Tooth Extraction

Unfortunately for some, tooth extraction is an inevitable adventure!  Teeth often have to be removed to ensure adequate infection control and to improve the overall health of a patient, but before it "needs" to be done understanding the why or why not is important.  

Webster's dictionary states, "tooth extraction is the removal of a tooth from its socket in the bone".  If a tooth has been damaged by decay or a fracture, dentists try to repair it and restore it with a filling, crown or other treatment. Sometimes, though, the damage is too extensive for the tooth to be repaired and the only logical solution is to remove it, and this is the most common reason for extracting a tooth.

Here are some other common reasons for tooth removal:

• Extra Teeth --- these often can block other teeth from erupting into the mouth.
• Orthodontic Work --- teeth may need to be extracted to create room for the teeth that are being moved into place.
• Head and Neck Radiation Therapy --- these people may need to have teeth in the field of radiation extracted.
• Chemotherapy Patients--- individuals undergoing this treatment may develop infected teeth.  Chemotherapy weakens the immune system and increasing the risk of infection.
• Organ Transplant Patients--- teeth that are at risk of being potential sources of infection after the transplant when immuno-suppressive medications are given may need to be removed.
• Wisdom Teeth --- are often extracted for preventative reason.  They can be removed before or after they come in and are most often extracted in the late teens or early twenties.  Wisdom teeth may be impacted (partially or completely covered by bone or soft tissue) or have dental decay present causing pain requiring their removal.  Similarly, a wisdom tooth that has emerged partially may be blocked by other teeth or may not have enough room to come in completely and this can irritate the gums, causing pain and swelling, requiring the tooth/teeth to be removed.

 

Extracted Wisdom Teeth (Third Molars)

Preparation For The Appointment

Through medical and dental histories will be collected, this helps to determine if any medical/dental condition will increase the risk for tooth removal.  A radiograph (x-ray) of the area will be taken, this helps in seeing and planning the best way to remove a tooth.  If you are having all of your wisdom teeth removed, you may have a panoramic x-ray, which takes a picture of all of your teeth at once.  This type of x-ray shows the relationship of your wisdom teeth to your other teeth, as well as the upper teeth’s relationship to your sinuses and the lower teeth’s relationship to the inferior alveolar nerve, which provides sensation to your lower jaw, lower teeth, lower lip and chin.

Some health care professionals prescribe antibiotics to be taken before and after surgery, but this varies by practitioner. Antibiotics are more likely to be given to people with infection at the time of surgery or with weakened immune systems, those who will be undergoing longer surgeries, or very young or elderly people.

If you’re going to have conscious sedation or deeper anesthesia, wear clothing that has short sleeves or will allow you to roll the sleeves up easily so that an intravenous (IV) line can be placed in a vein. You will be told not to eat or drink anything for six hours before the procedure. You should also make sure you have someone available to drive you home.

How It’s Done

• Simple extraction --- is performed on a tooth that can be seen in the mouth.  Most can be done under a local anesthetic, with or without anti-anxiety drugs.  In a simple extraction, the tooth will be grasped with forceps and move the forceps back and forth to loosen the tooth before removing it.  Sometimes, an instrument called a luxator or elevator, which fits between the tooth and the gum, is used to help loosen the tooth.
• Surgical extraction --- involves teeth that cannot be seen easily in the mouth, either because they have broken off at the gum line or because they have not come in yet.  Another reason for a surgical extraction is that the tooth to be removed requires a flap be cut in the gum for access to remove bone or a section of the tooth.  They can be done with local anesthesia or conscious sedation.  Patients with special medical conditions and young children may be given general anesthesia.  In a surgical extraction, the dentist will need to make an incision in your gum to reach the tooth.  In some cases, the tooth will need to be broken into sections to be removed.

 

Removal of An Upper Tooth

If you are having teeth extracted and are receiving conscious sedation, you may be given steroids in your IV line to help reduce postoperative swelling.

