Tooth Extractions

Your dentist’s main purpose is to help you look after your natural teeth, keeping them in good condition for as long as is reasonable. Certainly, no one wants to have a tooth extracted, but there are times when it’s the only solution for you, or for your child. There are any number of reasons why a tooth might need to be pulled. Perhaps it’s been damaged due to a blow or other trauma, or it’s simply too decayed to be salvageable – and of course, impacted wisdom teeth simply have to go. Teens who need orthodontic treatment and don’t have enough space for their adult teeth to grow properly (this is called “crowding”) may also need extractions. Or perhaps a baby tooth isn’t falling out, despite being well past its “best before” date.

Regardless of the reason why extraction is warranted, in most cases it’s a routine procedure – a kind of minor surgery. The location of the tooth, and the condition of the roots, will determine in large part how straightforward the procedure will be. As an example, front teeth with simple, straight roots are easier to extract than molars, which have multiple roots. And if the molar, or a wisdom tooth, is impacted (meaning it’s sub-surface, and surrounded by bone and gum tissue), the procedure will be more complicated. Wisdom teeth can often be prevented from growing in by other teeth that are in the way.

If all this sounds scary, you should know that in the hands of an experienced practitioner, a tooth extraction isn’t really anything to be afraid of. Teeth are not usually firmly fixed in the bone that surrounds them. They’re actually attached by means of a fibrous network, otherwise termed the “periodontal ligament.” An extraction can usually be easily achieved by manipulating the tooth in such a way that the fibers are dislodged and the tooth is freed.

Why Would You Need an Extraction?

We’ve already talked in general about the reasons for removing a tooth, but let’s go into a little more detail. And of course, we’re always happy to talk with you about the benefits and possible difficulties of any type of dental treatment when you visit us.

  • Trauma or Disease — In either case, our preferred course of action will be to attempt to save your tooth. This can be accomplished in a variety of ways – perhaps you need a root canal, a crown, or both. When that’s not sufficient to keep the tooth healthy and attractive, we’ll consider removing the tooth and filling the gap with a dental implant.
  • Orthodontics — When the jaws aren’t big enough to support the number of teeth, crowding occurs. When this happens, we might remove one or more of teeth so that the ones that remain can come in properly. Usually this is done with the first premolars – those are the teeth that are located next to the canines, or eyeteeth.
  • Wisdom Teeth — When wisdom teeth become impacted, they can harm the neighboring teeth, the gum tissue, the bone, and even the blood vessels and nerves. For this reason, if a wisdom tooth is impacted and not in a good position, the best course of action is to take it out before the roots become fully formed.
  • Baby Teeth — Baby teeth sometimes come in out of sequence, or in bad positions, and this can prevent the underlying permanent tooth from coming in the way it should. When this happens, it’s best to extract the problematic baby tooth so that orthodontic treatment isn’t needed later on.

The Extraction Process

Before extracting a tooth, we’ll do a radiographic examination (an x-ray) so that we can get a good look at both the roots of the tooth, and the surrounding bone. That way, we’ll know if there are likely to be complications. Then we’ll talk with you about your medical history and any medications you might be taking, in order to make sure that you’re healthy before undergoing the procedure. We’ll also talk about anesthesia. Usually, extractions are done using a local anesthetic, which numbs the tooth, along with the gum tissue and bone surrounding it. We may also recommend an oral sedative (a pill), nitrous oxide (inhaled), or another type of conscious sedation delivered intravenously. You’ll ordinarily only need intravenous sedation if you’re undergoing a complicated extraction, or if multiple teeth are being removed. When the sedation wears off, you’ll feel just fine, and might not even remember the procedure.

We will, of course, be extremely careful not to damage the bone surrounding your teeth. In fact, we might even put some bone-grafting material in the tooth’s socket, just to ensure that the bone volume is preserved. This is commonly done when you’ll be having an implant placed following the extraction – this is because the implant needs to fuse to the bone.

What Happens Post-Extraction?

Once your tooth has been extracted, we’ll cover the socket with sterile gauze and ask you to apply gentle pressure to the area for about fifteen minutes – this is so that any bleeding can be controlled. We may also use small sutures to achieve the purpose. You can expect some discomfort and swelling immediately following the extraction, but it should be mild – moderate at worst. Generally speaking, the discomfort should be easily controlled using an anti-inflammatory, non-steroidal medication like aspirin or ibuprofen. Eating soft foods and using ice packs can also ease the discomfort. Additionally, we may prescribe antibiotics to ensure that you don’t develop an infection following the extraction.

Text Copyright © 2015 Louis K. Cheung DDS PS – All rights reserved. Images used under license from Dear Doctor, Inc.