Extractions

Dental extraction is a common dental practice that consists of removing a tooth from its socket. Both the crown, which is the visible portion of the tooth, and the tooth roots are removed. Teeth that have fully erupted are generally removed through a process called simple extraction, which involves using specialized tools to lift or pull the tooth from its socket. Teeth that have not yet erupted are removed surgically, often with the patient under IV anesthesia to prevent discomfort and trauma. If necessary, the extracted tooth can later be replaced by a dental implant or bridge.

 

WHEN DO I NEED TOOTH EXTRACTION?

Dental extraction is usually performed as a last resort when teeth are too badly damaged to be saved, or when leaving a tooth in the mouth will cause more harm than good. There are four primary reasons why you might need to have a tooth extracted.

Tooth Decay

Tooth decay is the erosion of the tooth by acids secreted by oral bacteria. Decay begins as a small cavity, and if you have the cavity filled at this stage, the decay usually stops progressing, enabling you to keep the tooth in your mouth. However, if you do not detect and treat a cavity soon enough, the decay can become more extensive, weakening the tooth. There may not be enough healthy tooth structure left to support a filling or a crown. In this case, to alleviate pain and prevent the decay from spreading to other teeth, your dentist may recommend having the tooth extracted.

Tooth Damage

Teeth that are chipped or cracked in an accident can often be restored with dental bonding or a crown. However, if the chip or crack extends into the tooth pulp, which is the innermost layer of the tooth, your dentist may not be able to repair the tooth, and extraction may be the best option. Sometimes your dentist may attempt to restore a badly damaged tooth, but infection or decay will set in afterwards, making extraction necessary.

Dental Abscess

A dental abscess is an infection of the tooth root and the tissue that surrounds it. In many cases, dentists can save an abscessed tooth by performing a root canal, which is a procedure in which the infected material is removed from within your tooth roots. However, the most serious abscesses can cause extensive damage to the tooth roots, making it unwise to leave the tooth in the mouth. Extracting the tooth may be your best choice to prevent infection from spreading to other teeth and into your jaw bone.

Misalignment or Crowding

The other reason to have a dental extraction performed is if your teeth are crowded or badly misaligned. Some people have jaw bone structures that are not large enough to accommodate all of their teeth. In this case, a dentist may extract one or more teeth before referring the patient to an orthodontist for braces or other alignment procedures. This is often done during the teen years.

Many people also have their wisdom teeth extracted to prevent crowding. The jaw bone is often not large enough to accommodate the wisdom teeth, so they either end up impacted in the jaw bone and need to be extracted surgically, or they erupt at an improper angle and need to be removed with a simple extraction procedure.

 

THE TOOTH EXTRACTION PROCESS

Patients often fear having a tooth extracted, but modern anesthetic techniques make the procedure far more comfortable than you might imagine. There are two types of tooth extractions. A simple extraction is performed when the tooth has erupted through the gums, and a surgical extraction is performed when the tooth has not yet erupted.

Simple Extraction

When you sit down in the dentist’s chair for your extraction procedure, your dentist will begin by injecting some local anesthetic into your gums. Over the next few minutes, the portion of your mouth surrounding the tooth to be removed will go numb. If you are nervous or anxious about the procedure, your dentist may also have you breath laughing gas through a mask, or they may prescribe an oral sedative for you to take prior to your appointment.

Once you are numb, your dentist will use a tool called an elevator to lift the tooth up, exposing the ligament that holds it into place. He or she may rock the tooth back and forth to create more room in the socket. Then, a tool called forceps, which look like tweezers, will be used to pull the tooth from the socket. Sometimes, your dentist may apply a stitch or two to hold the socket closed and accelerate clotting. He or she will pack the area with gauze to absorb the blood. You are usually free to drive home once the bleeding has slowed down. If you took an oral sedative, you will need to have a friend drive you home.

Surgical Extraction

If you require a surgical extraction, your oral surgeon may administer an IV anesthetic so that you are unconscious during the procedure. Then, he or she will cut away the bone and connective tissue that hold the tooth in place. The tooth may need to be broken into chunks and removed one piece at a time. The socket may be stitched closed. When you wake up, your mouth will be packed with gauze to absorb the blood. You will need to have someone drive you home as the anesthesia will wear off slowly over the next few hours.

AFTER A TOOTH EXTRACTION

Your dentist will likely prescribe you pain medication to help with discomfort in the days following the extraction. You will need to stick to soft foods for a few days after the procedure, but as you heal and are able to chew comfortably again, you can slowly start introducing harder and chewier foods into your diet. Most patients are able to resume eating their normal diet within one to two weeks.

Caring For the Extraction Site

To encourage the extraction site to heal properly, your dentist may recommend rinsing your mouth with salt water several times per day. The salt helps kill oral bacteria, and it also reduces inflammation and discomfort in the extraction site. Brush your teeth as normal following your tooth extraction, but be very gentle in the area surrounding your empty socket. To alleviate pain, you can also hold a cold compress against the outside of your cheek or sip chilled beverages throughout the day. Sleep with your head elevated to reduce inflammation and pain.

Do not drink through a straw or smoke while you are recovering from a tooth extraction. The suction created by these activities can dislodge the clot that forms in the empty tooth socket, leading to a condition known as dry socket. Dry socket is very painful, and it slows down the healing process. Your dentist can apply special dressings to a dry socket to reduce the pain and help accelerate the healing process.

Depending on what caused you to require a tooth extraction, your dentist may prescribe you antibiotics to take as you recover from the procedure. The antibiotics will help fight off and prevent any infection in the tooth socket and surrounding tissues. If your dentist does prescribe antibiotics, make sure you take them for as long as is recommended.

Tooth Replacement Options

If you had your tooth extracted to address crowding or alignment issues, then it will not need to be replaced. However, if your tooth was extracted due to decay or an abscess, your dentist will want to discuss tooth replacement options once the empty socket has had time to heal.

Dental implants are the preferred tooth replacement option for most patients. They consists of a metal screw that is surgically implanted in the jaw bone to replace the tooth root, along with a porcelain crown that replaces the visible portion of your tooth. Implants help prevent the bone around the empty tooth socket from deteriorating because they place pressure on this bone in the same way a natural tooth would. Once you heal from implant surgery, the implanted tooth will look and function just like a natural tooth.

If you are not a candidate for dental implants, your dentist may recommend replacing the missing tooth with a dental bridge. This restoration replaces only the visible crown portion of your tooth. It is fixed to the teeth on either side of the extraction site with dental cement.

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