Teeth should not be extracted during a periodontitis flare-up, as it may involve symptoms like swollen gums, pus discharge, or the presence of inflammatory processes in the periodontium. Extracting teeth during such a flare-up could lead to the systemic spread of the inflammation, potentially causing severe conditions such as bacteremia or sepsis, and even life-threatening situations.

Periodontitis involves the resorption of the supporting periodontal tissues. If periodontitis can be managed by cleaning the teeth to remove local irritants, or through guided bone regeneration, and if the teeth can be preserved, it is generally best to avoid extractions. Teeth that can be preserved should be retained. However, if the periodontitis has caused severe lesions and the teeth cannot be preserved, showing signs of looseness or are even on the verge of falling out, extraction should only be considered after the inflammation is under control.