Preparing for a tooth extraction starts days before you sit in the chair. The steps you take beforehand, from managing medications to stocking your kitchen, directly affect how smoothly the procedure goes and how quickly you recover. Here’s what to do in the days and hours leading up to your extraction.
Talk to Your Dentist About Your Medications
Certain medications need to be adjusted or discussed before an extraction, and this conversation should happen well in advance. Blood thinners are the most common concern. The older guidance of stopping warfarin five to seven days before dental surgery is no longer the standard recommendation. Current guidelines from the American College of Chest Physicians suggest either continuing warfarin with the use of a local clot-promoting agent or stopping it for only two to three days beforehand in patients with low risk of complications. Your dentist and prescribing doctor should coordinate on the right approach for you.
If you take osteoporosis medications like bisphosphonates or denosumab, let your dentist know. These drugs carry a rare but serious risk of a condition called medication-related osteonecrosis of the jaw (MRONJ), where bone in the jaw fails to heal properly after surgery. The risk is low for people on oral bisphosphonates for osteoporosis, estimated between 0.001% and 0.01%, but it increases with factors like being over 65, smoking, diabetes, poor oral hygiene, or having taken the medication for more than two years. The American Dental Association does not recommend stopping these medications before dental work, since there isn’t enough evidence that a “drug holiday” prevents the problem. Instead, your dentist may take a more conservative surgical approach and have you use an antimicrobial rinse before and after the procedure until the site heals.
Some patients also need preventive antibiotics before an extraction. This applies to a specific group: people with prosthetic heart valves, a history of infective endocarditis, certain congenital heart defects, or a cardiac transplant with valve problems. If any of these apply to you, your dentist will prescribe antibiotics to take before the procedure. Notably, people with prosthetic joint implants (like a hip or knee replacement) generally do not need preventive antibiotics before dental work.
Plan Your Time Off
How much time you’ll need away from work or school depends on the complexity of the extraction. A simple extraction of a fully erupted tooth may only require a day or two of rest. Surgical extractions, like impacted wisdom teeth, typically call for three to seven days of recovery.
Plan to take the first full day off no matter what. During the first 24 hours, you’ll be managing bleeding, swelling, and the aftereffects of anesthesia. From days one through three, you can usually handle light activities but should avoid anything physically demanding. Most people feel significantly better by days four through seven and can ease back into normal routines. If your job involves heavy lifting or strenuous physical work, lean toward the longer end of that range.
Arrange a Ride Home
If you’re receiving any form of sedation (IV sedation, oral sedation, or general anesthesia), you cannot legally drive for 24 hours afterward. Arrange for someone to pick you up, and plan for that person to stay with you for three to four hours after surgery. Even if you feel fine, sedation can impair your judgment and coordination longer than you expect. You also should not sign any important documents during that 24-hour window.
If you’re only getting local anesthesia (a numbing injection with no sedation), you can typically drive yourself, but having someone along is still a good idea in case you feel lightheaded afterward.
Stock Up on Soft Foods
You won’t want to figure out what to eat while your mouth is packed with gauze. Shop a day or two ahead and focus on foods that are soft, nutrient-dense, and don’t require much chewing. Protein supports tissue repair, so prioritize options like scrambled eggs, Greek yogurt, cottage cheese, protein shakes, soft-cooked tofu, and poached or flaked white fish. Hummus is another easy protein source.
For carbohydrates and vegetables, good choices include mashed potatoes, butternut squash puree, steamed and mashed carrots, cooked spinach, oatmeal (served lukewarm, not hot), cream of wheat, and well-cooked soft pasta. Bone broth is particularly useful because it provides hydration, protein, and minerals in a form that requires zero chewing.
Avoid anything with small seeds, crunchy textures, or extreme temperatures. And skip the straws entirely. The suction can dislodge the blood clot forming in the extraction site, leading to a painful complication called dry socket.
Gather Your Recovery Supplies
A few items will make your first day home much more comfortable. Have these ready before your appointment:
- Gauze pads. Your dentist will send you home with some, but having extra sterile gauze on hand is helpful since you’ll be replacing it as needed for several hours.
- Ice packs or cold compresses. Apply these to the outside of your cheek in 20-minute intervals to reduce swelling during the first 24 to 48 hours. A bag of frozen peas wrapped in a towel works fine.
- Pain relievers. Your dentist will recommend or prescribe specific pain medication. Have it filled and ready before the procedure so you’re not running to the pharmacy afterward.
- Extra pillows. Keeping your head elevated, even while sleeping, helps minimize swelling and bleeding.
Follow Fasting Instructions
If you’re receiving IV sedation or general anesthesia, your dentist or oral surgeon will give you fasting instructions. This typically means no food or drink for six to eight hours before the procedure. The exact window varies, so follow whatever your provider specifies. Eating or drinking too close to sedation increases the risk of nausea and, in rare cases, aspiration.
For extractions under local anesthesia only, fasting usually isn’t required. In fact, eating a light meal beforehand is often a good idea since your mouth will be numb for a few hours after, making eating difficult.
What to Do the Morning Of
On the day of your extraction, you can brush your teeth and use mouthwash as normal. Just be careful not to swallow any toothpaste or mouthwash, especially if you’ve been told to fast. Clean teeth actually help reduce the bacterial load in your mouth before surgery, so don’t skip this step.
Wear comfortable, loose-fitting clothing. If you’re receiving IV sedation, choose a short-sleeved shirt or one with sleeves that roll up easily so the anesthesiologist can access your arm. Leave jewelry and contact lenses at home. Bring your ID, insurance card, and any paperwork your dentist asked you to complete.
If you take daily medications that your dentist has approved you to continue, ask whether you should take them with a small sip of water that morning. This is especially important for blood pressure medications, which are often continued right up to the procedure.