In some cases, having a tooth pulled in the adulthood is necessary. Many people expect that when their tooth is pulled, it will hurt them a lot. But, before your dentist can even consider pulling your tooth, there are certain steps which he must do. When he or she does these steps, they will be sure that your extraction will go safely and uneventfully as possible, but also that your tooth was removed for a good reason. It can include X – ray evaluation of your tooth. Your doctor will take your medical history and identify the associated risks.
You should tell if you take some medications and identify any possible complications. The tooth extraction is a very safe procedure, but it can allow harmful bacteria to enter into your bloodstream. Also, the gum tissue has a risk of infection. If you have some condition which increases your risk of developing a severe infection, then you may need antibiotics before and after extraction. You should tell your doctor your complete medical history, the medications and supplements you take. Also, you should tell your dentist if you have any of the below mentioned conditions:
- History of bacterial endocarditis 
- Artificial joint, such as a hip replacement
- Liver disease (cirrhosis) 
- Impaired immune system
- Congenital heart defect 
- Damaged or man – made heart valves
You should know that it is normal to feel some pain after the anesthesia wears off. After 24 hours passed from the pool extraction, you should expect some swelling and residual bleeding. But, if the bleeding or pain is still severe more than four hours after your tooth is pulled, then you should call your dentist. Also, you should call your dentist if you experience any of the following symptoms:
- There can be cough, shortness of breath, chest pain, or severe nausea or vomiting
- Redness, swelling, or excessive discharge from the affected area
- Nausea or vomiting
- Signs of infection, including fever and chills
The initial healing period usually takes about one to two weeks and new bone and gum tissues will grow into the gap. As the time passes, having a tooth (or teeth) missing can cause the remaining teeth to shift, which is affecting your bite and it makes difficult to chew. For this reason, dentists can advise replacing the missing tooth or teeth with an implant, fixed bridge or denture. Also, children who have extracted their tooth or teeth undergo a slightly different procedure.
Dentists will put children under general anesthesia to make the tooth extraction and this means that the child will be unconsciousness and not feel anything throughout the procedure. But, the healing process is similar. It is very important for parents or caregivers to monitor the healing and oral health closely and to ask them questions about symptoms, such as bleeding and pain. The tooth extraction completely removes a problematic tooth to prevent future complications.
After the tooth extraction, proper aftercare is vital, because it can help to promote the clotting and protect the extraction site during the healing process. Most simple extractions should heal in a period of seven to ten days. Every single person who experience worsening symptoms after a tooth extraction should see their dentist. Your doctor will recommend you some treatments which can help in the healing process, such as nonsteroidal anti – inflammatory drugs, ice packs and saltwater rinses.
The saltwater rinse will help to kill bacteria in the mouth and it will reduce the pain and swelling. You can apply a towel – wrapped ice pack to the affected side of the ice for twenty minutes at a time because this can help to reduce the swelling and pain. NSAIDS, such as Aleve and Advil, can help to reduce both pain and swelling . You should always take the antibiotics under guidance of your dentist, so you will be sure that you will not have any side effects.
Reasons for pulling tooth extraction
The permanent teeth are meant to last a lifetime, but there are many different reasons why the tooth extraction may be needed. The most common reason why the teeth are pulled is they are too badly damaged, from decay or trauma and they need to be repaired. But, there are other causes for the pulling of your teeth, such as:
- Infection: If the tooth decay or the damage extends to the pulp (the center of the tooth which has nerves and blood vessels), then the bacteria in the mouth can enter the pulp, which leads to infection. In many cases, this can be corrected with the RCT (root canal therapy), but if the infection is so severe that antibiotics or RCT do not cure it, and then the extraction may be needed to prevent the spread of the infection. 
- A crowded mouth: There are some cases when dentists pull teeth to prepare the mouth for orthodontia. The goal of the orthodontia is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. If the tooth cannot break through the gum (erupt) because there is not room in the mouth for it, then your dentist may recommend pulling it.
- Risk of infection: If your immune system is compromised (for example, if you are having an organ transplant or you are receiving chemotherapy), even the risk of infection in a particular tooth can be reason enough to pull the tooth. 
