Tooth extraction is always the last resort at Dr. Mittal's. We explore every option to save the tooth first — fillings, crowns, pulp treatment — because premature loss of a tooth, especially a baby tooth, can affect how permanent teeth erupt and how the jaw develops. When extraction is unavoidable, the procedure is carried out gently, comfortably, and with full aftercare guidance for parents.
When Is Extraction Necessary?
- Severely decayed tooth — when decay has destroyed so much tooth structure that a filling or crown is no longer viable, and infection risk is high.
- Failed or unsuitable pulp treatment — a tooth that has not responded to pulpectomy or where the infection has spread to the surrounding bone.
- Over-retained baby tooth — a milk tooth that refuses to fall out naturally and is deflecting the permanent tooth underneath, causing it to erupt in the wrong position.
- Orthodontic extraction — deliberate removal of one or more teeth to relieve crowding so braces or aligners can align the remaining teeth correctly.
- Dental abscess with spreading infection — where antibiotics alone cannot control the infection and the tooth is the source.
- Supernumerary (extra) teeth — an extra tooth that is blocking normal eruption of permanent teeth, particularly common in the upper front region.
- Impacted wisdom teeth (in older teens) — wisdom teeth that have no room to erupt and are causing pain, decay in adjacent teeth, or crowding.
Before recommending extraction, we take an X-ray and assess whether a pulpectomy, crown, or indirect pulp cap can save the tooth. We explain every option clearly. Extraction is recommended only when saving the tooth would cause more harm than good — or when the tooth simply has no future.
What to Expect on the Day
Before We Start
We apply a topical anaesthetic gel to the gum for a few minutes so the child does not feel the injection. The local anaesthetic injection is given slowly and gently — this is the most important step, and we take all the time needed. The child will feel pressure during the procedure but no pain. For anxious children, we offer nitrous oxide (laughing gas) which keeps them calm and relaxed throughout.
The Extraction
The tooth is loosened gradually using an instrument called a periotome or elevator before removal with forceps. We work slowly and gently, checking with the child throughout. A simple extraction of a baby tooth typically takes 5 to 10 minutes once the area is numb. Surgical extractions — for impacted teeth, broken roots, or teeth that have not erupted fully — take longer and may involve a small incision in the gum.
After the Procedure
A sterile gauze pad is placed on the socket and the child bites gently for 20 to 30 minutes to control bleeding. We give written aftercare instructions and the parents' number is saved for follow-up. Mild discomfort is expected for 24 to 48 hours, which paracetamol manages well. The socket closes over 7 to 10 days.
Post-Extraction Care at Home
- No spitting, rinsing, or sucking through a straw for the first 24 hours — this dislodges the blood clot that is forming in the socket and delays healing.
- Soft diet for 2 to 3 days — khichdi, curd rice, mashed dal, idli, soft fruit. Avoid hard, crunchy foods (biscuits, chips) and very hot foods or drinks.
- No vigorous gargling — gentle warm salt water rinses from the next morning are helpful and safe.
- Paracetamol (Calpol or equivalent) as needed for discomfort — ibuprofen can also be used if there is no contraindication.
- Avoid touching the socket — children are curious; gently remind them not to probe the area with tongue or fingers.
- Bleeding — a small amount of blood-tinged saliva for a few hours is normal. If active bleeding continues beyond 30 minutes, place fresh gauze and call us immediately.
- Swelling — minimal swelling after a simple extraction. For surgical extractions, ice applied to the cheek in the first few hours reduces swelling. More swelling on day 2 or 3 is normal and peaks before settling.
When a baby tooth is removed early (before the permanent tooth is ready to erupt), a space maintainer is strongly recommended to hold the space. Without it, neighbouring teeth drift into the gap over months, blocking the permanent tooth's path and creating a crowding problem that requires orthodontic treatment later. We take an X-ray to assess the situation and advise whether a maintainer is needed.
Types of Extractions We Perform
Simple Extraction
The most common type. The tooth is fully erupted, visible in the mouth, and loosened then removed with forceps under local anaesthesia. Baby teeth, over-retained milk teeth, and most orthodontic extractions fall in this category.
Surgical Extraction
Required when the tooth is impacted (partially or fully embedded in bone), when only the root remains after the crown has broken off, or when a wisdom tooth has no eruption path. A small incision is made in the gum, and sometimes a small amount of bone is removed to access the tooth. Stitches are placed and dissolve on their own in 7 to 10 days.
Orthodontic Extraction
Planned removal of specific teeth — often upper and lower first premolars — to create space for orthodontic correction. These are usually straightforward simple extractions. The extraction sequence is coordinated precisely with the orthodontic treatment plan.
Frequently Asked Questions
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