To extract a permanent tooth, you will, at the very least, need the following:

A dental extraction forceps (#150A is a good general one for uppers and #151 is reasonable for lowers; they get much more specialized for each type of tooth, however).

A periosteal (meaning “around the bone”) elevator instrument to loosen the ligaments holding the tooth in place.

A typical dental elevator ->

Gauze or cotton rolls or squares and a “pickup” forceps or tweezers.

A very cooperative patient or a good local anesthetic.

Proper positioning will help you perform the procedure more easily. For an upper extraction (also called “maxillary extraction”), the patient should be tipped at a 60 degree angle to the floor and the patient’s mouth should be at the level of the medic’s elbow.  For a lower extraction, (also called a “mandibular extraction”), the patient should be sitting upright with the level of the mouth lower than the elbow.  For right-handed medics, stand to the right of the patient; for left-handers, stand to the left.  For uppers and most front lower extractions, it is best to position yourself in front.  For lower molars, some prefer to position themselves somewhat behind the patient.

Tooth Extraction Procedure

To begin with, you will want to wash your hands and put on gloves, a face mask, and some eye protection. Floss the teeth and give the patient an antibacterial rinse.  Keep the area around the tooth as dry as possible, so that you can see what you’re doing.  There will be some bleeding, so have cotton balls or rolled gauze squares available.  These may have to be changed from time to time if you place them between the cheek and gum.

The teeth are held in place in their sockets by ligaments, which are fibrous connective tissue.  These ligaments must be severed to loosen the tooth with an elevator, which looks like a  small chisel.  Go between the tooth in question and the gum on all sides and apply a small amount of pressure to get down to the root area.  This should loosen the tooth and expand the bony socket.  Expect some bleeding.

Grasping the tooth with the extraction forceps

Take your extraction forceps and grasp the tooth as far down the root as possible.  This will give you the best chance of removing the tooth in its entirety the first time.  For front teeth (which have 1 root), exert pressure straight downward for uppers and straight upward for lowers, after first loosening the tooth with your elevator.  For teeth with more than 1 root, such as molars, a rocking motion will help loosen the tooth further as you extract.  Once loose, avoid damage to neighboring teeth by extracting towards the cheek (or lip, for front teeth) rather than towards the tongue.  This is best for all but the lower molars that are furthest back.

Use your other hand to support the mandible (lower jaw) in the case of lower extractions. If the tooth breaks during extraction (not uncommon), you will have to remove the remaining root.  Use your elevator to further loosen the root and help push it outward.

Afterwards, place a folded gauze on the bleeding socket and have the patient bite down.