Tooth Extraction Criteria: How Bad Does a Tooth Have to Be?

the dentist explains the condition of the teeth to the patient

Some people have a tough time deciding whether or not to have their natural tooth extracted, often unsure of how to recognize the true severity of their dental issue. This uncertainty usually stems from a lack of knowledge about when should a tooth be extracted. Bad oral health can cause severe pain and the risk of infection, but not all dental problems need extraction.

Knowing the balance between treatable conditions and those that require dental extractions is important to make informed decisions.

How Bad Does a Tooth Need to Be Extracted?

Severe Decay

When a tooth has decayed severely, it may be beyond repair. If the decayed tooth compromises the pulp, causing an infection that cannot be treated with root canal therapy or if a tooth is so extensively decayed that it cannot support a filling or a crown, dentists may recommend an extraction procedure to eliminate the spread of infection and relieve pain.

Periodontal (Gum) Disease

Periodontal disease is a tissue and bone infection that surrounds the supporting teeth. In its advanced stages, it loosens the teeth. If the gum disease has significantly damaged the bone and soft tissues, rendering the tooth excessively loose and beyond salvage with periodontal treatments, tooth extraction may be the only possible course of action.


This commonly happens with wisdom teeth (third molars) but can also happen with other teeth. An impacted tooth is one that is obstructed from growing or erupting into its proper position. It leads to pain, infection, or damage to adjacent teeth. Often, removing the impacted tooth is the ideal option to fix these complications.


Sometimes, a tooth is extracted as part of orthodontic treatment. If your mouth has overcrowded teeth, removing one or more can provide the space needed for the remaining teeth to be properly aligned. This is often assessed and recommended by an orthodontist.

Trauma or Injury

If a broken tooth is severely damaged due to trauma or injury and cannot be saved through restorative treatments such as dental crowns or bonding, a simple extraction might be required. Dentists will also consider a tooth extraction if a significant loss of tooth structure or support compromises function or esthetics.

Risk of Infection

In some cases, dentists can extract your teeth if they find infected teeth, which could concern people undergoing chemotherapy, organ transplants, or those with compromised immune systems. The reason is to remove the source of potential infection that could lead to severe complications.

Non-functional or Supernumerary Teeth

Teeth that do not serve a functional purpose, such as extra (supernumerary) teeth or those that do not touch the opposite tooth (non-functional), may sometimes be extracted. Dentists will also recommend removing it, especially if it poses a problem for the alignment of other teeth or the health of the oral cavity.

Baby Teeth That Don’t Fall Out

Sometimes, a child’s primary (baby) teeth don’t fall out to make space for permanent teeth. This can lead to crowding and misalignment issues. In such cases, a dentist might recommend extracting the retained primary teeth.

What Is The Tooth Extraction Procedure?

The tooth extraction process includes different phases to ensure the procedure is successful and minimizes discomfort for the patient. Here is an overview of the tooth extraction process, including an explanation of each step involved:

1. Preparation

The first step is reviewing the patient’s medical history thoroughly and conducting necessary imaging studies like X-rays. It is needed to evaluate the tooth’s condition and surrounding bone, understand its position, and find potential complications. It’s also important for the dentist to be aware of medications the patient takes that could affect blood clotting or allergies, particularly local anesthetics.

2. Anesthesia

To ensure the patient does not feel pain during tooth extraction, the dentist will administer local anesthesia to numb the area around the tooth that will be extracted. This is typically done by injecting an anesthetic into the gum tissue.

In certain cases, especially if the tooth extraction is complex or the patient is very anxious, the dentist might use sedation anesthesia or general anesthesia, making the patient extremely relaxed or completely unconscious, respectively, throughout the procedure.

3. Tooth Loosening and Elevation

Once the area is fully numb, the dentist uses specialized tools to gently rock the tooth back and forth from its socket to loosen it from the jaw bone and periodontal ligament. They may use elevators or dental luxators to lift the tooth from its socket carefully. This step is crucial for smooth tooth removal with minimal force, reducing the risk of surrounding tissue damage.

4. Extraction

After the tooth is sufficiently loosened, the dentist uses dental forceps to grip it and remove it from the mouth securely. The goal is to extract the tooth as gently as possible and minimize trauma around the tissues. If the tooth is impacted or cannot be easily lifted out (e.g., because it’s broken at the gum line), a surgical extraction may be necessary.

This involves making a small incision into the gum to expose the tooth, removing any bone covering the tooth, and possibly sectioning the tooth into smaller parts for easier removal. While it may sound scary, it’s a completely safe dental procedure when you visit an experienced oral surgeon.

5. Post-extraction Care and Cleaning

Immediately after the dentist extracts the tooth, they will ask the patient to gently bite down on a piece of sterile gauze to aid in blood clot formation at the extraction site, which is vital for healing. They clean the socket to remove any debris or remaining tooth parts and smoothen out the socket’s edges if needed. Sometimes, they may apply stitches to help the gum tissue heal.

6. Recovery and Aftercare Instructions

The final step involves offering the patient caring instructions for the extraction site at home. This may include advice on managing pain and swelling, guidelines on diet (e.g., eating soft foods and avoiding the extraction area while chewing), and oral hygiene tips to avoid severe infection.

Patients are also recommended to halt smoking and drinking from a straw, as the sucking motion can dislodge the blood clot within the socket, causing a painful condition known as dry socket.

Need a Tooth Pulled? Talk to North Atlanta Family Dentistry Today!

Many dental experts will tell you to never wait for signs of dental issues. Remember that these issues may become difficult to deal with and even cost you a lot. That’s why getting dental check-ups from North Atlanta Family Dentistry can prevent your teeth from worsening.

You can call us to set your appointment and have your teeth checked. But if we determine that your teeth are far from saving, there is no need to fret because our tooth extraction process will be as pain-free as possible.