Extractions

EXTRACTIONS

A dental extraction is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to render the tooth non-restorable. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment.

Historically, dental extractions have been used to treat a variety of illnesses, as well as a method of torture to obtain forced confessions. Before the discovery of antibiotics, chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries. In the 14th century, Guy de Chauliac invented the dental pelican, which was used through the late 18th century. The pelican was replaced by the dental key which, in turn, was replaced by modern forceps in the 20th century. As dental extractions can vary tremendously in difficulty, depending on the patient and the tooth, a wide variety of instruments exist to address specific situations.

Reasons for tooth extraction

The most common reason for extraction is tooth damage due to breakage or decay. There are additional reasons for tooth extraction:

  • Severe tooth decay or infection
  • Extra teeth which are blocking other teeth from coming in.
  • Severe gum disease which may affect the supporting tissues and bone structures of teeth.
  • In preparation for orthodontic treatment (braces)
  • Fractured teeth
  • Insufficient space for wisdom teeth (impacted third molars).

Types of extraction

Extractions are often categorized as "simple" or "surgical" while there are many different types of extractions below are two of the most common extractions.

Simple extractionsare performed on teeth that are visible in the mouth, usually under local anesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and using dental forceps, rocked back and forth until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Typically, when teeth are removed with forceps, slow, steady pressure is applied with controlled force.

Surgical extractionsinvolve the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or because they have not erupted fully. Surgical extractions may sometimes require an incision. In a surgical extraction the doctor may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding jawbone tissue with a drill.  Frequently, the tooth may be split into multiple pieces to facilitate its removal. Surgical extractions are usually performed under a local anesthetic. 

Patients are sometimes very scared to get dental extractions.  If you fall into that category please see our section on nitrous oxide.

Post-Op Instructions

After an extraction, it's important for a blood clot to form to stop the bleeding and begin the healing process. That's why your dentist will ask you to bite on a gauze pad for 30 to 45 minutes after an extraction. If bleeding or oozing continues after you remove the gauze pad, place another gauze pad on the area and bite firmly for another 30 minutes. You may have to do this several times.
After the blood clot forms, it's important to protect it, especially for the next 24 hours. It's important to not:

  • Smoke
  • Suck through a straw
  • Rinse your mouth vigorously
  • Clean the teeth next to the extraction site


These activities could dislodge the clot and slow down healing.

Limit yourself to calm activities for the first 24 hours. This keeps your blood pressure lower, reduces bleeding, and helps the healing process.

After the tooth is extracted, you may feel some pain and have some swelling. You can use an ice bag (20 minutes on, 20 minutes off) to keep this to a minimum. The swelling usually starts to go down after 48 hours.

To control discomfort, take pain medication as recommended. Don't take medication on an empty stomach or nausea may result. If antibiotics are prescribed, continue to take them for the indicated length of time, even if all symptoms and signs of infection are gone. Also:

·      Drink lots of fluids.

·      Eat only soft, nutritious foods on the day of the extraction.

·      Don’t use alcoholic beverages.

·      Avoid hot and spicy foods.


You can begin eating normally the next day or if not by then, as soon as it's comfortable. Gently rinse your mouth with warm salt water three times a day (put a teaspoon of salt in a cup of warm water, and then gently rinse, swish, and spit). Also, rinse gently after meals. This helps keep food out of the extraction site.

It's very important to resume your normal dental routine after 24 hours. This should include brushing your teeth and tongue and flossing at least once a day. This will speed healing and help keep your breath and mouth fresh. Call your dental office right away if you have heavy bleeding, severe pain, continued swelling after two or three days, or a reaction to the medication. After a few days, you'll be feeling fine and can resume your normal activities.