Tooth extraction: All you need to know

Tooth extraction: All you need to know

According to Colgate, tooth extraction, which is also known as tooth pulling or removal, is the removal of a tooth from its dental socket in the jaw bone.

Why would one need a tooth extraction?

Permanent teeth are meant to last throughout one’s life but there are scenarios that call for them to be pulled out. Below are some of the reasons:

The tooth has been damaged:  This is one of the most common reasons for tooth extraction. If a tooth has been broken, made very loose or even damaged by decay or trauma to the point where other options such as filling and crowning can no longer work, then extraction becomes the only solution.

Infection: If one has a tooth decay, chances of getting an infection are high. Sometimes root canal therapy is prescribed to get rid of the infection but in other cases, the infection is so severe that the therapy and antibiotics do not work. This is when one has to go through tooth extraction to prevent the spread of the infection.

When the tooth becomes a risk of infection: One can have a tooth extraction when there is the risk that the particular tooth may become a source of infection in cases where your immune system is compromised. Examples of such instances are like when you are scheduled for an organ transplant or if you are undergoing chemotherapy. In such situations, a patient takes medicines that decrease or suppress the immune system, making the body vulnerable to infections. Having a tooth that risks to expose the body to infections becomes very risky and therefore calls for extraction.

Gum disease: If one has gum disease, sometimes referred to as periodontal gum disease, they may need an extraction. This is because this disease affects the tissues and bones that support the teeth. In such cases, extraction is needed to enable treatment.

A crowded or full mouth: In some cases, dentists pull out teeth to have the rest of them properly aligned. Some patients have teeth that take up a lot of jaw space, while some have extra teeth that block others from breaking through the gum because there is no jaw space left. Such cases call for tooth removal.

Prescription of braces: People who are getting braces may have to have a tooth extracted so as to create room for alignment and treatment.

To facilitate radiation treatment: For people who are scheduled to receive radiation to the head and neck, the teeth that are in line of the radiation will need to be removed to enable the treatment.

When baby teeth do not fall out: In these cases, there will be a need to extract them to allow the permanent teeth to come out.

Cosmetic reasons: A tooth/teeth may be pulled out to improve the general appearance of the jaw and face or get rid of teeth that are not physically appealing.

Contents

• Types of Extractions
  • Simple Extraction
  • Surgical Extraction
• After Extraction
• Post-Extraction: Follow Up
• Complications arises After extraction
  • Dry Socket
  • Infection
  • Prolonged bleeding
  • Sinus exposure and communication
  • Swelling and soreness
  • Nerve injury
  • Bruising
  • Loss of a tooth
  • Accidental damage to nearby teeth
  • Incomplete extraction
  • Misdiagnosis: Extraction of the wrong tooth
  • Osteonecrosis of the jaw
  • After Tooth Removal: When to Call the Dentist

Types of Extractions

There are two basic types of extractions: simple extraction and surgical extraction.

A simple extraction is performed on teeth that can be seen in the mouth. Simple extraction is the most common tooth removal procedure that dentists do. The extraction is done under local anesthesia with the aid of an elevator and forceps. During the removal, the tooth is lifted and loosened with an elevator and pulled out by the forceps.

On the other hand, surgical extractions are performed on teeth or areas of the teeth that are not visible and easily accessible to the dentist. A surgical extraction is applicable when the tooth is broken under the gum line or has not erupted into the mouth yet. It is a more complex procedure that requires incision. In some cases, it is necessary to cut a tooth into half or into multiple pieces to facilitate its extraction or even remove the bone around the tooth. Surgical extractions are performed by oral surgeons or dentists and are done under general anesthesia.

One does not feel any pain during an extraction; the only thing you are expected to feel is pressure. If you feel pain, let the dentist know.

Important Information to tell the Dentist before Tooth Removal

Tooth removal is generally a safe procedure but it can be compromised and complications can occur if not well handled. Before the procedure, give your dentist your full medical history and brief them on any medication you are on. It is also important to let them know if you have the following;

· Liver disease (cirrhosis)
· An impaired immune system
· An artificial joint for example a hip replacement
· If you are pregnant
· A congenital heart defect
· Damaged or man-made heart valves
· A history of bacterial endocarditis

What to Expect During Tooth Extraction

Simple Extraction

First, the dentist will administer a local anesthetic to numb the area that will be affected by the removal (tooth, bone and gum). If you are having more than one tooth removed, the dentist may administer a strong general anesthetic to prevent pain in your body- this may make you sleep all through the procedure.

A tooth is normally encased firmly in its socket by its root. To be able to remove the tooth, the dentist must be able to expand the socket to loosen the grasp at the root and to separate the tooth from the ligament- this is what will result into a successful detachment. To achieve this, the dentist will rock the tooth back and forth or side to side to enlarge the socket. Space will be created and the repeated pressure will wear out the ligaments that attach the tooth to the gums. Consequently, a point will be reached where the tooth can easily be pulled out.

