Extractions are performed to remove teeth:
- which have become unrestorable through tooth decay or periodontal disease or dental trauma
- to reduce crowding
- which are impacted , such as wisdom teeth
Tooth extraction is usually relatively straightforward, and most can be performed quickly while the individual is awake by using local anesthetic injections to eliminate uncomfortable sensations. Local anesthetic blocks pain, but the pressure is still vaguely felt. Some teeth are more difficult to remove for several reasons, especially related to the tooth’s position, the shape of the tooth roots and the integrity of the tooth. In this case, a surgical may be required, which involves reflecting the gum and removing some bone which is holding the tooth. After the tooth is removed, stitches are used to replace the gum into the normal position.
Sometimes wisdom teeth are impacted (stuck and unable to grow normally into the mouth) and may cause recurrent infections of the gum (pericoronitis).
Wisdom teeth are the third molars. The third molars usually will try to grow in at around age 17 to 21 years. Since that is considered to be the age when people become wiser, third molars gained the nickname, “wisdom teeth.”
When wisdom teeth are prevented from erupting into the mouth properly, they are referred to as being impacted. A dentist must examine a patient’s mouth and his or her X-rays to determine if the teeth are impacted or will not grow in properly. Impacted teeth may cause problems, such as infection, decay of adjacent teeth, gum disease or formation of a cyst (fluid-filled sac) or tumor from the follicle, which is the tissue that formed the crown of the tooth
Erupted wisdom teeth may also need to be removed. The reasons may be if the tooth is nonfunctional, interfering with the bite, badly decayed, involved with or at risk for periodontal disease, or interfering with restoration of an adjacent tooth. Every case is different.
Orthodontics and extractions
In orthodontics if the teeth are crowded, sound teeth may be extracted to create space so the rest of the teeth can be straightened. Often these teeth are the first premolars, located behind the “eye” teeth.
Baby (primary) teeth and extractions
Should a child have baby teeth removed?
If the primary teeth are there for too long, they can adversely affect the eruption path of the underlying permanent teeth.
An example is when a permanent tooth starts to come in adjacent to a primary one that isn’t loose. This commonly happens in the lower anterior when a permanent incisor erupts behind a primary one . There appears to be a “double row of teeth” as many parents describe it.
Baby teeth “fall out” when the adult tooth erupts directly under it , resorbing the root of the baby tooth. If the adult tooth “misses” and erupts behind the baby tooth, there is no loosening effect of baby tooth. Therefore the baby tooth must be removed.
The first solution is to encourage your child to “wiggle out” his/her baby tooth. If this fails, one or more of the baby teeth can be removed easily by the dentist.
If the baby teeth are removed in time, the “back row” permanent teeth will generally move forward into better alignment. Removing the primary teeth in these instances does NOT correct the crowding that created the problem. Orthodontics will still be necessary in the future to correct the problem.
Other times when primary teeth need to be removed are when:
- The primary tooth is painful for your child, or preventing your child from eating properly
- The primary tooth is collecting a lot of plaque
Lastly, there are times when it is better to not remove primary teeth:
- Primary teeth should be restored and preserved until the underlying permanent ones are ready to come in since they maintain the needed space.
- If the corresponding permanent teeth are missing, the primary teeth should be maintained until a certain age.
Post-Operative Instructions for at-home speed recovery
Things to do
- For Pain: Take medication as advised by your Dentist
- For Bleeding: Bite on a rolled damp gauze (or a damp tea bag) for at least 20 minutes. Do not repeat often.
- For Swelling: Apply a cold pack (a bag frozen peas of ice wrapped in a towel) for 20 minutes on and 20 minutes off.
- NOTE: Starting the day after surgery, rinse gently with warm salt water, in the morning, after meals, and before bedtime.
Things to avoid
- Strenuous Activity: This will tend to cause
- Alcohol: For 48 hours
- Smoking: For 48 hours
- Straws, Rinsing, Spitting: This will dislodge a blood clot and cause bleeding.
- Popcorn, nuts: These foods collect in, and irritate the extraction site.
The dentist has a variety of means at their disposal to address bleeding; however, small amounts of blood mixed in the saliva after extractions are normal, even up to 72 hours after extraction. Usually bleeding will stop within eight hours of surgery, with only minuscule amounts of blood mixed with saliva coming from the wound. A gauze compress will significantly reduce bleeding over a period of a 45 minutes.
Generally, when a surgical flap must be elevated (i.e. and the periosteum covering the bone is thus injured), minor to moderate swelling will occur. Similarly, when bone must be removed using a drill, more swelling is likely to occur.
Bruising may occur as a complication after tooth extraction. Bruising is more common in older people or people on aspirin or steroid therapy. It may take weeks for bruising to disappear completely.
Sinus exposure and oral-antral communication
The maxillary sinus is right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. If this membrane is exposed after an extraction, but remains intact, a “sinus exposed” has occurred. If the membrane is perforated, however, it is a “sinus communication”. These two conditions are treated differently. In the event of a sinus communication, the dentist may decide to let it heal on its own or may need to surgically obtain primary closure—depending on the size of the exposure and the likelihood of the patient to heal. In both cases, a resorbable material called “gelfoam” is typically placed in the extraction site to promote clotting. Patients are typically provided with an antibiotic prescription, and careful instructions to follow.
This is primarily an issue with extraction of third molars, but can occur with the extraction of any tooth should the nerve be close to the surgical site. Such injuries can occur while lifting teeth but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but depending on the type of injury can be prolonged or even permanent.
- Displacement of tooth or part of the tooth into the maxillary sinus (upper teeth only).
- Dry Socket (Alveolar osteitis) is a painful phenomenon that most commonly occurs a few days after the removal of mandibular (lower) wisdom teeth. It typically occurs when the blood clot within the healing tooth extraction site is disrupted. Inflamed bone, unprotected and exposed to the oral environment after tooth extraction, can become packed with food and debris. A dry socket typically causes a sharp and sudden increase in pain commencing 2–5 days following the extraction of a mandibular molar, most commonly the third molar.A dry socket is not an infection, and is not directly associated with swelling because it occurs entirely within bone – it is a phenomenon of inflammation within the bony lining of an empty tooth socket. Because dry socket is not an infection, the use of antibiotics has no effect on its rate of occurrence. The risk factor for alveolar osteitis can dramatically increase with smoking after an extraction.
It is not uncommon for the bones which formerly supported the tooth to shift and in some cases to erupt through the gums, presenting protruding sharp edges which can irritate the tongue and cause discomfort. This is distinguished from a similar phenomenon where broken fragments of bone or tooth left over from the extraction can also protrude through the gums. In the latter case, the fragments will usually work their way out on their own. The dentist may decide to remove the fragments in another procedure.
Trismus, also known as lockjaw, affects functions of the oral cavity by restricting opening of the mouth. It is primarily a muscle problem and resolves readily with self-care instructions given by the dentist.
Osteonecrosis of the jaw is the slow destruction of bone in an extraction site. Women using bisphosphonates for more than two years are ten times more likely to experience osteonecrosis of the jaw, while women who have taken bisphosphonates for less than two years are four times more likely to suffer from osteonecrosis of the jaw when compared to women who were not taking bisphosphonates. Therefore, it is extremely important to report all medications used to the dentist before an extraction.
Replacement of your extracted tooth is possible by several means.