How long does a tooth extraction take?

How long does it take to extract a tooth?

If you are scheduled to have a tooth pulled, you may be wondering just how long the tooth extraction will take. Unfortunately, I do not have a simple answer to this question.  The only accurate answer is: that it depends on the type of tooth, the reason behind the extraction, and the general health of the patient.

I understand why patients ask this question.  Many people like to mentally prepare themselves for the dental procedure and the length of time in the chair is one of the most important considerations.  I think this question comes second only to the most pressing concern on the minds of most facing a dental procedure: will it hurt?

When your dentist plans to extract a tooth, they take many factors into consideration.  Based on experience and the information obtained during pre-operative imaging and evaluation of the tooth, he or she may give you an estimate of how long the extraction might take.

The dentist will typically communicate this information to the office staff who schedules the appointments to ensure there is ample time in the schedule for the procedure.  

With experience, a dentist will become more and more skilled at the art of estimating the time necessary for a specific procedure. 

I have extracted several thousand teeth in my career, but even with that level of experience, I have occasionally been wrong in my estimates. Some teeth have come out more easily than I anticipated, and others that I expected to be simple took more time than I had prepared for.

Pre-Operative Procedure

The time allotted for a tooth extraction typically includes the time necessary for the entire procedure, not simply the time the dentist actually spends extracting the tooth. 

When you arrive for your tooth extraction, you will first go through paperwork, often with a dental assistant or office staff.  This involves explaining the patient’s consent to have the tooth removed.  These forms usually require signatures stating the patient understands the procedure to which he or she is consenting.

A dentist might take time to perform preventative pain management treatment. A relatively new approach to minimizing tooth extraction pain is to administer analgesics before the procedure. Taking painkillers before a tooth extraction can help reduce postoperative pain. Studies have also shown that premedication with Ibuprofen can also improve the effectiveness of the anesthetic.

While sedation options are typically discussed at a separate visit before the tooth extraction, you may have a second discussion if you have changed your mind about how you want to undergo the treatment.  If you choose to add a sedative option that you had not previously selected and consented to, there will be additional time requirements.

A local anesthetic’s onset of action may take effect within just a few minutes for some patients, but for others, it can take up to 30 minutes before feeling the effect of the anesthetic (the numbness in the mouth).  While this is time in the dental chair, it actually has little to do with the extraction procedure.  The local anesthetic used to extract a tooth is the same as that used for fillings and dental crowns.  

Operative Procedure

Reason for Tooth Extraction vs. Time to Extract a Tooth

The diagnosis of the problem with a specific tooth does affect the time necessary to extract it.  There are a wide variety of reasons for which teeth require extraction.  They include large decay that has destroyed the majority of the tooth, a root canal treatment that has failed, fractures that extend down the tooth’s roots, or extensive bone loss from gum disease.  

The reason behind the need for extraction can definitely affect the time necessary to remove the tooth.  For example, if the tooth has suffered severe bone loss and has no supporting tissues around it, as in the case of severe gum disease, the extraction procedure is usually simple and quick.

Any condition that causes the tooth to break or crumble under pressure will make the extraction more complicated and require more time for extraction.  This includes teeth with extensive decay, root fractures, and existing root canals.  Teeth with “dead nerves” tend to be very brittle and break easily.  These situations require your dentist to remove the tooth in many small pieces instead of in a single removal of the tooth as a whole.  This takes longer.

Type of Tooth vs. Time to Extract a Tooth

It is safe to say that some types of teeth are more difficult to extract than others.  The difference depends on the root structure of the teeth.  While there are some variations from the normal root anatomy, typically we see molars with two to three roots.  These are harder to remove than teeth with only a single root.  Most front teeth have one root, as do lower premolars.  Upper premolars can have two well-formed roots.

The shape of the roots matters as well.  Some roots are very straight and conical (shaped like an ice cream cone).  These are simple to remove.  Roots with curves or flared angles have much stronger anchorage into the jawbone, and they are therefore much harder to pull.  

Your dentist will likely allot more time for a molar extraction than for an incisor or premolar. Canines have notoriously long roots, which gives them more anchorage and makes them tough to extract.

