| Definition
Tooth extraction is the removal of a tooth from its
socket in the bone.
Purpose
Extraction is performed for positional, structural, or
economic reasons. Teeth are often removed because they are
impacted. Teeth become impacted when they are prevented
from growing into their normal position in the mouth by
gum tissue, bone, or other teeth. Impaction is a common
reason for the extraction of wisdom teeth. Extraction is
the only known method that will prevent further problems.
Teeth may also be extracted to make more room in the mouth
prior to straightening the remaining teeth (orthodontic
treatment), or because they are so badly positioned that
straightening is impossible. Extraction may be used to
remove teeth that are so badly decayed or broken that they
cannot be restored. In addition, patients sometimes choose
extraction as a less expensive alternative to filling or
placing a crown on a severely decayed tooth.
Precautions
In some situations, tooth extractions may need to be
postponed temporarily. These situations include:
- Infection that has progressed from the tooth into
the bone. Infections may make anesthesia difficult.
They can be treated with antibiotics before the tooth
is extracted.
- The patient's use of drugs that thin the blood
(anticoagulants). These medications include warfarin (Coumadin)
and aspirin. The patient should stop using these
medications for three days prior to extraction.
- Patients who have had any of the following
procedures in the previous six months: heart valve
replacement, open heart surgery, prosthetic joint
replacement, or placement of a medical shunt. These
patients may be given antibiotics to reduce the risk
of bacterial infection.
Description
Tooth extraction can be performed with local anesthesia
if the tooth is exposed and appears to be easily removable
in one piece. An instrument called an elevator is used to
loosen (luxate) the tooth, widen the space in the bone,
and break the tiny elastic fibers that attach the tooth to
the bone. Once the tooth is dislocated from the bone, it
can be lifted and removed with forceps.
If the extraction is likely to be difficult, the
dentist may refer the patient to an oral surgeon. Oral
surgeons are specialists who are trained to give nitrous
oxide, an intravenous sedative, or a general anesthetic to
relieve pain. Extracting an impacted tooth or a tooth with
curved roots typically requires cutting through gum tissue
to expose the tooth. It may also require removing portions
of bone to free the tooth. Some teeth must be cut and
removed in sections. The extraction site may or may not
require one or more stitches to close the cut (incision).
Preparation
Before an extraction, the dentist will take the
patient's medical history, noting allergies and
prescription medications. A dental history is also taken,
with particular attention to previous extractions and
reactions to anesthetics. The dentist may then prescribe
antibiotics or recommend stopping certain medications
prior to the extraction. The tooth is x-rayed to determine
its full shape and position, especially if it is impacted.
If the patient is going to have deep anesthesia, he or
she should wear loose clothing with sleeves that are
easily rolled up to allow for an intravenous line. The
patient should not eat or drink anything for at least six
hours before the procedure. Arrangements should be made
for a friend or relative to drive the patient home after
the surgery.
Aftercare
An important aspect of aftercare is encouraging a clot
to form at the extraction site. The patient should put
pressure on the area by biting gently on a roll or wad of
gauze for several hours after surgery. Once the clot is
formed, it should not be disturbed. The patient should not
rinse, spit, drink with a straw, or smoke for at least 24
hours after the extraction and preferably longer. Vigorous
exercise should not be done for the first three to five
days.
For the first two days after the procedure, the patient
should drink liquids without using a straw, and eat soft
foods. Any chewing must be done on the side away from the
extraction site. Hard or sticky foods should be avoided.
The mouth may be gently cleaned with a toothbrush, but the
extraction area should not be scrubbed.
Wrapped ice packs can be applied to reduce facial
swelling. Swelling is a normal part of the healing
process. It is most noticeable in the first 48-72 hours.
As the swelling subsides, the patient may experience
muscle stiffness. Moist heat and gentle exercise will
restore jaw movement. The dentist may prescribe
medications to relieve the postoperative pain.
Risks
Potential complications of tooth extraction include
postoperative infection, temporary numbness from nerve
irritation, jaw fracture, and jaw joint pain. An
additional complication is called dry socket. When a blood
clot does not properly form in the empty tooth socket, the
bone beneath the socket is painfully exposed to air and
food, and the extraction site heals more slowly.
