What Is It?
Tooth extraction is the removal of a tooth from its socket in the bone.
Reasons for Pulling Teeth
Removing a tooth is necessary when decay or an abscessed tooth is so severe that no other treatment will cure the infection. Removing the tooth can help keep infection from spreading to other areas of your mouth.
Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired.
Other reasons include:
● A Small Mouth or Crowded Teeth: Sometimes dentists pull teeth to prepare the mouth for braces. The goal of braces or Invisalign is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend pulling it.
● Infection: If tooth decay or damage extends to the pulp — the center of the tooth containing nerves and blood vessels — bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canal therapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.
● Risk of Infection: If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant), even the risk of infection in a particular tooth may be reason enough to pull the tooth.
● Periodontal (Gum) Disease: If periodontal disease — an infection of the tissues and bones that surround and support the teeth — have caused loosening of the teeth, it may be necessary to the pull the tooth or teeth.
● Some people have extra teeth that block other teeth from coming in.
● Sometimes baby teeth don’t fall out in time to allow the permanent teeth to come in.
● People receiving radiation to the head and neck may need to have teeth in the field of radiation extracted.
● People receiving cancer drugs may develop infected teeth because these drugs weaken the immune system. Infected teeth may need to be extracted.
● Some teeth may need to be extracted if they could become a source of infection after an organ transplant. People with organ transplants have a high risk of infection because they must take drugs that decrease or suppress the immune system.
● Wisdom teeth, also called third molars, are often extracted either before or after they come in. They commonly come in during the late teens or early 20s. They need to be removed if they are decayed, cause pain or have a cyst or infection. These teeth often get stuck in the jaw (impacted) and do not come in. This can irritate the gum, causing pain and swelling. In this case, the tooth must be removed. If you need all four wisdom teeth removed, they are usually taken out at the same time.
● Least Expensive Option: Some people may opt to lose a tooth rather than save it for financial or cultural reasons.
What to Tell Your Dentist Before You Have a Tooth Pulled
Although having a tooth pulled is usually very safe, the procedure can allow harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. If you have a condition that puts you at high risk for developing a severe infection, you may need to take antibiotics before and after the extraction. Before having a tooth pulled, let your dentist know your complete medical history, the medications and supplements you take, and if you have one of the following:
● Damaged or man-made heart valves
● Congenital heart defect
● Impaired immune system
● Liver disease (cirrhosis)
● Artificial joint, such as a hip replacement
● History of bacterial endocarditis
If you have been diagnosed with osteoporosis and are taking drugs for that condition, or if you expect to have treatment with intravenous drugs called bisphosphonates for a medical condition, be sure to see your dentist first. If any teeth need to be extracted, this should be done before your drug treatment begins. Having a tooth extraction after bisphosphonate treatment increases the risk of bone death in the jaw.
Your dentist or oral surgeon will take an X-ray of the area to help plan the best way to remove the tooth. Be sure to provide your full medical and dental history and a list of all medicines you take. This should include both prescription and over-the-counter drugs, vitamins and supplements.
If you are having multiple teeth removed or teeth in certain places, you may have a panoramic X-ray. This X-ray takes a picture of all of your teeth at once. It can show several things that help to guide an extraction:
● The relationship of your wisdom teeth to your other teeth
● The upper teeth’s relationship to your sinuses
● The lower teeth’s relationship to a nerve in the jawbone that gives feeling to your lower jaw, lower teeth, lower lip and chin. This nerve is called the inferior alveolar nerve.
● Any infections, tumors or bone disease that may be present
Some doctors prescribe antibiotics to be taken before and after surgery. This practice varies by the dentist or oral surgeon. Antibiotics are more likely to be given if:
● You have infection at the time of surgery
● You have a weakened immune system
● You will have a long surgery
● You have specific medical conditions
How It’s Done
There are two types of extractions:
A simple extraction is performed on a tooth that can be seen in the mouth. Some General dentists commonly do simple extractions. In a simple extraction, the dentist loosens the tooth with an instrument called an elevator. Then the dentist uses an instrument called a forceps to remove the tooth.
