Services
Tooth Extraction in Ituiutaba, Brazil
Exodontia, tooth extraction, is a careful indication, always considered only when all conservative alternatives are not viable. In Ituiutaba, Dra. Maria Vitória Lima performs simple extractions (of erupted, accessible teeth) with proper technique, modern local anesthesia, and clear instructions for a calm recovery. More complex surgical cases, such as impacted wisdom teeth, deep residual roots, or surgeries near important anatomical structures, are referred to oral and maxillofacial surgeons in our regional network, while we continue to oversee your overall care in parallel.
What is Tooth Extraction?
Exodontia is the technical term for the surgical procedure of removing a tooth that can no longer be preserved. Although called 'surgery,' the simple extraction of a fully erupted tooth is a quick outpatient procedure, performed under local anesthesia, without need for hospitalization or prolonged absence. Modern medicine and dentistry make extraction considerably more peaceful than it was decades ago, effective anesthetics, refined techniques, quality analgesic and antibiotic medications, and well-established post-operative care protocols. There are three major categories of exodontia, classified by complexity. Simple extraction is performed on completely erupted teeth, accessible through the oral cavity, without need to cut gum or bone. Only manual instruments are used, elevator to displace the tooth from the socket, forceps for grasping and removal. It's the most common type: destructive cavities, tooth with failed root canal, tooth with severe mobility from periodontal disease. Surgical extraction (or complex) is performed in cases requiring gum incision, osteotomy (removal of a small portion of bone), and sometimes tooth sectioning (cutting the tooth into smaller fragments for piecemeal extraction). Indicated for impacted wisdom teeth (not erupted), deep residual roots, teeth with unfavorable anatomy, and cases where the tooth cannot be luxated with simple technique. It demands more time, more post-op care, and in some cases, conscious sedation in addition to local anesthesia. Extraction of impacted teeth is a subcategory of surgical extraction, refers specifically to teeth that never fully erupted. Third molars (wisdom teeth) are the most common example, but canines and premolars can also become impacted. At our clinic, we handle simple extractions, which cover the majority of clinical needs in general dentistry. For complex surgical extractions (especially impacted wisdom teeth and teeth near critical anatomical structures like the inferior alveolar nerve or the maxillary sinus), we refer to dentists specialized in oral and maxillofacial surgery and traumatology. This division of competencies ensures each type of extraction receives the appropriate professional, with the necessary infrastructure and experience for the case. The decision to extract a tooth is never taken lightly. Before indicating exodontia, we always weigh all conservative alternatives: extensive restoration, root canal treatment, prosthetic crown, advanced periodontics. Extraction is the last resort, considered only when the tooth truly cannot be saved viably and functionally.
When is it recommended?
When to consider
Indication for exodontia appears when a tooth has lost the conditions to be preserved viably, clinically, aesthetically, or functionally. The general rule in modern dentistry is: preserve whenever possible. Natural teeth, even when restored, offer irreplaceable function and tactile sensation. So before any extraction indication, we exhaust all conservative alternatives: restoration even in extensive cases, root canal, prosthetic crown, subgingival scaling, referral to periodontist. When, despite all these options, the tooth cannot be saved, or when preserving it would generate more problems than benefits, extraction becomes the right indication. In all cases, the decision is discussed openly with you before scheduling, with clear explanation of the reasons, the alternatives that didn't work (or don't apply), and the rehabilitation options after extraction.
Cavity so destructive that there isn't enough dental structure for restoration or crown, generally when more than 50% of the dental crown is lost and the root is also compromised
Irrecoverable coronary or radicular fracture, especially vertical root fractures, which cannot be endodontically treated
Failed or impossible root canal treatment, when the canal hasn't responded to treatment, or retreatment is unviable
Pulpal necrosis with severe infection and unviable root canal treatment, case where extraction is necessary to resolve the infection
Advanced periodontal disease with severe tooth mobility (grade III), when bone support is so compromised that the tooth cannot be maintained
Impacted wisdom teeth causing problems, recurrent pericoronitis, pain, cysts, displacement of neighboring teeth, hygiene difficulty
Wisdom teeth without space for eruption that will cause future problems, preventive indication, generally between 18 and 25 years before the root forms completely
Supernumerary teeth, 'extra' teeth that aren't part of normal dentition and interfere with positioning of others
Retained teeth that won't erupt and are causing resorption of neighboring roots
Orthodontic indication, extraction of premolars (or other specific teeth) to create necessary space in orthodontic treatment (always guided by the orthodontist)
Preparation for complete dentures, when remaining teeth in poor condition need to be removed before denture fabrication
Teeth with infection that don't respond to conservative treatment and represent systemic risk (in patients with specific comorbidities)
How does the procedure work?