- Periodontal (gum) disease: If the periodontal disease, have caused loosening of the teeth, then it may be necessary to pull the tooth or teeth. The periodontal disease is an infection of the tissues and bones which surround and support the teeth.
What to expect with the tooth extraction
The tooth extraction is done by dentists and oral surgeons (dentists with special training to perform surgery). Before your dentist pull your tooth, he or she will give you an injection of a local anesthetic to numb the area where the tooth will be removed. There are some cases, when the dentist may use a strong general anesthetic. This can prevent the pain throughout the body and it will make you sleep through the procedure.
If the tooth is impacted, then the dentist will cut away gum and bone tissue which covers the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments which hold it in place. When the tooth is hard to pull, then your dentist must remove it in pieces. When the tooth has been pulled, then a blood clot usually forms in the socket. Your dentist will pick a gauze pad into the socket and have you bite down on it to help stop bleeding.
Also, there are some cases when your dentist will place a few stitches (usually self – dissolving), to close the gum edges over the extraction site. In some cases, the blood clot in the socket breaks loose, exposing the bone in the socket. This is a painful condition which is known as dry socket. If this happens, then your dentist will place a sedative dressing over the socket for a few days to protect it as a new clot forms.
After you have had a tooth extraction
When your dentist will finish with the tooth extraction, then he will send you home to recover. Typically, the recovery time takes a few days. Below are given some tips which you should do, to minimize the discomfort, reduce the risk of infection and speed the recovery process.
- Do not smoke, which can inhibit healing 
- You should not drink from a straw for the first 24 hours
- After 24 hours, rinse with your mouth with a solution made of one – half teaspoon salt and eight ounces of warm water
- You should avoid rinsing or spitting forcefully for 24 hours after the tooth extraction to avoid dislodging the clot that forms in the socket
- You should relax for at least 24 hours after the tooth extraction. You should limit your activity for the next day or two.
- You should apply an ice bag to the affected area immediately after the procedure to keep down swelling. You should apply ice for ten minutes at a time.
- You should bite firmly, but gently on the gauze pad placed by your dentist to reduce bleeding and allow a clot to form in the tooth socket. You should change gauze pads before they become soaked with blood. Otherwise, you can leave the pad in place for three to four hours after the extraction.
- Take painkillers as described.
- You should continue to brush and floss your teeth, and brush your tongue, but be sure to avoid the extraction site. Doing so will help prevent infection.
- When lying down, prop your head with pillows. Lying flat may prolong bleeding.
- Eat soft foods, such as yogurt, pudding, soup or applesauce the day after the tooth extraction. You should add gradually, add solid foods to your diet, as the tooth extraction site heals.
 Mang-de la Rosa MR, Castellanos-Cosano L, Romero-Perez MJ, Cutando A. The bacteremia of dental origin and its implications in the appearance of bacterial endocarditis. Medicina Oral, Patologia Oral, Cirugia Bucal. 2014;19(1):e67–e73. doi:10.4317/medoral.19562
 Martinez SR, Serna JT, Silvestre FJ. Dental management in patients with cirrhosis. Gastroenterología y Hepatología. 2016;39(3):224-32.
 Carrillo C, Russell J, Judd P, Casas MJ. Oral health of children with congenital heart disease at a pediatric health science centre. Journal of the Canadian Dental Association. 2018;84:i7.
 Roda RP, Bagan JV, Soriano YJ, Romero LG. Use of nonsteroidal antiinflammatory drugs in dental practice. A review. Medicina Oral, Patología Oral y Cirugía Bucal (Internet). 20017;12(1).
 Maestre Vera JR, Gómez-Lus Centelles ML. Antimicrobial prophylaxis in oral surgery and dental procedures. Medicina Oral, Patología Oral y Cirugía Bucal (Internet). 2007;12(1).
 Yi EKY, Ying ALS, Mohan M, Menon RK. Prevalence of postoperative infection after tooth extraction: A retrospective study. International Journal of Dentistry. 2021.
 Sanari AA, Alsolami BA, Abdel-Alim HM, et al. Effect of smoking on patient-reported postoperative complications following minor oral surgical procedures. The Saudi Dental Journal. 2020;32(7):357-63.