Can a Dentist Pull an Infected Tooth? Here's What Happens When Decay Goes Too Far

A tiny cavity might not seem like a big deal, but leave it untreated, and you're inviting a world of trouble. What starts as mild tooth sensitivity can quickly spiral into intense pain, swelling, and infection.

At that point, it’s no longer just about saving the tooth, it’s about stopping the infection before it spreads. So, when things go south, how far can your dentist go? Can they actually pull an infected tooth?

Short answer: yes. If the infection has progressed and the pain is under control, a dentist can absolutely extract the tooth. The real question is whether an extraction is the right solution, and what happens afterwards.

How to Know If a Tooth Is Infected?

An infected tooth doesn’t always announce itself with unbearable pain, at least not in the beginning. But the body sends signals, and recognizing them early can shift the outcome entirely. Infection typically begins at the center of the tooth in the pulp, where nerves and blood vessels are located.

• Persistent, throbbing toothache - the most common symptom. The pain might radiate to the jaw, neck, or ear on the same side.

• Swelling in the face or cheek - this may appear overnight and can lead to visible facial asymmetry.

• Increased sensitivity to hot or cold, especially when lingering after the stimulus is gone.

• Pus or a bad taste in the mouth - this often results from a ruptured abscess draining into the mouth.

• Discolored or darkening tooth - inside the tooth, infection causes tissue death, which changes the tooth's color.

• Fever and swollen lymph nodes in the neck - indicators that the infection has moved beyond the tooth.

Symptoms don’t always appear all at once. Sometimes the only early clue is a dull ache or strange pressure when biting down - easy to dismiss, but often the first step in a cascade of escalating discomfort.

How to Recognise Symptoms of an Emergency?

A dental infection that spreads beyond the tooth creates immediate health risks. When swelling extends beneath the jaw or into the neck and begins to impact swallowing or breathing, the situation turns critical. This suggests the infection has possibly entered the deep fascial spaces of the neck or is impinging on the airway.

Another red flag: a sudden drop in pain after intense throbbing. This doesn’t mean the problem resolved itself - quite the opposite. The nerve may have died, temporarily silencing the pain but signaling that the infection has advanced to a new stage.

If fever spikes over 101°F (38.3°C), if the face grows visibly swollen, or if there’s difficulty opening the mouth, immediate dental or medical attention is necessary.

What Happens If You Don’t Treat an Infected Tooth?

Untreated dental infections have a direct path to becoming systemic health emergencies. Infection in a tooth can penetrate deeper tissues, travel through facial planes, and enter the bloodstream. In severe cases, this leads to sepsis, a life-threatening condition that overwhelms the body’s immune response.

Recent studies have further explored the connection between periapical infections (also known as apical periodontitis) and serious health conditions like cardiovascular disease and diabetes complications

Another paper published in PMC detailed hospitalizations caused by dental abscesses that expanded into deep neck spaces. In those cases, incomplete management of dental infections led to surgical drainage, airway compromise, and extended intubation.

The Tooth Will Not Survive Long-Term

When the pulp inside a tooth becomes infected and isn't treated, the surrounding bone and tissue eventually begin to deteriorate. The body responds by resorbing the bone around the tooth root as it tries to contain the infection. Left unchecked, bone destruction reaches a threshold where the tooth becomes mobile - and ultimately unsalvageable.

The American Association of Endodontists reports that pulpal infection significantly reduces the success rate of subsequent restorative procedures. Once the periodontium is compromised, no filling or crown can stabilize the tooth.

Tooth loss becomes the only outcome.

Delays Come with a High Human Cost

Real patient cases underscore just how fast and far infections escalate. A 26-year-old man in California died of a dental abscess that spread to his bloodstream. He had been given antibiotics but had delayed surgical treatment.

Take the example of a patient admitted to Massachusetts General Hospital with a routine dental infection that had gone untreated for weeks. By the time he received care, the infection had reached the mediastinum - an area near the heart.

The risk isn't remote or restricted to those without insurance. Delays stem from underestimating dental pain, avoiding procedures, or waiting for symptoms to disappear. In each case, the decision to wait came at a cost: longer treatment times, higher medical bills, and permanent damage.

• Bone loss begins within days after the onset of infection and accelerates without intervention.

• The infection travels through facial and neck planes, bypassing physical barriers quickly.

• Hospitalizations occur in one out of every 2,600 untreated dental abscess cases, according to the Agency for Healthcare Research and Quality (AHRQ).

Can a Dentist Safely Extract an Infected Tooth?