How we run your treatment
A simple tooth extraction is a well-established procedure with a predictable sequence and total duration generally of 20 to 40 minutes from entry to exit (the procedure itself can take 5 to 20 minutes; the rest is evaluation, anesthesia, and instructions). The patient is fully conscious, but without pain, feeling only pressure and movement during tooth manipulation. Modern technique prioritizes atraumatic removal: preserve maximum alveolar bone, minimize injury to neighboring tissues, control bleeding, and immediately initiate formation of the clot that will heal the socket. Each step has a specific clinical purpose.
- 1
Clinical and radiographic evaluation
Before any procedure, we evaluate the tooth clinically (mobility, infection, periodontal state) and request periapical radiograph (shows entire root) or panoramic (shows both arches and maxillary sinus). The radiograph reveals the number of roots, their shape and proximity to critical structures (inferior alveolar nerve, maxillary sinus, neighboring teeth). In complex cases or when there's suspicion of significant technical difficulty, the indication shifts to oral surgeon via referral. For simple extractions, we close the diagnosis, review general health history and medications, and discuss the procedure.
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Health history and current medications
Identify patients requiring special management, uncontrolled diabetes, bisphosphonate use (osteonecrosis risk), anticoagulants (warfarin requires recent INR; DOACs generally don't need interruption), antiplatelet agents, cardiac conditions with endocarditis risk (require prior antibiotic prophylaxis per AHA/SBC guidelines), history of anesthetic or antibiotic allergy. When necessary, we request medical opinion from cardiologist, hematologist, or general physician before scheduling.
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Local anesthesia
We apply local anesthesia, generally lidocaine 2% with epinephrine 1:100,000 or articaine 4% with epinephrine 1:100,000 or 1:200,000. Choice of anesthetic and dose considers patient health history (in uncontrolled hypertensive or cardiac patients, we adjust epinephrine concentration). Technique varies by tooth: local infiltration for most upper teeth and lower anteriors, inferior alveolar nerve block for lower molars and premolars. Before the injection, we apply topical gel anesthetic on the gum, most patients barely feel the needle insertion. Effect begins in 2-5 minutes. You feel only pressure during the procedure, never pain.
- 4
Syndesmotomy and luxation
Before removing the tooth, we detach the periodontal fibers that hold it to the socket, this step is called syndesmotomy. We use a delicate instrument (syndesmotome or periotome) carefully inserted around the tooth. Then comes luxation: with an elevator, we apply controlled force to slightly expand the socket and break the last connecting fibers. Luxation is a technical maneuver requiring patience, slow, controlled expansion of the socket prevents bone fractures and root fractures. You'll feel pressure during this phase, but no pain (thanks to anesthesia).
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Avulsion with forceps and socket inspection
With the tooth luxated and mobilized, we use the appropriate forceps to grip the tooth crown (each region of the mouth has a specific forceps model, upper incisor, lower molar, etc.). We apply gentle vestibular-to-lingual (or mesio-distal, as the case may be) movements until complete removal of the tooth. After avulsion, we inspect the socket: confirming no root fragment remains, that there was no bone fracture, and we perform curettage if there's inflammatory tissue or residual cyst. In some cases, we smooth the bony edges to favor healing.
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Suture (if necessary) and clot formation
For simple extractions without need for incision, there's generally no suture. For extractions with prior incision, large posterior teeth, or wide sockets, we suture with resorbable thread (Vicryl) or nylon. After suturing or at the end of the procedure, we compress sterile gauze over the socket, you bite to maintain pressure for 45 minutes to 1 hour. This step is decisive: pressure controls initial bleeding and favors clot formation, which is the first stage of healing. Without a stable clot, there's risk of alveolitis (the most feared post-extraction complication).
