The short answer
A tooth extraction appointment usually takes under an hour. You are examined and x-rayed, the area is numbed, the tooth is loosened and lifted out, and you bite on gauze for about an hour while a clot forms in the socket.
The removal itself is often the shortest part of the visit. What follows walks through each stage in order, including the parts people say they wish they had been warned about.
Before you go
Eat a normal meal unless you have been told otherwise. You will be avoiding that side of your mouth for a day or two, and starting hungry helps nothing. If you are having sedation, follow the fasting instructions you were given instead.
Bring a list of everything you take, prescription and otherwise. Blood thinners, bisphosphonates for bone density, and some diabetes medications all change how the appointment is planned, and none of them rule it out. Say if you are pregnant.
Wear something you do not mind getting a spot on, and give yourself a slower afternoon than you think you need.
The exam
The first few minutes are spent confirming that removal is the right decision, and whether the tooth needs a simple extraction or something more involved. An x-ray shows the roots, the bone around them, and whether infection has spread past the tooth. For a lower back tooth, three-dimensional imaging may be used to see exactly where the nerve to the lip and chin runs.
This is the point to ask what happens to the gap afterwards. Whether you want to replace the tooth changes what happens on the day, because a bone graft placed into the fresh socket keeps the ridge in shape for an implant later, and that opportunity closes once the socket heals.
Numbing
A topical gel goes on the gum first, which takes the edge off what follows. Then the local anesthetic, which stings for a few seconds while it goes in. That sting is the sharpest thing in the whole appointment.
For a lower tooth the injection numbs the nerve serving that side of the jaw, so your lip and tongue go heavy and thick, and that feeling reaches further than you expect. For an upper tooth the numbness stays closer to the tooth itself.
Numbness takes a few minutes to settle in, and it gets checked before anything starts. If you feel anything sharp at any point, say so. There is more anesthetic and there are other ways to place it.
The removal
An instrument called an elevator goes between the tooth and the bone and widens the socket, separating the tooth from the ligament that holds it. This is where the pressure begins.
Then forceps, and steady rocking rather than pulling. Bone carries sound directly to your ear, so you hear the movement clearly, and it is louder than almost anyone expects. Knowing that in advance is what keeps it from being alarming.
If the tooth is stubborn it may be sectioned and taken out in pieces. That is not a complication and it is often gentler on the socket than persisting with a whole root.
If you are dreading it
For most people who dread an extraction, the fear is less about pain than about not knowing what is happening and not being able to stop it. That problem has a different answer.
Say at the start that you are nervous. It is a normal thing to say and it changes how the appointment is run: more explanation before each stage, and an agreed signal, usually raising a hand, that means stop. Being able to stop it is most of what makes it bearable, even if you never use the signal.
Bringing someone to sit in the waiting room is allowed, and it often helps. Headphones are usually fine to wear during the appointment, and they take the edge off the noise, which for a lot of people is the worst part.
The last few minutes
The socket is cleaned, and stitches go in if the site needs closing. Gauze goes over the top and you bite down firmly.
You will be given written instructions and a number to call. Keep the gauze in for about an hour, replace it once if bleeding is still bright, and leave the clot alone.
Numbness fades over two to four hours. Take a painkiller before it goes rather than after, so soreness never gets ahead of you. Then soft food, no straws, no smoking, and an early night. The day-by-day recovery timeline covers the week that follows.