Molars, the back teeth, do most of the work of chewing and grinding food, so they are worth keeping whenever possible. Sometimes, however, a molar tooth extraction cannot be avoided because of deep decay, infection, a fracture or other causes. At Dr Haim Aseriel's clinic in Jerusalem, conservative options are always considered first.
When extraction is the only solution, it is done carefully under local anesthesia, adapted to each patient, so that healing is as smooth and comfortable as possible. Depending on the case, a surgical extraction may be recommended when the tooth is broken, partly impacted or has an unusual anatomy. Wisdom teeth, the third molars, are covered on a separate page: wisdom teeth removal.
When does a molar need to be extracted? Warning signs
Severe, persistent pain
Severe, lasting pain in the molar area, especially when it does not respond to pain relievers, is a warning sign not to ignore. It may indicate an infection that has spread deep into the root or even into the jawbone (see toothache).
Swelling, bleeding gums and a loose tooth
Swelling of the jaw, bleeding gums, or sores around the tooth are also worrying signs. A badly damaged molar can become loose, feel as if it moves when chewing, or gradually sink into the gum. An impacted wisdom tooth pressing on the neighboring molar can also cause damage that conservative treatment cannot repair.
Bite changes and a bad taste
A sudden change in your bite, or a feeling that your teeth no longer meet properly, can signal a problem with a molar. A persistent bad taste or bad breath that does not improve with careful oral hygiene can point to a deep infection in a molar.
Molar tooth extraction: what you should know
Because of their position at the back of the mouth and their complex root structure, molars present specific challenges. A molar extraction is more complex than removing a front tooth, mainly because molars have more roots (two to four) and a more complex anatomy. These roots can be curved, divergent or fused, which calls for advanced techniques and a high level of skill.
The upper molars are close to the maxillary sinus, and the lower molars to the lingual and mandibular nerves, which calls for extra care during the extraction. For an impacted wisdom tooth, the complexity is even greater because the tooth sits deep in the tissues. Particularly challenging cases are treated at the clinic together with an oral and maxillofacial surgeon, Dr Yves Weinberg, head of the Oral and Maxillofacial Surgery Department at Barzilai Medical Center.
How a surgical molar extraction is done
01
Examination and imaging
Treatment starts with an examination and X-rays; when needed, a 3D CBCT scan is taken at the clinic on a Planmeca ProMax 3D unit to see the tooth, its roots and the nearby structures precisely and plan the procedure.
02
Incision, flap and sectioning
Under deep local anesthesia, sometimes with light oral sedation by prescription for anxious patients, a precise incision is made in the gum, a small flap is lifted and some bone is removed around the tooth if needed. Large molars may be divided into sections before removal, which reduces trauma to the surrounding tissues.
03
Cleaning, ridge preservation and stitches
The socket is cleaned and inflamed tissue removed. In some cases, a bone graft may be placed right away to preserve the ridge for a future implant. The flap is then repositioned and closed with fine stitches.
Examination, treatment plan and price quote
detailed and personalized
During the consultation, Dr Haim Aseriel examines your teeth, explains all the options and gives you a transparent price quote, with no obligation. The clinic is at 12 HaTnufa Street, Jerusalem.
The day after a molar extraction
After a molar tooth extraction, your dentist gives you detailed instructions. The essentials:
- Bleeding: bite on the gauze pad with steady pressure. Light bleeding and pink-stained saliva in the first hours are normal; if the bleeding is heavy, does not stop with steady pressure on gauze, or starts again significantly several hours later, contact the clinic. Details: bleeding after a tooth extraction.
- Protect the clot: in the first days, do not rinse forcefully, spit or drink through a straw (no straw for at least 24 hours), and avoid strenuous exercise. According to MedlinePlus, gentle rinsing and spitting can resume about three days after the extraction; salt water only if your dentist recommends it.
- Eating: do not eat until the numbness has worn off, then choose soft, not-too-hot food and chew on the opposite side; avoid alcohol. Details: what to eat after a tooth extraction.