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Prescription, post-op instructions, and follow-up plan
We prescribe medication according to the case: analgesic (generally acetaminophen or dipyrone; ibuprofen in some cases) for the first 2-3 days; antibiotic only when indicated (pre-existing infection, impacted wisdom teeth with pericoronitis, immunocompromised patients, endocarditis prophylaxis). We provide detailed written post-op instructions: what to do, what NOT to do, warning signs. We schedule return for suture removal in 7 days (if there's one) and healing evaluation. You leave the clinic with direct contact for any questions or complications in the first 48-72 hours.
How much does it cost?
Costs vary by case. After a clinical evaluation, we present treatment options and payment terms. Inquire about pricing and conditions directly on WhatsApp.
Aftercare
Aftercare after the visit
The first 2 to 3 days after extraction are the most important for peaceful healing. The central goal is to protect the blood clot that forms in the socket, this clot is the first stage of healing, and any gesture that displaces it can cause alveolitis (also called 'dry socket' or alveolar osteitis), a painful complication that significantly delays recovery. The good news: with proper care, most patients have a peaceful recovery, with mild to moderate discomfort in the first 2-3 days and complete return to normal activities in one week. Expected post-operative symptoms include mild to moderate discomfort (controlled with prescribed analgesics), slight facial swelling (peak in 48-72h, then reduces), small hematoma (purple mark) in the area, sensation of 'sore neighboring tooth' due to manipulation in the area, occasional increased salivation in the first hours. All of this is normal and improves progressively. Warning signs that call for return to the clinic: pain that INCREASES after the 3rd day (especially radiated to the ear or temple, may be alveolitis); heavy bleeding that doesn't cease with pressure; fever above 38°C; pus draining from the socket; swelling that increases after the 4th day; prolonged numbness of the lower lip after lower molar extraction (suspicion of nerve injury). Complete gum healing takes 7-14 days; initial bone healing, 4-6 weeks; complete bone healing, 3-6 months. For rehabilitation with prosthesis or implant, we wait the 3-6 months for the bone to stabilize completely. In case of multiple extractions or in patients who will go without teeth in a visible area, we discuss beforehand the possibility of an immediate provisional prosthesis so you don't go without teeth during the healing period.
Keep the gauze pressed for 45 minutes to 1 hour after leaving the clinic, this step is decisive for clot formation
Apply external cold compresses (ice wrapped in thin cloth) for 15 to 20 minutes every hour, in the first 24 hours, significantly reduces swelling
Take prescribed medication as instructed, analgesic for pain, antibiotic (if prescribed) at the correct doses and times, completing the entire cycle
In the first 24h: DO NOT rinse the mouth, DO NOT spit forcefully, DO NOT use a straw, any negative pressure can dislodge the clot
After 24h, do gentle (not vigorous) rinses with salt water (1 teaspoon in a glass of warm water) or with chlorhexidine 0.12% (if prescribed), 2-3 times a day
Brush other teeth normally, avoiding only the operated area in the first 2-3 days, then reintroduce gentle brushing in the region
First 24h diet: cold or room-temperature foods, mushy or liquid (cold soups, yogurt, smoothie without a straw, purée, vitamins, ice cream in a cup)
Avoid hot, hard, crunchy, spicy, or acidic foods in the first 48-72h, heat dilates vessels and may restart bleeding; hard foods can traumatize the area
Chew on the opposite side of the mouth for at least 1 week
DO NOT smoke for at least 72h (ideally 7-10 days), tobacco is the greatest risk factor for alveolitis, in addition to delaying healing
DO NOT consume alcohol in the first 48-72h, dilates vessels, may interact with medications, and delays healing
Rest in the first 24 hours, no intense physical exertion, no gym, no sports. Light activities are allowed
Sleep with head elevated in the first nights (use an extra pillow), helps reduce swelling and bleeding
For extractions with sutures: return in 7 days for removal (nylon suture) or just evaluation (resorbable suture)
If you notice pain that INCREASES after the 3rd day, persistent bleeding, fever, pus, or growing swelling after 72h, contact us via WhatsApp immediately
Frequently asked questions
Does extraction hurt?