In the case where the tooth is impacted, the dentist will cut away the gum or bone that is covering the tooth and proceed with extraction.

What you will feel During Simple Extraction

The dentist will administer local anesthesia during a simple extraction. The anesthesia will numb up the tooth, jaw and the area surrounding and this will inhibit any pain, so you are not expected to feel any at all. In case you feel pain, alert your dentist so that they can administer additional anesthesia.

You will feel pressure during the procedure. This is because the process of extraction involves a lot of pressure application and movement. This will not at any point translate into pain.

Report the sensations to the dentist in an accurate manner because an overdose or under dose of anesthesia may cause complications during the procedure.

What you Might hear during Simple Extraction

You may hear some noises during the procedure as it is a very physical process. Do not be surprised if you hear a snap or breaking noise; there are hard tissues such as teeth and bones involved in the process.

Surgical Extraction

Before a surgical extraction, your dentist will ask about your medical and dental history. This is important so be sure to provide it because such information sheds light on how to proceed with the surgery. The oral surgeon or dentist will then take an X-ray of the area to further guide them on the course of action.

If you are scheduled for the extraction of your wisdom tooth/teeth, your dentist may perform a panoramic X-ray that will bring the following information areas to light:

· The relationship of your other teeth to your wisdom teeth.
· Infections, bone disease or tumors that may be present.
· The relationship of your upper teeth to your sinuses.
· The relationship of your lower teeth to the inferior alveolar nerve; the nerve in the jawbone that is responsible for the feelings in your lower lip, lower teeth, jaw and chin.

After the X-ray, some dentists may prescribe some antibiotics to be taken before the surgery. This happens in cases where:

· Your immune system has been compromised.
· You have an infection.
· Your medical history reveals specific medical conditions that will call for administration of antibiotics.
· You are scheduled for a long surgery.

After an analysis and when it is determined that you are ready for surgery, the oral surgeon will administer anesthesia that may range from conscious sedation to general choices. They will then proceed with the surgery.

Points to note before surgical extraction

· Do not eat or drink anything for eight hours before the extraction. The dentist can advise in exceptional cases.
· If you catch a cold and get a stuffy nose or cough around time of surgery, consult your dentist beforehand. This will guide them on administration of the anesthesia.
· If you happen to be nauseated or vomit a day or night before the extraction, again let the dentist know. This again, will guide on the administration of anesthesia.
· Avoid smoking on the day of extraction.

After Extraction

After simple extractions, a blood clot usually forms in the socket. The dentist will put a gauze pad into the socket and advise you to bite on it for a few hours to help stop the bleeding. In some cases you will have a few self-dissolving stiches to close the gum edges over the open socket. In some cases, the blood clot breaks and exposes the open socket, causing a condition called the dry socket. When this happens, the dentist will use a special dressing for a few days to protect the extraction site where the new clot forms.

For surgical extractions, the process of closing up the extraction is slightly longer and a bit more delicate than anticipated. The oral surgeon will gently scrap the walls of the empty socket to remove any infected tissue residue. This is referred to as curettage and is critical in preventing subsequent cyst formation. Thereafter, the dentist will wash out the socket with saline solution; a process that will remove any loose tooth or bone fragments remaining.

Once this is done, they will inspect the area to see if there are any sharp bone edges. If they find any, they will be trimmed off. They will also evaluate the area for any sinus cavity involvement if your extraction was for the upper teeth. The dentist will then use their fingers to compress the enlarged socket and restore the shape of the jawbone, place on the socket some medication that will aid in clot formation then stitch the area up. The dentist will then give you a piece of gauze to bite on to control bleeding.

Post-Extraction: Follow Up

After extraction, you will be given some instructions that should help you recover well. These instructions will also help you avoid complications that could arise after simple extraction and surgery.

· Bite on the piece of gauze for the amount of time advised by the dentist. The pressure will allow the blood to clot and prevent excessive bleeding. Do not disturb the clot that forms over the wound by touching it or poking it. Keep in mind that a cut in the mouth tends to bleed more that any other part of the body.

· Tooth removal is surgery just as any other. It is therefore important to expect some discomfort even after the simple extractions. The dentist will therefore prescribe anti-inflammatory drugs that should decrease the pain after removal. Examples of these drugs include ibuprofen, aspirin or paracetamol. Take them as per prescription.

· To reduce swelling, you can place ice packs on your face around the area of extraction. Do this in 20 minute intervals. If you encounter stiffness after the swelling has reduced, use warm compresses.

· 24 hours after extraction, use warm salty water to gently rinse your mouth. This will keep the area clean and disinfected. Also, if you have stitches, the solution will help them dissolve.

· Eat soft foods of medium temperature for the first few days. You can get back to the other solid foods slowly as you monitor your comfort levels.

· Do not smoke before and after extraction; you can withhold for 72 hours before and after the procedure. Smoking within the frame of procedure will cause a painful condition known as dry socket.

