Understanding Tooth Extraction

Published: 20th April 2012
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What is tooth extraction?
Tooth extraction is a process of removing a tooth from its bone socket.
When should you go for tooth extraction?
If a tooth is broken or damaged or decayed, and the normal dentist treatments to repair it fail, then tooth extraction is the last choice for treatment.
Why should you go for tooth extraction?
o If you want to remove an extra tooth, which is blocking other teeth
o If you want to wear braces and wants to make space for them
o If you receive radiation on your neck and head and your teeth have come in the radiation field
o If you develop infection due to strong drugs (cancer drugs), which weaken the immune system
o If you have undergone an organ transplantation and the teeth are infected after the transplant
o If you want to remove wisdom teeth or third molars (note that 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.)
How should you prepare for tooth extraction?
Before you undergo the procedure, the dentist will ask your past medical and dental health and perform an X-ray over the infected area to decide the best course of action. Some dentists may even prescribe antibiotics before and after surgery.
During the procedure, you need to be prepared for local or deeper anesthesia. So wear short sleeved clothes which you can roll up to allow easy access to the intravenous (IV) line. You will also be asked to refrain from eating or drinking anything for at least 6-8 hours before the surgery.
Finally, have a friend or a family member by your side to drive you around, take care of your things, and for moral support.
How is tooth extraction performed?
There are two types of tooth extraction:
o Simple extraction: If a tooth is easily seen in your mouth, then dentists generally perform simple extraction with the help of a local anesthetic injection. The dentist clutches the damaged tooth with a pair of forceps or a dental elevator (an instrument that fits between the tooth and the gum). He or she loosens the tooth by moving the forceps or elevator backward and forward. Once the tooth is loose, he or she pulls it out.

o Surgical extraction: If a tooth is not easily seen, then the oral surgeon performs surgical extraction under local anesthesia or conscious sedation. In this case, the teeth might either not have come up yet or might have broken off in such a way that half of it still remains in the gum. To see and remove such a tooth, the surgeon cuts and pulls the gums back. When the gums are pulled back, he or she extracts the bone and/or the piece of tooth that remains inside. In critical cases, the surgeon cuts the tooth into pieces and then removes it.
What are the follow-up guidelines post-surgery?
o Take prescribed drugs for pain relief and other purposes. If it is a simple extraction, there may not be much pain. You will be prescribed over-the-counter non-steroidal anti-inflammatory (NSAID) drugs such as Ibuprofen (Advil, Morton, etc.) for a couple of days. However, if it is a surgical extraction, you may feel severe pain post surgery. You may be prescribed pain relief medicines for a couple of days followed by NSAID.

o Take proper steps to stop bleeding. Incise within the mouth usually bleeds for a long period. You may need to bite a piece of gauze for about 30 minutes to put pressure on the wound and allow the clotting of blood. Even then the bleeding may continue for another 24 hours before tapering off. Do not remove the cloth that covers the mouth.

o Use ice packs on the face to reduce swelling. The bleeding and swelling stops after 1 or 2 days of surgery. Initial healing will occur in about 2 weeks.

o Do not spit, use straw, or smoke, as these actions can stimulate the blood clot and might pull out the socket where the tooth lay. This would cause even more bleeding and eventually dryness of the socket. Dry socket happens in almost 20 to 30% post-surgery cases and mostly with smokers and women taking contraceptive pills.

What are the risks post-surgery?
o Infections due to a weak immune system
o Dry socket due to no formation or breakage of blood clot in the hole. As a result, the bone that lies under the wound is exposed to food and air, which is very painful and can cause bad breath and taste
o Accidental fracture of teeth close to the site
o Incomplete extraction, where a part of the tooth still remains inside the jaw
o Fractured jaw, which is caused due to pressure exerted on your jaw during extraction
o A hole in your sinus while removing the molar (upper back tooth)
o Soreness in the jaw joints or muscles due to injections
o Ongoing numbness in the chin and lower lips

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