In order to do a straightforward extraction, the dentist uses an elevator to release the tooth. The dentist next removes the tooth with forceps. A surgical extraction is a more complicated operation utilized when a tooth has broken off at the gum line or has not erupted in the mouth. In this case, the surgeon will make an incision at the side of the face near the ear and cut through connective tissue to expose the bone surrounding the tooth. Next, he/she will drill holes in the bone and thread a stringed instrument called an "osteotome" through them. The osteotome will be used to break up the bone so it can be removed. Once the bone is loose enough to be pulled out, it will be removed using a spoon-shaped tool called an "ouster". The hole where the root ball was before it was removed is then filled with a dental cement. A simple extraction can be done under local anesthesia (numbing medication injected into the jaw). This method does not require cutting into the face but rather injecting around the tooth to numb it first. The dentist may also recommend that you see a pain reliever by your family doctor before having any work done on your teeth. Some medications such as warfarin (Coumadin), have been known to affect the blood clotting process and therefore increase the risk of bleeding during surgery.