Tooth extraction and wisdom tooth removal in Skopje

How a tooth extraction can help

A tooth extraction is recommended when a tooth can no longer be saved or causes problems that nothing else can solve. At our practice in Skopje, saving your natural teeth comes first.

When needed, an extraction can:

• remove the source of pain or infection, often bringing quick relief
• stop repeated inflammation around a wisdom tooth that has partly come through
• prevent damage to the neighbouring tooth

If you have toothache, read what to do until you see a dentist or ask for a same-day appointment during opening hours, when one is available.

Do you need a tooth extraction?

An extraction is usually considered when a tooth:

• is so badly decayed that it cannot be repaired
• has broken below the gum line or split, for example after an injury
• is very loose because of gum disease (periodontitis)
• has been reduced to a root, with too little healthy tooth left to build on
• is stuck in the jawbone (impacted) and causing problems

Wisdom tooth removal: not every wisdom tooth has to come out

Wisdom teeth usually come through between the ages of 17 and 25 and often lack space. Removal is recommended when they cause pain, repeated gum infections (pericoronitis), decay, a cyst or damage to the neighbouring tooth.

Wisdom teeth that cause no problems are usually left in place and monitored at routine check-ups. A 2020 Cochrane review found too little evidence to say whether such teeth should be removed routinely. We decide together, after an examination and an X-ray.

When extra care is needed

Tell us about all your medicines, supplements and health conditions.

If a lower wisdom tooth’s roots are very close to the nerve, referral to an oral surgeon may be advised.

Tooth extraction step by step

An extraction can be simple or surgical. In a surgical extraction, for example of an impacted wisdom tooth, the gum is opened, a little bone is sometimes removed and the tooth may be cut into pieces.

1. Examination, X-ray and discussion. The X-ray shows the roots, nerve and sinus. We check your medicines and explain the reasons and the alternatives.
2. Local anaesthetic. The gum around the tooth is numbed with an injection.
3. Removal. The tooth is carefully loosened and lifted out. You will feel pressure but should not feel pain.
4. Cleaning and stitches. The socket is cleaned and, if needed, closed with stitches, usually dissolvable ones.
5. Gauze and aftercare advice. You bite on gauze while we explain how to look after the area.
6. Follow-up, if needed. Often about two weeks after a more complex extraction.

How long it takes and how many visits you need

One visit is usually enough. The extraction itself often takes a few minutes; a difficult wisdom tooth can take up to about an hour, including preparation. Most people resume normal activities the next day, or 1–3 days after a difficult extraction.

The gum usually closes over the socket within 3–4 weeks. The bone takes longer: up to about 4 months for back teeth (molars).

Does a tooth extraction hurt? Anaesthesia and comfort

A tooth extraction is done under local anaesthetic. During the procedure you should not feel pain, only pressure. While you are still numb, take care not to bite your lip or cheek.

If you are nervous about the dentist, tell us when you book. We can agree a signal, such as raising your hand, to ask for a pause. We explain each step before we do it.

Tooth extraction aftercare and recovery

The aim is to keep the blood clot in the socket, where it protects the healing wound.

The first 24 hours

• Bite on the gauze for 10–15 minutes (about 30 minutes if you take blood thinners).
• Rest and avoid strenuous activity for at least 24 hours.
• Do not rinse or spit until the next day, and leave the socket alone.
• Do not smoke, and avoid straws for about a week.
• Avoid alcohol, very hot drinks, and hard or crunchy food such as nuts and seeds.
• Hold a cold pack to your cheek: 20 minutes on, 20 minutes off.

From the second day

• Rinse gently with warm salt water (a teaspoon of salt in a glass of water) 3–4 times a day for about 5 days.
• Eat soft, lukewarm food and chew on the other side.
• Brush as usual, but carefully around the socket.

Paracetamol or ibuprofen usually helps with pain; follow the pack instructions. If you take blood thinners, take paracetamol rather than aspirin, ibuprofen or diclofenac, unless your dentist advises otherwise.

When to call us

Call us on +389 78 218 457 (Monday to Friday, 11:00–19:00) if:

• bleeding does not stop with pressure
• the pain or swelling gets worse after the third day, or painkillers do not help
• the socket looks empty and you can see bone
• you have a bad taste, pus or a temperature of 38 °C or higher

Outside opening hours, contact the public out-of-hours dental service.

Risks and alternatives

Pain, swelling, bruising and a stiff jaw are normal for up to two weeks and usually start to settle after 1–2 days. Possible complications include:

• Dry socket (alveolar osteitis). The blood clot is lost and the pain gets worse 2–3 days after the extraction. It occurs after about 1–5% of routine extractions, but the rate can reach 30% or more after surgical wisdom tooth removal. It is more than three times as common in smokers, and more common in women taking a contraceptive pill containing oestrogen. It is treated with cleaning and a medicated dressing, and usually heals within 7–10 days.
• Infection. It is treated, with antibiotics if needed; they are not given routinely.
• Numbness or tingling in the lip, chin or tongue. Mainly after lower wisdom tooth removal. It usually gets better within a few weeks or months and is rarely permanent.
• The sinus and neighbouring teeth. With upper molars, an opening between the mouth and the sinus can occur; damage to a neighbouring tooth is rare.
• Osteonecrosis of the jaw. Rare but serious; it can affect people taking certain medicines for osteoporosis (about 0.15% after an extraction) or cancer (about 3%).

Alternatives to extraction

See also when root canal treatment is better than extraction.

An extraction is permanent. Wisdom teeth usually need no replacement; a gap left by another tooth can be filled with a bridge, partial denture or implant. Without a replacement, the gum and bone in the gap shrink over time.

Tooth extraction cost in Skopje: what affects the price?

The price depends on:

• whether the extraction is simple or surgical
• which tooth it is and how it is positioned
• how many teeth and X-rays are needed
• follow-up visits and any treatment for dry socket

Replacing the tooth is planned separately. You will receive the exact cost in a written plan after your examination, before treatment begins. More on our prices page.

The practice has a contract with the Health Insurance Fund (FZO) for primary dental care. If Dr Kiril Milanovski is your chosen dentist (izbran stomatolog), ask us what the Fund covers for you.

Why choose Dr. Milanovski?

Tooth extraction and wisdom teeth: frequently asked questions

Not sure whether your tooth has to come out?

Come in for an examination and we will check together whether the tooth can be saved. Book an appointment or give us a call.