Tooth extractions

Keeping your own tooth is usually the better long-term deal, so that's where we start. Removing it becomes the right call when:

• Decay or a break goes too deep for a filling, crown or root canal to fix
• A crack runs down into the root
• Gum disease has destroyed so much bone that the tooth is loose
• An infection keeps coming back in a tooth that can't be treated again
• A wisdom tooth is impacted or damaging the tooth in front of it
• Teeth are crowded and orthodontic treatment needs the space
• A baby tooth won't come out on its own and is blocking the adult tooth

A simple extraction is for a tooth that's fully visible above the gum. Once the area is numb, the dentist gently widens the socket and lifts the tooth out. You'll feel pressure and some pushing, not sharp pain.

A surgical extraction is for a tooth that's broken off at the gumline, has long or curved roots, or hasn't fully come in. The dentist opens the gum slightly and may divide the tooth into sections, so each piece comes out with less force on the bone. A few stitches may close the area.

Both are done here with the area fully numbed, and nitrous oxide or oral conscious sedation can make it easier if you're nervous. Both of our dentists do simple and surgical extractions.

A few details change how we plan. Bring your medication list and mention any of these:

• Blood thinners, including a daily aspirin. Don't stop them on your own; we'll coordinate with your doctor if needed.
• Bone medicines for osteoporosis or cancer, by pill or by injection, now or in the past. Some affect how the jaw heals.
• Diabetes, a heart condition, an artificial joint or heart valve, or a recent surgery.
• Any past reaction to numbing medicine or antibiotics.
• If you're choosing oral conscious sedation: line up a driver, and follow the eating and drinking instructions we give you.

The first 24 hours are about protecting the blood clot that forms in the socket. Bite firmly on gauze for the first half hour or so, and replace it if oozing continues. No spitting, no straws, no smoking or vaping, and no hard rinsing. Rest with your head raised and use a cold pack on your cheek, 20 minutes on and 20 off.

From the second day, rinse gently with warm salt water after meals. Eat soft, lukewarm foods and chew on the other side. Soreness usually peaks in the first two or three days and fades after that. Over-the-counter pain relievers usually do the job, and we'll tell you which suit your health.

The gum usually closes over the socket within a couple of weeks, and the bone underneath keeps filling in for months. If pain gets worse around day three instead of better, often with a bad taste, the clot may have come loose. That's called a dry socket, and it's very treatable, so call us.

Also call if bleeding won't stop with firm pressure or you run a fever. Go to the ER for swelling that spreads into your face or neck, trouble breathing or swallowing, or bleeding you can't control.

A gap in the back may not show, but it still matters. The teeth beside it tend to drift and tip into the space, the tooth above or below can grow toward it, and the bone where the root was shrinks over time. That makes chewing harder and any future replacement more complicated.

So before an extraction, we talk through what comes next: an implant, a bridge, or a partial denture, with rough timing and cost for each. If an implant is likely, ask whether the site will need a bone graft; our 3D scan answers that. Sometimes the best answer is to leave the space alone, as with most wisdom teeth, and we'll tell you when that's the case.

Sometimes more than one tooth needs to come out, often because of advanced gum disease. That's a big decision, and it deserves a plan, not a rush. We'll show you which teeth can be saved, which can't, and what you'd wear while healing, whether that's a partial, a full denture, or a path toward implants.

Some people prefer to handle extractions in stages; others would rather do it all at once and heal one time. There's no single right way. We'll explain the trade-offs in comfort, healing time and cost so you can choose.

The price depends on whether it's a simple or surgical extraction, how many teeth, and whether you choose sedation. You get the cost in writing before we start.

Most dental plans cover extractions, often as basic care, though surgical extractions are sometimes paid at a different level. We also help adult Medicaid patients use the services their plan covers; call with your plan details and we'll check what applies.

Without insurance, the Sunshine Membership is a $110 one-time fee for 2 checkups with x-rays, unlimited limited exams for pain, and 30 to 40% off dental treatment. Sunbit and Cherry let you pay over time. And if the tooth hurts right now, the $40 emergency exam with limited x-rays is the place to start.