Normal results
After an extraction, the wound usually closes in about
two weeks. It takes three to six months for the bone and
soft tissue to be restructured. Complications such as
infection or dry socket may prolong the healing time.
Why might a person require a tooth extraction?
There are a number of reasons why your dentist
might recommend that you have a tooth, or even several teeth,
extracted. Listed below are some of these reasons:
A tooth extraction might be indicated if repairing
a damaged tooth is not practical.
Broken, cracked, or extensively decayed teeth can
be extraction candidates.
Some teeth will have extensive decay (dental
caries) or else will have broken or cracked in such
an extreme manner that an extraction might be
considered the best, or at least a reasonable,
solution. Of course there will be a number of
factors that will come into play with any specific
situation. In some cases the obstacles that present
themselves might be so formidable that a repair for
the tooth is simply not possible. In other cases the
cost of needed dental treatment or else a
questionable long-term outlook for the success of
the treatment may be the reason an extraction is
chosen.
Teeth that are unsuitable candidates for root
canal treatment should be extracted.
Some teeth may require treatment of the nerve
space that lies within them (root canal treatment)
in order to make a repair. While most teeth
typically are candidates for root canal treatment
there can be complicating factors that remove this
option. If this is the case and needed root canal
treatment cannot be performed then the extraction of
the tooth is indicated.
Teeth associated with advanced periodontal
disease (gum disease) may need to be pulled.
By definition, teeth that have experienced the
effects of advanced periodontal disease (gum
disease) are teeth whose supporting bone has been
damaged. In general, as periodontal disease worsens,
a tooth is supported by less and less surrounding
bone, often to the point where the tooth becomes
loose. In those cases where significant bone damage
has occurred and a tooth has become excessively
mobile extraction of the tooth may be the only
option.
Malpositioned or nonfunctional teeth may need to
be extracted.
Some teeth are extracted because they are
malpositioned. As an example, sometimes when wisdom
teeth come in they lie in a position that proves to be
a constant source of irritation to the person's cheek
(by either rubbing against the cheek or causing the
person to bite it). As a solution, a dentist may
suggest that the offending wisdom teeth should be
extracted.
Some teeth might be extracted because they provide
very little service to the dental patient but do offer risk for becoming problematic. A
common example is a wisdom tooth that has come in but
has no matching tooth to bite against. Wisdom teeth
are typically in a region of the mouth that is hard to
clean, thus placing them and their neighboring tooth
at greater risk for decay and periodontal disease.
Depending on the precise circumstances that they find,
a dentist may advise their patient that removing a
nonfunctional tooth might be in that patient's best
long-term interest in regards to maintaining good oral
health.
Impacted teeth are often extracted. Impacted teeth
are teeth whose positioning in the jaw bone is such
that they cannot erupt into normal alignment. So by
definition, impacted teeth are malpositioned and
because they are malpositioned they are often
nonfunctional. This combination of factors makes
impacted teeth common candidates for extraction.
Tooth extractions may be required in preparation
for orthodontic treatment (braces).
When orthodontic treatment is performed for a
patient the dentist is trying to perfect the alignment
of the patient's teeth but they can only do so within
the confines of the size of the person's jaws.
Especially in those cases where a large discrepancy
exists between the size of the patient's jaws and the
needed space required for the improved alignment of
their teeth, some strategically located teeth may need
to be extracted.
When might a tooth extraction be a bad idea?
During their examination of your teeth and mouth it is
possible that your dentist will be able to recommend one
or more alternative treatments to having a tooth
extraction. While extracting a tooth might be less
expensive than the other treatment options your dentist
proposes, it may not be the least expensive treatment in
the long-run.
When a tooth is removed its neighboring teeth will
tend to shift, sometimes significantly. Any alignment
changes that do occur can have a major impact on your
dental health. Removing even a single tooth can lead to
problems associated with chewing ability or jaw joint
function. Additionally, teeth whose alignment has
changed can become traps for food or be harder to clean
thoroughly, thus placing them at greater risk for tooth
decay and gum disease.
So to avoid these types of complications, in most
cases your dentist will probably recommend to you that
you replace any tooth that has been extracted. Replacing
a tooth after an extraction with an artificial one can
easily cost more than the alternative of not extracting
a tooth and instead rebuilding it.
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