Simple extraction

Before you start

• • Medical history: anticoagulants or antiplatelets — check INR / DOAC timing Patients on anticoagulants
• • Antiresorptive drugs (bisphosphonates, denosumab) — assess MRONJ risk
• • Pre-op radiograph of roots and surrounding anatomy; written consent
• • Calculate the maximum local anaesthetic dose for the patient's weight

Steps

1. 1

   Anaesthesia

   Give local anaesthetic (infiltration or block) and confirm soft-tissue and pulpal anaesthesia.

2. 2

   Detach soft tissue

   Sever the gingival attachment around the tooth with a periosteal elevator or luxator.

3. 3

   Luxate

   Use an elevator with controlled rotation, supporting the alveolus with the other hand. Never use adjacent teeth as a fulcrum.

4. 4

   Deliver

   Apply forceps as far apically as possible; use slow, sustained buccal–lingual and rotational movements suited to the root form.

5. 5

   Inspect

   Check the tooth is complete; inspect socket, remove debris, gently compress the socket walls.

6. 6

   Haemostasis

   Damp gauze pressure for 10–15 min. Add oxidised cellulose, sutures or tranexamic acid if bleeding risk is raised.

   Patients on anticoagulants

Aftercare

• • Analgesia: ibuprofen + paracetamol if not contraindicated Analgesics for dental pain
• • Written aftercare: no rinsing or smoking for 24 h, then warm salt-water rinses
• • Warn about dry socket — severe pain on day 2–4 Dry socket (alveolar osteitis)

Related topics

Sources

• SDCEP — Management of dental patients taking anticoagulants or antiplatelet drugs (2022)UK
• SDCEP — Oral health management of patients at risk of MRONJUK
• SDCEP — Drug Prescribing for DentistryUK

Checked on 2026-10-22.