Definition and Overview

Tooth extraction is a procedure where a tooth or teeth are removed by an oral or maxillofacial surgeon using dental tools and equipment. Also known as oral surgery, it is a simple technical procedure that usually requires local or general anesthesia or sedation. Like any other minor surgeries, careful medical evaluation is necessary before a tooth extraction is performed. The procedure is accompanied with pain management for maximum patient comfort.

Reasons for Tooth Extraction

Keeping the teeth healthy is very important for aesthetic reasons and proper maintenance of masticatory function of the mouth. Permanent teeth (the set of teeth that grows after milk teeth are removed in childhood) are meant to last a lifetime. However, there are reasons and cases where tooth extraction may be necessary. Among these reasons are:

  • Damage - Tooth that is severely damaged due to decay or trauma and can no longer be repaired through restorative procedures would need to be pulled out. Damaged teeth can bring unbearable pain and discomfort if not removed.

  • Crowded Mouth - Dentists may pull out teeth to ensure proper alignment of teeth when they no longer fit well in the mouth.

  • Impacted Teeth - Wisdom tooth may need to be removed if it exhibits abnormal growth or if it is impacted.

  • Infection - Damage to the tooth or tooth decay may extend to the pulp, which is located at the core of the teeth and is connected to nerves and blood vessels. When bacteria enters the pulp, infection can ensue which may worsen. Tooth extraction or root canal therapy (RCT) is the only options for infection teeth to prevent the spread of infection.

  • Risk of Infection - Patients whose immune system has been compromised (such as cancer and organ transplant patients) may need to go through tooth extraction for certain teeth to prevent the risk of infection.

  • Periodontal or Gum Disease - Severe gum problems can cause infection in the gums, tissues and bones that support and surround the teeth. To prevent worsening of the infection, tooth removal is usually recommended.

  • Aesthetic Purposes - Some individuals seek tooth extraction to remove aesthetically unpleasant-looking teeth, such as those with endogenous staining.

Preparing for Tooth Extraction

Tooth extraction is a safe process that does not take more than an hour. However, just like any other minor procedure, it is important to inform your dentist about your complete medical history. This will minimize the risk of complications that rarely happens during this routine procedure. Before having your tooth pulled, make sure to inform your dentist if you have any of the following:

  • Congenital heart condition
  • Damaged heart valves
  • Liver disease
  • Compromised immune system
  • History of bacterial endocarditis
  • History of bleeding
  • Any bone problems
  • Any medical procedures recently performed
  • Any medications or supplements you are taking
  • If you are pregnant

What to Expect During Tooth Extraction

Dentists and oral or maxillofacial surgeons are trained to perform routine tooth extraction. Before the tooth is pulled, the dentist will administer a local anesthetic to numb the gum area where the tooth is to be extracted. In cases of wisdom tooth extraction or where more than one tooth will be pulled, general anesthesia or sedation may be administered.

When the area is already numb, the actual tooth extraction will be performed with the use of forceps. Bigger teeth may first have to be cut up into two, before pulling free each piece. For impacted tooth, the dentist will cut through the gum and bone tissue before grasping the tooth, loosening it back and forth, and pulling it free.

When the tooth is successfully pulled, a blood clot typically forms in the gum socket. Your dentist will pack it with a gauze pad and instruct you to bite on it to help stop the bleeding. Under normal conditions, the bleeding stops after a few minutes. Some pain will persist even after the extraction, so your dentist will recommend the intake of pain medications such as ibuprofen in the next few days. (Note: It is best to keep away from aspirin as it has blood thinning properties and may make your mouth bleed)

What Happens After Tooth Extraction

It is generally safe to resume normal daily activities after the tooth is pulled. However, you will be restricted from performing any strenuous physical activities or lifting in the next 24 hours. To promote faster healing, your dentist will recommend these along with your pain medications:

  • Chew on ice packs to control any bleeding
  • Take it easy in the next 24 hours
  • Rinse your mouth using warm salt water only in the next 24 hours (no strong antiseptic rinses)
  • Continue with normal brushing and flossing, but go easy on the empty socket
  • Avoid food and drinks that are hot
  • Eat only soft foods within the next two meals, gradually adding solids as the extraction site heals
  • Avoid the use of straws, spitting, blowing the nose, or any activity that can induce pressure on the socket
  • Avoid alcohol

Pain from extraction usually disappears after the second day. However, gum tissues usually take three weeks to heal completely.

When to See a Doctor

After the anesthesia wears off after a few hours, it is normal to feel pangs of pain in the extraction area. Some swelling and residual bleeding may also be observed. However, if the pain or the bleeding is still uncontrollable even after four hours, you may need to contact your dentist again. More importantly, you must see your dentist if you experience the following:

  • Nausea or vomiting
  • Anesthesia not wearing off after 6 hours
  • Signs of infection, such as chills and fever
  • Cough, chest pain, shortness of breath
  • Redness and swelling that persist in the affected area
  • Excessive bleeding or discharge in the extraction site

After an extraction, the missing teeth may cause the remaining teeth to shift, thus affecting your bite and the mouth’s normal function. Depending on your case, your dentist may prescribe replacing your missing tooth with restorative options such as implants, dentures or bridges.

References:

  • American Dental Association: "Tooth Extractions.” Available: http://www.ada.org/en/Home-MouthHealthy/az-topics/e/extractions
  • British Dental Association. “Tooth Extraction” Available: http://www.bdasmile.org/adults/adults.cfm?contentid=1113&contentparentid=1035
  • Colgate Oral and Dental Health Resource Center. “Tooth Removal / Tooth Extractions” Available: http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Checkups-and-Dental-Procedures/Tooth-Removal-Extraction/article/Tooth-Removal-Tooth-Extractions.cvsp
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