires manipulation of the gums or the removal of the bone tissue to remove the tooth. The procedure which is performed to do a complicated extraction is referred to as a surgical extraction.


When do you need to do a surgical extraction to remove a tooth?

  • Tooth has broken off at the gum line
  • Tooth has not erupted in the mouth, which is also called as impacted teeth
  • Third molar or wisdom tooth extractions
  • Fracture of the crown of the tooth during a normal simple extraction
  • Severely broken down teeth
  • Teeth with long curved roots
  • Impacted teeth
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Wisdom teeth all you need to know about them.

  • These are the last molars on each side of the jaw, both upper and lower
  • There are total of 4 wisdom teeth in each person, however this varies from person to person and patients may have anywhere between none to 4
  • These teeth may erupt and are visible in the mouth or they may continue to be present inside the gums or bone and are not visible in the mouth.
  • The normal age of eruption of these molars is 17-21, however they may erupt beyond 21 years of age
  • Wisdom teeth are impacted most often due to the size of the jaws, in smaller jaws there is a greater probability the wisdom teeth will be impacted
  • It is advised by American Dental Association to have one check up to evaluate all your wisdom teeth. The dentist may advise removal of these molars.
  • Wisdom teeth are removed for the following reasons
    • Wisdom teeth can develop cavities
    • Wisdom teeth that are not fully erupted and angulated may put pressure on neighboring teeth and damage them
    • They may develop and progress into pathological conditions like cysts
  • Third molars and wisdom teeth are generally removed by experienced dentist who are confidant to remove wisdom teeth or by qualified specialists in Oral and Maxillofacial surgery.
  • General anesthesia can be used to remove the wisdom teeth. The cost of the removal of the teeth will increase under General Anesthesia

Investigations or tests

  • A single radiograph is required for surgical extraction of teeth other than the third molars. The dentist may also request a Orthopantomogram (Full Mouth X-ray) instead
  • An Orthopantomogram is required for impacted teeth
  • Blood investigations may be desired based upon the past and existing medical history you provide to the doctor

Why is Medical History important to be disclosed to the Dentist?

  • Medicines that we take for some medical conditions can delay the healing and cause bleeding from the area where the tooth has been removed. Example: Aspirin for heart disease.
  • Presence of medical conditions can delay healing, the patient may go into fits (seizures if he has epilepsy), damage the organs of the body if he has heart disease and if proper precautions and appropriate medicines are not taken before and after the removal of the tooth.
  • Allergic reactions can take place if medical history of allergy is not shared with the doctor
  • Patients with medical conditions or on certain medications are predisposing factors for patients going into unconsciousness during the dental procedures. The dentist will have to take adequate precautions prior to initiation of the procedure in such instances.


  • A gel is applied to the gums prior to use of the injections to anaesthetize the area
  • The dentist will need to expose the gum over the bone to gain access to the tooth
  • If the tooth is inside the bone, the dentist will have to further expose the bone to gain access to the tooth.
  • Once the tooth is visible, the dentist may split the tooth into two or more pieces for ease of removal
  • The tooth is then removed
  • Once the tooth is removed, the dentist will clean the area from where the tooth was removed and will put in a stich to allow the gums to cover the area.
  • Stitching the gums will help in the healing process
  • A cotton or gauze pack is placed over the area from where the tooth was removed
  • A follow up checkup is advised after 5 days from the date of the extraction. If stiches were placed it would have to be removed after 5-7 days, depending upon the advice of the dentist

Post procedure Instructions

  • First 24 hours
    • Keep the Cotton pack or gauze pack for 1-2 hours after the procedure
    • Ice is applied over the jaw near the surgical site for the first 24 hours after the procedure, apply for 20 minutes and repeat every 20-40 minutes interval
    • Keeping your head elevated for the first 2-3 days as it reduces the swelling and prevents bleeding down due to gravity
    • Take your medicines prescribed on time to manage the pain
  • Next 24 Hours
    • Warm saline rinses with ½ Tsp salt in a cup of water 8-10 times per day after the first 24-48 hours depending upon the advice of the dentist. Rinse gently as vigorous rinsing can disrupt the extraction or surgical site
    • Any oozing present from the site of the tooth extraction should be reported immediately
    • Mild swelling may be present which will usually reduce within 3-5 days.
  • Diet Intake
    • Soft and liquid diet
    • Food must be taken at room temperature
    • Take plenty of liquids
  • What to Avoid
    • No Spitting is allowed for first 24 hours after the procedure
    • No Brushing of teeth for the first 24 hours, thereafter avoid brushing near the area of the procedure
    • No straws to be used for any intake of liquid
    • Avoid any hot foods
    • Avoid Tobacco use or smoking
    • Avoid strenuous activities
  • When to consult the Dentist
    • Bleeding from the site of the procedure
    • Increase in swelling over the cheeks or face, or inside the mouth
    • Severe pain, with no relief from the medications
    • Difficulty in swallowing or breathing
    • Pus or oozing from the site of the procedure
    • Raise in body temperature above normal
    • Development of any rash or itching

Dry Socket

A dry socket is a very painful condition, and it can occur after tooth extraction

  • One must see your dentist immediately if severe pain persists
  • The dentist may clean the area or prescribe antibiotics as per the clinical findings
  • He may also place a medicated dressing to heal the area from which the tooth was removed and to control the severity of the pain

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