If you need all four wisdom teeth removed, they usually are taken out at the same time. Or if you wish and depending on the practitioner, they can be removed in halves, left at one appointment and the right at another.......there are pros and cons to each method, which Dr Rigby is happy to expound upon.  The top teeth usually are easier to remove than the lower ones.

Here are the types of wisdom teeth in order from easiest to remove to most difficult to remove:

• Erupted (already in the mouth)
• Soft-tissue impacted (just under the gum)
• Partial-bony impacted (partially stuck in the jaw)
• Full-bony impacted (completely stuck in the jaw) 

Also, if your wisdom teeth are tilted sideways, they can be harder to remove than if they are vertical.

Follow-Up After Extraction
 

Most simple extractions do not cause much discomfort after the procedure.  You may take an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin and other brand names) for several days, or you may not need any pain medication at all.......everyone is different when it comes to healing.

Because surgical extractions are more complicated, they generally cause more pain after the procedure.  The level of discomfort and how long you have discomfort depend on the difficulty of the extraction.  You may be prescribed a pain medication for a few days and then suggest switch to an NSAID.  Most postsurgical pain disappears after a couple of days.  It is possible you will be tender over the area for a few weeks, but there should not be any major discomfort long term.

A cut in the mouth tends to bleed more than a cut on the skin because the incision cannot dry out and form a scab.  So after an extraction, you’ll be asked to bite on a piece of gauze for about 20 to 30 minutes to put pressure on the area and allow the blood to clot.  The area may still bleed minimally for the next 24 hours or so and taper off after that.  Don’t disturb the clot that forms on the wound.

You can put ice packs on your face to reduce postoperative swelling.  If your jaw is sore and stiff after the swelling dissipates, try warm compresses.  Eat soft foods for a few days then try other food as you feel comfortable.  Rinse with warm salt water (1/2 teaspoon of salt in a cup of water) for the first few days to help keep the area clean.  Most swelling and bleeding ends within one or two days of the surgery.  Overall healing takes between one and two weeks.

If the extraction needs to be closed with stitches, the stitches are usually dissolvable and should disappear in one to two weeks.  Rinsing with warm salt water will help the stitches to dissolve.

You should not smoke, use a straw or spit after surgery.  These actions can pull the blood clot out of the hole where the tooth was.  That causes more bleeding and can lead to a dry socket, which occurs in about 5% of all extractions.  It is most common when lower back teeth are removed and happens more often in smokers and women who take birth control pills.

Risks To Be Aware Of

Infection can set in after an extraction, although you probably won’t get an infection if you have a healthy immune system.

A common complication called a dry socket occurs when a blood clot doesn’t form in the hole or the blood clot prematurely breaks off or breaks down.  In a dry socket, the underlying bone is exposed to air and food.  This can be very painful and can cause a bad odor or taste.  A dry socket needs to be treated with a medicated dressing to stop the pain and encourage the area to heal.

Please contact us if pain is a persistent problem!

Other potential risks and complications include:

• Accidental damage to adjacent teeth --- such as fracture.
• An incomplete extraction --- a tooth remnant remains.  Most often the remnant is removed to prevent infection, but occasionally it is less risky to leave a small root tip in place, if needed.
• A fractured jaw --- caused by the pressure applied during the extraction.  This is a risk most often encountered in older people with osteoporosis of the jaw.
• A hole in the sinus during removal of an upper molar.  A small hole will usually close up by itself in a few weeks but may require additional surgery if it doesn’t heal spontaneously.
• Sustained numbness in the lower lip and chin, caused by trauma to the inferior alveolar nerve (during removal of the lower wisdom teeth). Complete healing of the nerve may take three to six months. In rare cases, the numbness, although not disfiguring, may be permanent. 

When To Call a Professional
 
If a swelling gets worse instead of better, or you experience fever, chills or redness in an area, please give us a call.  If you have an infection, antibiotics will usually be prescribed.  Also please call, if after 3-4 days post surgery an extraction site becomes very painful or prolonged, this may be a sign that you may have a dry socket.  Similarly, If the area continues to bleed after the first 24 hours please give us a call.