Tooth extraction is a process of removing a tooth from its bone socket.
When is it done?
In case of a breaking tooth or a damaged or decayed tooth, a dentist will first try to mend it with certain options such as, crowning, filling or other such treatments. Sometimes, these treatments might not be of great help due to the intensity of the damage caused to the tooth. In such cases, extraction is the last method of treatment.
The reasons are noted herein:
Some people often have an extra tooth that blocks other teeth from getting in.
For people wearing braces, it is often essential to give space to those teeth that needs to be moved into the right position.
People who receive radiation on their neck and head might have to extract the teeth that come in the radiation field.
People under cancer drugs might also develop teeth infection. These drugs are very powerful and they weaken the overall immune system thus, elevating the risk of any infection. Any infected teeth might need an extraction.
People who have undergone an organ transplant might also need teeth extraction because the teeth can be a cause of infection post transplantation. People who have had organ transplants are vulnerable to infections because these patients have to take drugs to suppress their immune system.
Wisdom teeth or third molars are also extracted very often.
Preparation
You will be asked about your past medical health and about your dental history as well. An X-ray will be taken by the dentist of the affected area in order to plan the best method of tooth removal.
Some of the healthcare professionals might prescribe antibiotics that are to be taken pre and post surgery. This practice usually varies as per the dentist or the oral surgeon you are consulting.
If you are prepared for a conscious sedation or a deeper anesthesia, wear short sleeved clothes or sleeveless ones that can easily be rolled up. This allows an easy access to the intravenous (IV) line that needs to be placed in your vein.
You will also be told that you must not eat or even drink anything for at least 6 to 8 hours before the surgery. You should also make sure to have someone by your side, who will drive you back home after the surgical procedure.
How it is done?
Extractions are of two types:
A simple method of extraction can be performed on a tooth and can be seen in your mouth. General dentists prefer to do simple extractions. Most of these cases are done with the help of a local anesthetic injection, with or without any anti-anxiety drug. In case of a simple extraction, a dentist will clutch the damaged tooth with a pair of forceps and will loosen it by moving the pair of forceps backward and forward. After this, the tooth will be pulled out. In some cases, the dentist might also use a dental 'elevator' to slacken the tooth. An elevator is a dental instrument that actually fits between the tooth and gum.
Surgical extraction is needed in case if the teeth can not be easily seen. These teeth might either not have come up yet or might have broken off in such a way that half of the teeth still remains in the gum line. In order to see and to remove such a tooth, the dentist or the oral surgeon will have to cut and then pull the gums back. The gun "flap", when pulled back, allows access to extract the bone and / or the piece of tooth that remained inside.
Surgical extraction procedures are usually done by the oral surgeons. These procedures are conducted under local anesthesia (given as injections) and you may also opt for conscious sedation. Patients with medical complications and children are given general anesthesia. In case of a surgical extraction, the dentist must make an incision in the gum in order to locate the tooth. In critical cases, the tooth will be cut into pieces and then removed.
If you are getting a tooth extraction and you are to receive a conscious sedation, you might also be given steroids in the IV line to help in lessening the swelling caused after the surgery.
If you need to remove all of the four wisdom teeth, you have to get it done at the same time. The topmost teeth can be easily removed, but the lower ones might prove to be difficult.
Follow-up
Simple extractions are usually not followed by any other discomfort. You can take over-the-counter non-steroidal anti-inflammatory drugs (NSAID) like Ibuprofen (Advil, Morton and some more brands) for a couple of days. You might not need to take any pain relief medicines at all.
As surgical extractions are very complicated, they cause severe pain post surgery. The after effect of such a procedure results in discomfort and the duration of teat stage depends on the intensity of the extraction procedure. Your dentist will definitely prescribe pain relief medicines for a couple of days, followed by NSAID. After a couple of days, the pain will be gone.
Incise within the mouth usually bleeds more than any incise on the surface of the skin because the one in the mouth does not get the chance to dry out and results in the formation of a scab. After your extraction, you will have to bite a piece of gauze for as along as 30 minutes in order to put pressure on the wound and allow the clotting of blood. It might still bleed for another 24 hours and then taper off. Do not remove the cloth that covers the wound.
You can use ice packs on the face to lessen swelling post surgery. The bleeding and swelling stops after one or two days of surgery. Initial healing will take about 2 weeks time.
After surgery, you should not spit, use straw or smoke. Such actions can stimulate the blood clot and it might pull out of the socket where the tooth lay. That would cause more bleeding and could even lead to dryness of the socket, which happens to about 3 to 4 percent of the extraction cases. Dry socket happens almost 20 to 30 percent of the times when an impacted tooth is removed. It happens mostly with smokers and with women taking contraceptive pills. It is mostly expected in case of difficult extractions.
Risks
Infections can highly set in after the process of extraction but, if you have a healthy immune system, you might not get infected.
A very common complication is observed after an extraction called dry socket. It occurs when a there's no blot clot formation in the hole or the clot breaks down too early.
Incase of a dry socket, the bone that lies under the wound is exposed to food and air. This is very painful and can also cause bad breath and taste. Such cases need immediate treatment and medicated dressing in order to prevent the pain and encourage quick healing.
Other possible problems include:
Accidental cause in which the teeth close to the site of surgery is effected, a fracture etc.
Incomplete extraction, where a part of the tooth still remains inside the jaw. A dentist removes the root so as to prevent it from any infection, but sometime it is not that risky to leave small tip of the root inside.
Fractured jaw, which is caused due to pressure exerted on your jaw during the process of extraction. Elderly people suffering from osteoporosis are most likely to be effected by this.
A hole occurring in your sinus while removing the molar (upper back tooth). A tiny hole that closes up on its own after a couple of weeks. If it does not, another surgery might be needed.
Sore in the jaw joints or muscles. You might not be able to open your mouth wide.This happens due to the injections.
Ongoing numbness caused in the chin and lower lips. Any trauma or injury of the inferior alveolar nerve can be the cause of numbness. This happens during the removal of lower wisdom teeth. It takes about 3 to 6 months for this wound to heal completely. In some rare cases, the numbness might be permanent.