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Tooth Extraction Tell me all about it

Updated: Feb 18, 2022

Tooth Extraction

Tooth extraction also referred to as dental extraction is one of the most frequent procedures performed at the dentist's office. As its name indicates, it consists of removing teeth from the bone that surrounds and supports them (alveolar bone).

Ideally this procedure should be seen as a last resort when the tooth is infected, so, with some exceptions, it is always better to go from less to more. And what does this mean? Well, it means opting first for more conservative and less invasive treatments such as dental restoration or root canal.

And when it is no longer viable to keep the tooth in the mouth, both because the tooth decay is very extensive and a large part of the tooth structure has been lost, for example, or because the aforementioned alternatives have failed, is when it is necessary to resort to extraction.

Indications for dental extraction:

There are several reasons why an extraction also called exodontia is indicated. We can mention:

✔Very extensive and advanced tooth decay in which there is considerable loss of tooth structure and it is not feasible to perform a dental restoration or root canal treatment.

✔Destruction of the bone surrounding the tooth. This can occur in teeth associated with tumors and cysts or gum disease.

✔Lack of space in the dental arch.

✔Failure of root canal treatment.

✔Unrestorable crack or fracture that goes beneath the gum / to the nerve

✔Complicated dental trauma.

✔Advanced periodontal disease (periodontitis) with marked tooth mobility.

✔Supernumerary teeth (when there are one or more extra teeth).

✔When it is part of orthodontic treatment planning (removing teeth for braces).

✔Partially erupted or impacted teeth, a very common reason for extraction of wisdom tooth.

Since wisdom teeth are the last to erupt, they may be retained in the alveolar bone due to lack of space. This can lead to the development of infections such as pericoronitis, abscesses, cysts, etc.

Case planning

Prior to the dental extraction, the dentist will evaluate the patient's oral cavity, ask about the patient's medical and dental history, and imaging studies (x-rays).

The objective is to evaluate the patient's health situation and make sure that there is no condition that could compromise the performance of the procedure. And if there is, such as the feasibility of performing a dental extractions after radiation therapy, to be able to take all the necessary precautions, to make consultations with specialist physicians, etc.

In relation to x-ray, its function is to allow the dentist to study the position of the tooth in relation to the neighboring teeth and the surrounding bone, to know the length, shape and number of roots, quality of the bone, etc. All this will help determine the type and level of complexity of the extraction.

Tooth extractions can be

Simple: the tooth is visible in the mouth (not under the gum) so it is easily accesible and i sable to be removed in its entirety.

Surgical: indicated for teeth require cutting the tooth into smaller portions, those that require removal of the surrounding bone, and those that have not yet broken through the gum line, when the roots are divergent, etc. Here the dentist must make an incision in the gum surrounding the tooth and often remove a small portion of bone to access it.

the image shows a simulated mouth with a pair of forceps used to extract a tooth from a patient. The forceps are moved from side to side in order for the tooth to come out.
simulation of forceps pulling out a tooth

Do general dentists do extractions?

In case you are wondering if general dentists can perform this procedure, the answer is yes, as it is part of their training. But this is true as long as it is a case they can handle and it does not exceed their capabilities and knowledge. If this is the case, the correct thing to do is to refer the patient to a dentist specialized in oral surgery.

How many teeth can be removed at once?

There is no rule that determines the maximum number of teeth that can be removed in a single intervention, since there are different factors that must be taken into account: the state of general and oral health, if the patient is prone to bleeding, if they follow a pharmacological treatment and with what medications, how is their healing process, etc., and these may vary from one patient to another.

In addition, multiple extractions are usually carried out in specific situations such as: advanced periodontal disease with insertion loss, prostheses or dental implants, etc.

Step by step

In some cases it may be necessary for the patient to be medicated with antibiotics in the days prior to the dental extraction. This is to prevent the development of bacterial infections or when one is already present.

It is mandatory that the patient comes to the appointment having had breakfast.

Moments before the extraction, the patient may be asked to rinse their mouth with chlorhexidine gluconate antibacterial for 30 seconds.

Now, as for the procedure itself, the first thing the dentist does is infiltrate the local anesthesia. So if you are wondering, dodental extractions hurt? The answer is that although you may feel pressure in the area if the anesthesia was placed correctly, you should not feel pain. Often times if the area is infected, or the tooth is very painful at the time of the appointment it can require more anaesthesia to numb the tooth.

The local anesthesia may or may not be accompanied by nitrous oxide or conscious sedation, and this depends on the patient's preference and whether the dentist is trained to do so.

Whether the tooth is completely visible or below the gum will make a difference in the step-by-step procedure:

When the tooth is completely visible

After infiltrating the anesthesia, the dentist proceeds to separate the tooth from the ligaments that holds it to the alveolar bone. They then loosens it with dental extraction instruments called elevators and then extract it by making gentle but firm movements from one side to the other with an instrument called forceps.

When the tooth is under the gums

In this case it is necessary to make a flap (also under anesthesia), this consists of making a small incision in the gum to separate the mucosa and connective tissue that covers the tooth.

Then a small part of the alveolar bone is cut so that the tooth is exposed and can be removed with elevators or dental extraction forceps.

In other cases it may be necessary to split the tooth into multiple pieces to facilitate its removal and avoid complications.

The image shows a common situation of a wisdom tooth that is not erupted and then becomes crooked inside the mouth causing pain a pressure on the other molars
Why a Wisdom Tooth May Need to be Extracted

In both situations, once the tooth has been extracted, the alveolus (bone) should be irrigated with saline solution and a gentle scraping can be performed in its walls to favor the formation of the blood clot. In cases where it has been necessary to make a flap, the wound should be sutured.

Postoperative indications

Any dental extraction procedure whether it is simple or surgical, may entail postoperative complications of minor or major degree, and that is why the patient must comply to the letter with the indications given by the dentist in order to minimize the possible risks and reduce the probability of:

● Suffering postoperative bleeding.

● Developing infections.

● The detachment of the clot.

● The opening of the stitches.

● And to also minimize swelling.

What to do after removing teeth? After care for dental extractions:

- Keep the gauze over the surgical area for 30 minutes after the procedure.

- Comply with painkillers and/or antibiotic treatment.

- Do not spit or make suction movements (do not use straws) as this may dislodge the blood clot.

- As for what to eat after dental extraction, the ideal is to eat only soft foods for at least 2 days after the procedure: yogurt, creams, soups, purees, etc. Avoid foods that can get stuck in the wound, such as rice.

- You can use ice packs to reduce swelling.

- Perform oral hygiene in the area with extreme care, but do not skip it.

- Do not smoke for at least 5 days after surgery, as the nicotine reduces blood circulation which is important for your wound to heal

- In case of prolonged or severe pain, bleeding or fever, consult your dentist immediately.

Keep in mind that the success of the dental extraction will largely depend on the correct planning of the procedure and the academic background of the dentist. That is why if you are looking for a dentist in Morley, Perth WA you should make sure you choose a professional with adequate knowledge of the oral anatomy and the technique to be used; with work ethic and good academic background.

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