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Tooth
Extraction
Below: Tooth extraction is the removal of a tooth from its socket in the bone. 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. 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. 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). 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. 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. 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. 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. Dry socket A painful condition following tooth extraction in which a blood clot does not properly fill the empty socket. Dry socket leaves the underlying bone exposed to air and food. Extraction site The empty tooth socket following removal of the tooth. Impacted tooth A tooth that is growing against another tooth, bone, or soft tissue. Luxate To loosen or dislocate the tooth from the socket. Nitrous oxide A colorless, sweet-smelling gas used by dentists for mild anesthesia. It is sometimes called laughing gas because it makes some patients feel giddy or silly. Oral surgeon A dentist who specializes in surgical procedures of the mouth, including extractions. Orthodontic
treatment
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