· Do not spit or use straws after the procedure; give yourself at least six hours. The actions bear the risk of dislodging or disrupting the blood clot.

· Use pillows when lying down as lying flat may prolong bleeding.

· Continue brushing and flossing your teeth everyday to get rid of any harmful bacteria that can cause infection. It is recommended to avoid the extraction site as you brush your teeth.

· After extraction, do not take alcohol for at least 24 hours

· The healing period after extraction is mostly two weeks at most. The bleeding and swelling end in a day or two after extraction.

· Risks Involved and Complications that may arise after Tooth Removal

After extraction, there could be some complications that arise.

Dry Socket

This is a very painful situation that happens when a blood clot does not form in the socket or if it breaks off too early. It is a condition of inflammation within the bone lining of an empty socket. In this situation, the open socket is exposed to air and food and causes a lot of pain to the open wound, as well as bad odor and taste. The only symptom of this condition is pain that in most cases moves up and down the head and neck. Smokers and women on birth control are at higher risk of getting the dry socket after extraction. A dry socket is not an infection so the use of antibiotics has no effect on it; it is resolved by re-dressing the socket with medicated material that will stop the pain and hasten the healing process.

Infection

The end result of an extraction is an open socket that is prone to infections. The dentist may prescribe antibiotics pre or post-operation if it is determined that a patient is at risk of infection.

Prolonged bleeding

You may experience slight bleeding after the procedure; this is normal. This bleeding should however stop within eight hours after the extraction at most. Any bleeding beyond that is prolonged and may occur if the socket is not well dressed or the site has been tampered with. In the event of prolonged bleeding, contact the dentist.

Sinus exposure and communication

This risk is associated with extraction of the upper molars or pre-molars. The upper teeth are close to sinuses and during extraction a sinus can be exposed or perforated. When a sinus membrane is tampered with but remains intact during extraction, it brings about a condition known as sinus exposure. If on the other hand the membrane is perforated, it is results in sinus communication. The dentist may let the conditions heal on their own or use surgery to correct them.

Swelling and soreness

The severity of this depends on the amount of surgery performed, the activity and pressure applied on your jaws and the injections. For example, when a bone is removed using a drill, it is anticipated that more swelling will occur. When swelling or soreness occurs, it may become difficult for you to open your mouth wide.

Nerve injury

Nerve injury mostly happens when the third molars are being extracted but can also happen with the removal of any tooth as long as a nerve is close to the extraction site. This injury can happen while lifting teeth or when using a surgical drill. Said injuries are rare and temporary but in some unlikely and unfortunate cases, they can be prolonged and sometimes become permanent.

Bruising

Bruising is a complication that may arise after extraction and is due to the pressure that is exerted on the jaw during tooth removal. It is a more common risk among older people who have a thinned out jaw bone. It takes around two weeks for bruising to completely disappear.

Loss of a tooth

During extraction, the extracted tooth may slip out of the forceps and be swallowed or inhaled. The patient is aware if they have swallowed it or they may cough to indicate they have inhaled it. In such cases, the patient is sent to X-ray. If the tooth has been swallowed, no action will be taken as it will find a way out of the body through the alimentary canal without inflicting any harm. If it has been inhaled, the patient will be in need of urgent surgery to recover it from the airways before it causes further harm.

Accidental damage to nearby teeth

During extraction, the application of pressure and force is to be limited to the tooth in question. In some cases, the force is applied to the surrounding bones and gums to facilitate the procedure; when this happens, the teeth that are in front and behind of the one to be extracted may be loosened and permanently affected.

Incomplete extraction

This is a case where a tooth root remains in the jaw after extraction. It is common practice for the dentist to remove the root when they are performing the procedure so as to prevent any infections that may occur afterwards.

Misdiagnosis: Extraction of the wrong tooth

This is a complication that is unfortunate but possible. Altered tooth morphology, poor record of patient history, faulty clinic examinations, undetected or unmentioned dental history may all lead to the extraction of the wrong tooth. It is therefore important for both dentist and patient to be keen at the diagnosis stage to avoid this complication.

Osteonecrosis of the jaw

This is a condition where the bone cells of the jaw break down or die. It can happen after an extraction when the bone in the extraction site slowly destructs. It can be remedied by using mouth wash if in its early stages, antibiotics, topical gels or dental procedures.

After Tooth Removal: When to Call the Dentist

After tooth removal, it is normal to feel some pain and discomfort as the anesthesia wears off. It is also normal to experience some swelling and bleeding. These are all normal aftermath reactions; you should however raise an alarm if you experience or notice any of the following:
· Severe pains and bleeding that is continuous (Signs of dry socket)
· Nausea or vomiting.
· Shortness of breath, cough and chest pains.
· Infection symptoms including fever and chills.
· Excessive discharge (that is not blood) from extraction site.
· The swelling worsens.
· You are still numb on your chin, tongue and lip for at most 6 hours after the procedure.
· You experience difficulty in swallowing.