During the procedure, no. Modern local anesthesia is highly effective and completely eliminates pain, you'll feel only pressure and movement during tooth manipulation, but not pain. The needle prick is minimized with topical gel anesthetic applied to the gum before injection. In the post-operative, mild to moderate discomfort is expected in the first 2-3 days, controlled with prescribed analgesics (acetaminophen, dipyrone, or ibuprofen as appropriate). Most patients describe recovery as 'uncomfortable but tolerable,' not 'painful.' Pain that INCREASES after the 3rd day is a warning sign, may indicate alveolitis and deserves immediate evaluation.How long is recovery?
Initial discomfort resolves in 2 to 3 days with prescribed medication. Surface gum healing takes 7 to 14 days. Initial bone healing within the socket takes 4 to 6 weeks. Complete bone healing, with total remodeling of the bone architecture, takes 3 to 6 months, that's why we wait this period before making a definitive prosthesis or planning an implant in the region. Most patients return to normal activities (work, study, social life) in 1 to 2 days after a simple extraction. Intense sports and heavy physical exertion can be resumed after 5-7 days.I'll be missing a tooth, what now? What are the options?
Before extraction, we always discuss rehabilitation options so you know the path from the start. The main possibilities, depending on location and number of teeth involved, are: dental implant with single crown (replaces an isolated tooth, with referral to implant surgeon); fixed bridge supported by neighboring teeth (also involves referral to prosthodontist); removable partial denture (can be made by us when there are other missing teeth for combined replacement); maintaining the space without replacement (in some specific cases, such as extracted wisdom teeth, no replacement needed). For anterior teeth, we can discuss immediate provisional prosthesis so you don't go without a tooth in the visible region during the healing period. The definitive choice is made based on clinical factors (bone condition, neighboring teeth), functional (chewing), aesthetic, and your budget.Can I return to work the same day?
For simple extractions (erupted tooth, 5-15 minute procedure), most patients can resume light activities the same day, especially if the procedure was done in the morning and the rest of the day allows for afternoon rest. We recommend complete rest in the first 24 hours, avoiding physical exertion, intense sun exposure, and demanding activities. Office work, reading, or seated activities can be resumed the next day in most cases. For more complex surgical extractions (impacted wisdom teeth, deep roots, extensive sutures), we recommend 1-2 days of complete rest and gradual return to activities. Athletes should wait 5-7 days before resuming intense training. If you have a profession requiring physical exertion (construction, agriculture), plan for at least 2-3 days off.What is alveolitis and how to avoid it?
Alveolitis (also called 'dry socket' or alveolar osteitis) is the most feared post-extraction complication, although not serious in itself, it's very painful and delays healing. It happens when the blood clot formed in the socket is prematurely dislodged, leaving the bone exposed to saliva, food residue, and bacteria. Symptoms: intense pain that appears or increases between the 3rd and 5th day post-extraction, frequently radiated to the ear, temple, or neck; persistent bad breath; bad taste in the mouth; the socket appears 'empty' with exposed bone. Risk factors: smoking (multiplies risk several times), straw use, vigorous rinsing in the first 24h, forceful spitting, hormonal contraceptives, women during menstrual period, lower molar extractions (especially wisdom teeth). Prevention: rigorously follow ALL post-op recommendations, especially don't smoke, don't use a straw, don't do vigorous rinses in the first 24h. Treatment: local socket cleaning, application of medicated dressing (generally with antibiotic + analgesic paste), follow-ups to change the dressing until healing. Most cases resolve in 7-10 days with proper treatment.Do you do wisdom tooth extractions?
Depends on the case. Wisdom teeth (third molars) that are erupted, with favorable positioning and without anatomical complications, can be extracted like any other tooth in a general dentist's office, we do this when the case is appropriate for general practice competency. Impacted wisdom teeth (not fully erupted, within the bone, in horizontal or unfavorable position, close to the inferior alveolar nerve in lower ones or to the maxillary sinus in upper ones) require more complex surgery, with osteotomy and sometimes tooth sectioning. These cases are referred to dentists specialized in oral and maxillofacial surgery and traumatology in our regional network, they have the infrastructure, experience, and specific equipment (eventually CT scan for planning) for these procedures. In any doubt, we do the initial evaluation and decide together what's the appropriate path for your case.Do I need to take antibiotics for the extraction?