Amount of Teeth to be Removed vs. Time to Extract a Tooth

Obviously, the time necessary for your dental procedure will be longer if you have multiple teeth removed.  The increase factor depends on how many teeth are extracted and where they are located in the mouth.  Having ten teeth pulled in one visit does not mean that the time is ten times the amount of time necessary for a single tooth.  The dentist would estimate the time based on how long he or she thinks each individual tooth might take for removal.  This means your overall appointment time to remove a single tooth could be thirty minutes, and the time necessary to remove ten teeth is an hour and a half.  It all depends on the individual teeth.

If you have two teeth removed in a single visit, but they are located in different areas of the mouth, that requires two different areas of local anesthetic.  This increases the appointment time, too.

It is important to understand that removing as many teeth as possible in a single visit is not always prudent.  Patients could have medical conditions that make long visits intolerable, or conditions that make large surgical sites inadvisable.   These decisions may require consultation with the patient’s medical doctor to determine the length of surgery a patient can withstand.

There are some cases in which, for the patient’s safety, the extractions are performed under general anesthesia in a hospital setting with the help of an anesthesiologist.  This is common when the patient is medically compromised or requires extensive oral surgery that would be difficult to tolerate without sedation.

Post-Operative Procedure

After the tooth is removed, there are a variety of closing procedures necessary for optimal healing.  In instances of complicated extractions, your dentist may order a final x-ray to confirm the removal of all root fragments.  The dentist often has to remove the soft tissue from the socket after the root’s removal if a significant infection is present.

Some surgical extractions require reshaping of the bone and gum tissue after tooth removal.  

Many patients plan to replace the extracted tooth in the future and may opt for a socket preservation bone graft.  This requires an additional procedure of bone graft placement and sutures (stitches) to cover the socket and maintain the placement of the bone graft.

When the dentist has completed whatever procedures are necessary for the patient, he or she will usually place a small gauze pack over the socket and ask the patient to bite into it with good pressure.  The patient continues to bite onto the gauze while the dentist and assistant are cleaning up and going over the post-operative instructions.

This gauze helps the dentist gauge the risk for excessive bleeding while the patient is still in the chair.  After five to ten minutes, the dentist or assistant will remove the first gauze pack, assess the volume of bleeding, and place a second pack. 

The dentist or assistant will provide the patient or caregiver (if the patient is sedated) with written and verbal post-operative instructions. This process can take up to fifteen additional minutes after the dentist finishes working in the patient’s mouth.

Complications

Complications are possible any time the human body is involved.  We simply cannot always predict how a tooth will respond to the pressure forces used to extract it.  Complications during tooth extractions include breakage of a root, nerve damage (typically only on the lower molars), and sinus problems (on upper molars and premolars).

A complication is something that makes the procedure more difficult, but it is not something that means your dentist did anything wrong.  Dentists are always prepared for complications.  We do not like them, but we are ready for them.  A complication may necessitate the use of additional surgical instruments that were not readily available.  Do not be concerned if you hear the dentist asking the assistant to go get something different.  It simply means that he or she is trying a different tactic to remove the tooth.

Yes, a complication will make the extraction take longer than the dentist anticipated, but it does not mean you will have long-term complications with the tooth.  

Other Considerations

Another factor that impacts on the tooth extraction time is the patient’s behavior. If a patient is anxious or emotional, the dentist will take more time to guide them through the extraction procedure.  It is not unusual for patients to become tearful, even when they are feeling no pain, simply because the extraction can be a stressful experience.  

Most dentists will stop the procedure and take additional time to help the patient calm down before continuing to extract the tooth.  The best scenario is when we can anticipate this type of issue ahead of time and recommend sedation to keep the patient calm and comfortable throughout his or her extraction.

How Long will My Extraction Take?

The only way to estimate the time needed to extract a particular tooth is to undergo the in-person clinical evaluation and imaging necessary for an accurate diagnosis.  Your dentist will take a minimum of one x-ray showing the entire root of the tooth to be extracted.  He or she may also take some measurements or do additional testing on the tooth to determine its prognosis.  

Your dentist also factors in his own experience level with the type of extraction you require to provide you with an estimated length of time for the appointment.  Let your dentist know whether you have had problems with the onset of local anesthetic or other tooth extractions in the past.  This helps him give you the most educated guess for how long the extraction will take.