Tooth Extraction

What Is It?

Tooth extraction is the removal of a tooth from its socket in the bone.

What It’s Used For

If a tooth has been broken or damaged by decay, your dentist will try to fix it with a filling, crown or other treatment. Sometimes, though, there’s too much damage for the tooth to be repaired. In this case, the tooth needs to be extracted. A very loose tooth also will require extraction if it can’t be saved, even with bone replacement surgery (bone graft).

Here are other reasons:

  • 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 getting braces may need teeth extracted to create room for the teeth that are being moved into place.
  • 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.

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 osteonecrosis (death of bone) in the jaw.

Preparation

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 the medicines you take. This should include both prescription and over-the-counter drugs, vitamins and supplements.

If you are having wisdom teeth removed, 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

You may have intravenous (IV) anesthesia, which can range from conscious sedation to general anesthesia. If so, your doctor will have to give you instructions to follow. You should wear clothing with short sleeves or sleeves that can be rolled up easily. This allows access for an IV line to be placed in a vein. Don’t eat or drink anything for six or eight hours before the procedure.

If you have a cough, stuffy nose or cold up to a week before the surgery, call your doctor. He or she may want to avoid anesthesia until you are over the cold. If you had nausea and vomiting the night before the procedure, call the doctor’s office first thing in the morning. You may need a change in the planned anesthesia or the extraction may have to be rescheduled.

Do not smoke on the day of surgery. This can increase the risk of a painful problem called dry socket.

After the extraction, someone will need to drive you home and stay there with you. You will be given post-surgery instructions. It is very important that you follow them.

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. 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. Surgical extractions commonly are done by oral surgeons. However, they are also done by 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 simple extractions can be done using just an injection (a local anesthetic). You may or may not receive drugs to help you relax. For a surgical extraction, you will receive a local anesthetic, and you may also have anesthesia through a vein (intravenous). Some people may need general anesthesia. They include patients with specific medical or behavioral conditions and young children.

If you are receiving conscious sedation, you may be given steroids as well as other medicines in your IV line. The steroids help to reduce swelling and keep you pain-free after the procedure.

During a tooth extraction, you can expect to feel pressure, but no pain. If you feel any pain or pinching, tell your doctor.

When To Call a Professional

Call your dentist or oral surgeon if:

  • The swelling gets worse instead of better.
  • You have fever, chills or redness
  • You have trouble swallowing
  • You have uncontrolled bleeding in the area
  • The area continues to ooze or bleed after the first 24 hours
  • Your tongue, chin or lip feels numb more than 3 to 4 hours after the procedure
  • The extraction site becomes very painful — This may be a sign that you have developed a dry socket.

We love our patients and love to help them form healthy dental life that will last them a lifetime. For more information call us today to answer all of your questions so get an appointment today.

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