Before determining whether to extract a tooth, dentists conduct a thorough clinical and radiographic examination. They evaluate the severity of the infection, its location, the presence of swelling or abscesses, and whether surrounding tissue shows signs of spreading infection. Periapical and panoramic X-rays reveal bone loss, the extent of root involvement, and any sinus tract formation. Systemic signs, such as fever, rapid pulse, or facial swelling, signal potential complications and inform the timing and method of intervention.

If the infection is localized and the patient is stable, immediate extraction is often the preferred course. However, if facial cellulitis or systemic signs of infection are present, initial antibiotic therapy may be prescribed with a follow-up plan for extraction once inflammation subsides.

Procedures for Extracting an Infected Tooth

Once the infection is assessed as controllable, dentists proceed with a minor surgical procedure under local anesthesia. The infected tooth is extracted using elevators and forceps, followed by drainage if purulent material is trapped in the socket. In cases of advanced abscesses, the socket may be irrigated with saline or antimicrobial solutions to reduce residual bacteria before closure.

Sometimes, a dentist will leave the socket open temporarily to allow continued drainage, especially if there was significant pus accumulation. The tissue surrounding the tooth may also be debrided to remove necrotic material. Every decision during the procedure aims to reduce bacterial load and facilitate healing.

Emergency Dental Care in Acute Situations

When infections cause rapid swelling, difficulty breathing, or trismus (restricted mouth opening), dentists refer the patient for emergency care. Oral and maxillofacial surgeons typically handle extractions involving extensive infection, especially where airway obstruction is a concern. In emergency settings, IV antibiotics and hospital-based imaging guide surgical drainage and tooth removal.

Quick response to acute dental infections minimizes hospitalisation time and reduces the risk of complications like Ludwig’s angina or sepsis. Follow-up appointments track resolution and determine post-extraction rehabilitation.

• Localized infections can be managed with in-office tooth extraction and possibly drainage.

• Systemic signs or facial involvement require infection control measures before surgical intervention.

• Emergency settings handle advanced infections through multidisciplinary care involving dentists and medical professionals.

When Do I Seek Emergency Dental Care?

Not all dental issues demand immediate attention, but certain conditions require urgent care. When an infected tooth causes uncontrolled swelling, intense pain that won't subside with over-the-counter medication, or if you develop a fever alongside facial swelling, consider it an emergency.

These symptoms indicate that the infection may have spread beyond the tooth, potentially affecting soft tissues or even compromising the airway.

Additional red flags include:

• Difficulty swallowing or breathing

• Rapidly expanding gum or facial swelling

• Visible pus draining from the gums or tooth

• Severe sensitivity to hot or cold that's worsening

• Trauma to the mouth causing a fractured or dislodged infected tooth

Browse All Dental Services

Why Prompt Treatment Can’t Wait

Delays in treating a severe dental infection allow bacteria to spread. Once the infection bypasses the confines of the tooth and enters the bloodstream or deep facial spaces, the risks increase dramatically.

Complications such as Ludwig’s angina, cellulitis, or sepsis can develop quickly, requiring hospitalization and intensive treatment. A timely visit to an emergency dentist stops the progression before systemic effects take hold.

What Happens After? Post-Extraction Care and Instructions That Make a Difference

The dentist will place a sterile gauze pad over the site and ask you to bite down. Maintain firm pressure with gentle biting for 30 to 45 minutes. This forms the first blood clot—a critical seal that protects the socket from bacteria and promotes healing.

• Keep your head elevated for the first few hours. This reduces blood pressure in the area and controls bleeding.

• Avoid spitting, rinsing, or using a straw for at least 24 hours. These actions create suction and can dislodge the clot.

• Apply a cold compress in 20-minute intervals during the first 6 hours to reduce swelling and numb the area.

Learn more experts' insights about after-extraction care

What’s Normal? What’s Not?

You can expect mild swelling, occasional oozing, and some jaw stiffness. That’s the body’s natural response. These symptoms usually peak around day two and ease off by day four.

• Persistent bleeding that soaks the gauze after several hours requires evaluation.

• Severe pain after three days may indicate dry socket - a condition where the clot has been lost. It needs immediate attention.

• Signs of infection such as foul odors, fever, or increasing swelling beyond day three aren’t part of a normal recovery.

Set the Stage for a Full Recovery

Sleep matters. Rest for at least 24 hours and limit physical activity for the first few days. Smoking disrupts clot formation and healing. The carbon monoxide in smoke reduces oxygen supply to healing tissues, abstain for at least 72 hours, ideally longer.

Take antibiotics exactly as prescribed when part of your treatment plan. Stopping early, even if symptoms have improved - can fuel bacterial resistance and cause lingering infection.

The socket will gradually fill with granulation tissue, then bone, over several weeks. While soft tissue closes over the site within 7–10 days, internal healing can take up to three months, depending on the complexity of the extraction.