Not in all cases. Antibiotic is prescribed when there's specific indication, not as standard routine. The main indications for prophylactic or therapeutic antibiotic are: pre-existing infection in the tooth or adjacent tissues (abscess, active pericoronitis); surgical extraction of impacted wisdom tooth (especially lower); immunocompromised patients; patients with specific cardiac conditions requiring prophylaxis for infective endocarditis (per AHA/SBC guidelines, prosthetic heart valve, history of endocarditis, unrepaired congenital heart disease, etc.); uncontrolled diabetes; bisphosphonate use. For simple extractions in healthy patients without active infection, antibiotic is generally not necessary. Routine prescription of antibiotics for all extractions is in disuse, per current Ministry of Health and CFO guidelines, combating antimicrobial resistance.Can I get an extraction if I'm on anticoagulants or have a heart condition?
Yes, in the vast majority of cases, with proper management. For anticoagulants (warfarin, AAS, clopidogrel, DOACs like rivaroxaban, apixaban, dabigatran, edoxaban), the current recommendation is NOT to interrupt the medication, interrupting increases thromboembolism risk, which is generally more serious than the post-extraction bleeding risk. For warfarin, we request a recent INR (within 72h); for DOACs, generally there's no need for testing or adjustment. We use local hemostasis measures (suture, prolonged compression, ice, topical tranexamic acid in some cases). For cardiopathies with endocarditis risk (prosthetic valve, history of endocarditis, unrepaired congenital heart disease), we follow Brazilian and American guidelines for antibiotic prophylaxis, generally amoxicillin 2g orally 1 hour before the procedure (with alternatives for patients allergic to penicillin). In all cases, share your complete medical history and current medications when scheduling, allows for adequate and safe planning.Is it true that tooth extraction can cause problems in other parts of the body?
The extraction itself, performed with proper technique and post-op care, doesn't cause systemic problems. What can cause problems is UNTREATED dental infection, the infectious focus in the tooth can disseminate bacteria to other parts of the body, especially in patients with specific cardiopathies (infective endocarditis risk), uncontrolled diabetics, immunosuppressed. So, extracting an irrecoverable infected tooth is actually elimination of a risk focus, protects systemic health. The theory of 'tooth extraction as cause of distant diseases' (popular in some alternative approaches) has no backing in evidence-based medicine. What exists and is recognized: dental infectious focus as trigger for complications in specific conditions, justifying treatment or extraction when indicated.How is extraction in children? And in elderly?
In children, the most common extraction is of deciduous teeth (baby teeth) that are delaying eruption of the permanent tooth or that suffered destructive cavity. The procedure is generally simpler, deciduous tooth roots are short and the tooth is already in a process of natural root resorption. We use local anesthesia with gentle technique, we talk with the child throughout the procedure, and parents can accompany. In elderly, extraction has some particularities: denser, less flexible bones in some regions, frequent use of medications requiring attention (anticoagulants, bisphosphonates, antidepressants with anesthetic interaction risk), more frequent comorbidities (diabetes, hypertension, cardiopathies). Planning is more cautious, with more detailed prior evaluation of medical history and, when necessary, medical opinion. In both groups, the key is individualized planning and careful technique.What if the extraction was done long ago and the space remained without a tooth?
Rehabilitation is still possible. Even after years without replacement, prosthesis, implant, or bridge can be planned for the space, depending on the bone condition, neighboring teeth, and overall arch architecture. There are, however, considerations that accumulate with time. The alveolar bone tends to resorb in the region where the tooth was extracted (gradually loses volume), which can make implant placement difficult (eventually requiring prior bone graft). Neighboring teeth may have migrated to the space (inclination), and the opposite arch tooth may have extruded. In some cases, prior orthodontic treatment is necessary to reposition teeth before definitive rehabilitation. The longer the space remains without replacement, the more complex the rehabilitation plan tends to become, but it's rarely impossible. We evaluate each case individually.
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