A surgical extraction is a more complex procedure. It is used if a tooth may have broken off at the gum line or has not come into the mouth yet or has very curved roots or if the root has fused to the bone. Surgical extractions commonly are done by oral surgeons. However, they are also done by some general dentists. The doctor makes a small incision (cut) into your gum. Sometimes it’s necessary to remove some of the bone around the tooth or to cut the tooth in half in order to extract it.
Most extractions can be done using just a local anesthetic (Novocaine). You may or may not receive drugs to help you relax. Some people may need general anesthesia. They include patients with specific medical or behavioral conditions and young children.
During a tooth extraction, you can expect to feel pressure, but no pain. If you feel any pain or pinching, tell your doctor.
Your doctor will give you detailed instructions on what to do and what to expect after your surgery. If you have any questions, make sure to ask them before you leave the office.
Having a tooth taken out is surgery. You can expect some discomfort after even simple extractions. Usually it is mild. Research has shown that taking nonsteroidal anti-inflammatory drugs (NSAIDs) can greatly decrease pain after a tooth extraction. These drugs include ibuprofen, such as Advil, Motrin and others. All of those drugs, however, can be toxic if overused. Take the dose your doctor recommends, 3 to 4 times a day. Take the first pills before the local anesthesia wears off. Continue taking them for as long as needed. Dr. Locker will give you complete instructions.
Surgical extractions generally cause more pain after the procedure than simple extractions. The level of discomfort and how long it lasts will depend on how difficult it was to remove the tooth. Your dentist may prescribe pain medicine for a few days and then suggest an NSAID. Most pain disappears after a couple of days.
A cut in the mouth tends to bleed more than a cut on the skin because it cannot dry out and form a scab. After an extraction, you’ll be asked to bite on a piece of gauze for 1 hour. This pressure will allow the blood to clot. You will still have a small amount of bleeding for the next 24 hours or so. It should taper off after that. Don’t disturb the clot that forms on the wound.
You can put ice packs on your face to reduce swelling. Typically, they are left on for 20 minutes at a time and removed for 20 minutes. If your jaw is sore and stiff after the swelling goes away, try warm compresses.
Eat soft, cold foods for a few days. Then try other food as you feel comfortable. But make sure you avoid crumbly foods for a few days. Those would include cookies, chips, pretzels, popcorn, nuts etc. Because any of those things could irritate the new wound and cause unnecessary pain.
A gentle rinse with warm salt water, started 24 hours after the surgery, can help to keep the area clean. Use one-half teaspoon of salt in a cup of water. Most swelling and bleeding ends within a day or two after the surgery. Initial healing takes at least two weeks.
If you need stitches, your doctor may use the kind that dissolve on their own. This usually takes one to two weeks. Rinsing with warm salt water will help the stitches to dissolve. Some stitches need to be removed by the dentist or surgeon.
You should not smoke, eat crunchy or crumbly foods or eat on the side of the extraction for a week to avoid damage to the area. If you have persistent pain for more than a day or 2 after your extraction, or if pain begins a few days after your extraction and is relatively constant then you may have a dry socket. A dry socket is caused by the dissolution or destruction of the blood clot leaving an empty hole down to live bone. The exposed bone can be very sensitive. But there is a simple procedure that we can do here at Gentle Family Dentistry to relieve your pain and stimulate healing. The dry socket is packed with a medicated gauze which acts as a false scab. If you believe you have developed a dry socket make sure you contact Gentle Family Dentistry immediately to obtain relief.
Dr. Locker and his friendly, knowledgeable staff invite you to call Gentle Family Dentistry in Duncansville, PA for the greatest, most advanced, painless dental experience you have ever had.
And remember, You only have to floss daily the ones you want to keep.