- Smoking: smoking roughly triples the risk of dry socket, so do not smoke for at least the first few days, as your dentist advises. Details: smoking after a tooth extraction.
20 min
at most each time with a cold pack
A cold pack (ice wrapped in a towel, not directly on the skin) on the cheek, 10 to 20 minutes at a time, helps reduce swelling and pain. Warm compresses only if your dentist tells you to. Ask your dentist or pharmacist which pain reliever to take and at what dose; according to the ADA guideline, non-opioid pain relievers such as NSAIDs are usually the first choice for acute dental pain in adults without contraindications.
Pain that increases one to three days after the extraction, instead of easing, can signal a dry socket and needs to be checked at the clinic. A fever, swelling that spreads toward the eye or the neck, or difficulty swallowing or breathing require immediate care in a hospital emergency room.
What can replace an extracted molar?
The replacement is planned before the extraction, because a missing back tooth can let neighboring teeth drift, change the bite and put uneven pressure on the other teeth. The bone changes too: according to a systematic review, within six months of an extraction the bone ridge loses about 29% to 63% of its width (Tan WL et al., Clinical Oral Implants Research, 2012). The three main options:
- Dental implant: replaces the root as well and does not rely on the neighboring teeth. When there is not enough bone, it can be preserved or rebuilt with a bone graft.
- Bridge: an artificial tooth held by crowns on the two adjacent teeth, which need to be reshaped.
- Partial denture: a removable option, mainly when several teeth are missing.
Molar tooth extraction in Jerusalem: book a consultation
If you have pain in your back teeth or have been told you need an extraction, a consultation is the first step. The examination determines whether extraction really is the right solution or whether conservative treatment is possible. The clinical examination is completed with X-rays, and you receive a treatment plan that takes your medical and dental history into account. If you have dental anxiety, tell the team: the options for a more comfortable visit are discussed at the consultation.
After the extraction, you receive detailed instructions and a follow-up appointment to make sure healing is on track. Dr Haim Aseriel, a US-trained dentist (DDS, NYU College of Dentistry), explains everything in English and gives you a written quote, with itemized receipts you can submit to your insurer (coverage depends on your policy).
Molar extraction: frequently asked questions
A molar extraction is more complex than removing a front tooth mainly because molars have more roots (two to four) and a more complex anatomy. These roots can be curved, divergent or fused, which calls for more advanced extraction techniques and a high level of skill.
The main sign that a molar may need to be extracted is severe, persistent pain in the back teeth, especially when it does not respond to pain relievers. Swelling of the jaw, bleeding gums, sores around the tooth, a loose tooth or a persistent bad taste are also warning signs. An examination first checks whether the tooth can be saved.
An implant can be placed right after a molar extraction when the bone and gums in the area are suitable; the decision is based on the examination and imaging. According to a meta-analysis, the survival rate of implants placed immediately after extraction (97.4%) did not differ significantly from that of implants placed after healing (97.5%). When conditions are not suitable, the site is left to heal first, sometimes with a bone graft at the time of extraction to preserve the ridge.
After a molar extraction, pain and swelling usually ease within the first few days. The extraction site usually heals within one to two weeks, and the bone continues to rebuild for longer, depending on how complex the extraction was and on personal factors.
After a molar extraction, avoid strenuous exercise in the first few days and resume it when your dentist says so. Physical effort raises blood pressure and the risk of bleeding at the extraction site, and after a complex extraction the wait may be longer.
Sources
- MedlinePlus (U.S. National Library of Medicine), Tooth extraction, 2024 – View source
- American Dental Association (MouthHealthy), Extractions – View source
- Daly BJ et al., Cochrane Database of Systematic Reviews, 2022 – View source
- Kuśnierek W et al., Dentistry Journal, 2022 – View source
- Carrasco-Labra A et al., Journal of the American Dental Association, 2024 – View source
- Tan WL et al., Clinical Oral Implants Research, 2012 – View source
- Patel R et al., Dentistry Journal, 2023 – View source
