Before tooth extraction: eating, medicines, what to tell your dentist and when to postpone

What should you do before extraction? A checklist for the preceding days

Three things matter most before tooth extraction: giving your dentist a complete health history, eating a normal meal before local anaesthesia and planning for the first days of healing. This checklist puts preparations in the order you will need them.

• Write down all your medicines, including non-prescription ones, and bring the list to the appointment.
• Gather your documents: X-rays, hospital discharge summaries and records of treatment for chronic conditions.
• If you take anticoagulants or osteoporosis medicines, do not stop them; ask your treating doctor whether you need tests before the procedure.
• If you take warfarin, have a current INR result: SDCEP recommends testing ideally within 24 hours before the procedure, or within 72 hours if results are stable.
• Have soft food ready at home for the first few days and ask which painkiller you can take afterwards.
• For sedation or general anaesthesia, arrange for an adult to come with you and collect you afterwards.
• Plan time off: according to the NHS, most people return to usual activities the day after wisdom tooth removal, while a difficult procedure or general anaesthesia may require 1 to 3 days.

Should you eat before tooth extraction?

Yes, eat normally before an extraction under local anaesthesia. The University Hospitals Sussex maxillofacial surgery leaflet explicitly advises eating as usual beforehand. After extraction, the lip and cheek may remain numb for 3 to 4 hours, and your first meal should wait until the anaesthetic has worn off.

You also eat before inhalation sedation with nitrous oxide, but avoid a large meal, as the Wirral Community Health and Care NHS leaflet advises. General anaesthesia is different: adults usually avoid solid food for 6 hours and may drink clear fluids until 2 hours before treatment (2011 ESAIC guidance). Your anaesthesiologist gives the exact times at assessment, and those are the instructions to follow.

Which medicines should you not stop before tooth extraction?

Do not stop any regular medicine yourself before tooth extraction. The 2022 Scottish SDCEP guidance classes simple extraction of 1 to 3 teeth with a limited wound as a procedure with a low risk of bleeding. Whether it can be done without interrupting anticoagulant or antiplatelet drugs depends on the type of drug and an assessment of the patient: with warfarin the guidance requires an INR below 4, and with a treatment dose of low molecular weight heparin, consultation with the prescribing doctor. Bleeding is controlled locally (with pressure, a socket dressing and stitches), and any change to medication is agreed by your treating doctor or dentist; the article on anticoagulants explains the details.

The same applies to osteoporosis medicines such as bisphosphonates and denosumab. SDCEP guidance on medication-related osteonecrosis of the jaw (2017, retained following review in 2024) stresses that the risk is small and treatment breaks before surgery are not recommended; the prescribing doctor decides whether any break is appropriate.

Tell your dentist about medicines you took in the past too. According to SDCEP, bisphosphonates stay in bone for years, so someone who used them previously is assessed as though still taking them. Patients receiving these drugs for cancer are in a higher-risk group.

What else should you tell your dentist before extraction?

Before extraction, your dentist needs a full medical history because it determines the surgical plan and advice. Report each of these, even if it seems unrelated to your teeth:

• Heart conditions: the European Society of Cardiology (ESC) 2023 guidance recommends antibiotic prophylaxis before dental procedures for people including those with previous infective endocarditis or a prosthetic valve. The UK’s NICE does not recommend it routinely; the clinician decides.
• Pregnancy or breastfeeding, which affect the choice of medicines and X-rays.
• Diabetes, blood disorders and previous cancer treatment, including head and neck radiotherapy.
• Allergies, especially to anaesthetics; genuine local anaesthetic allergy is rare, confirmed in under 1% of people referred for investigation in a review of 23 case series (Bhole et al., 2012).
• Previous problems after extractions, such as prolonged bleeding or dry socket.

Tooth extraction during your period: should you postpone?

Menstruation alone is not an established reason in studies to postpone an extraction. A systematic review of 24 studies (Taberner-Vallverdú et al., 2017) found no agreement on whether the menstrual cycle increases the risk of dry socket, painful socket inflammation after loss of the blood clot.

The effect of hormonal contraception is better documented. In a meta-analysis of 15 studies (Tang et al., 2022), women taking oral contraceptives had about twice the risk of dry socket after wisdom tooth removal (relative risk 1.98). Do not stop contraception because of the procedure; tell your dentist so it can be taken into account in your aftercare advice.

If your period brings severe pain, feeling unwell or heavy bleeding, you can ask for a date in another phase of your cycle. Studies do not support routinely postponing treatment, so this is a matter of your comfort.

Tooth extraction with a cold sore or a cold

An elective procedure is usually postponed with an active cold sore. In guidance updated in 2020, the College of Dental Hygienists of Ontario advises delaying elective oral treatment until lesions on the lips and face have fully healed. If you have toothache or swelling, phone the practice: the dentist will assess whether treatment is needed straight away.

Before general anaesthesia, tell the clinic about a runny nose, cough or fever. A respiratory infection can be a reason to postpone anaesthesia; the anaesthesiologist decides. For local anaesthesia, report an ordinary cold when booking so the dentist can assess whether to proceed.

Smoking, alcohol and driving: how should you plan the day?

If you smoke, plan a break while the wound heals. A systematic review of 11 studies (Kuśnierek et al., 2022) found dry socket in about 13.2% of smokers and 3.8% of non-smokers, with over 3 times higher odds among smokers. Addenbrooke’s Hospital in Cambridge advises not smoking for at least 48 hours after surgery.

Avoid alcohol. The Bristol Dental School aftercare leaflet advises against alcohol or very hot drinks, while the Wirral NHS leaflet rules out alcohol before inhalation sedation and for the rest of the treatment day. After general anaesthesia, the NHS advises avoiding alcohol for at least 24 hours.

After local anaesthesia alone, ask your dentist about driving. The Wirral NHS leaflet advises a 2-hour break from driving after inhalation sedation, while the NHS advises 48 hours after wisdom tooth removal under general anaesthesia. Arrange for someone to take you home after such treatment.

Preparing for tooth extraction: quick answers to common questions

The table brings together common questions before extraction and answers based on the guidance and hospital leaflets cited here. If your dentist has given different instructions, follow those: they know your health and surgical plan.

How preparation for extraction works at DentalBlue

At DentalBlue in Białystok, the clinic’s own radiology unit provides the imaging needed before extraction, from intraoral X-rays to CBCT scans. “Wizyta bez bólu” (visit without pain) includes a panoramic X-ray, consultation, examination and written treatment plan with prices for each stage. “Wizyta z bólem” (visit in pain) includes a panoramic X-ray, consultation, examination and pain relief. For general anaesthesia, the first step is a combined dental and anaesthesiology consultation reviewing medicines and test results; fasting times are provided then, and the procedure is booked only afterwards. The clinic also offers inhalation sedation with nitrous oxide. A consultation can be arranged by phone.