Tooth extraction procedure: when is tooth removal necessary?

As much as it is very desirable to keep all of your natural teeth for as long as you can, sometimes there are circumstances that simply result in a tooth extraction. There are many reasons why a tooth may have to be removed; some of them good and some bad. The outcome though from a tooth extraction can now be all good. Modern day dentistry and evolving technology gives you numerous options after a tooth extraction. Let’s first look at that long reason why a tooth extraction may be either suggested or is necessary.

Why Should I Pull My Tooth or Wisdom Teeth?

The only way to know for sure whether or not you need to have your tooth pulled, is to schedule an exam and X-ray. Once dentists have all of the necessary information on hand, they can help you make an informed decision about your situation. Depending on your unique dental needs, there are usually only a few reasons why a tooth is extracted instead of being restored:

The Tooth is Non-Restorable

 The most common reason for our dentist to recommend pulling a tooth is if it is no longer restorable. No filling, crown, or root canal is going to be able to save the limited healthy tooth structure that still exists. Rather than attempt to fix the tooth and hope it takes, removing it altogether is the standard of care.

For Orthodontic Purposes

 It’s not as common these days, but some orthodontic patients do need to have teeth extracted to make more “room” inside of their mouth. Larger teeth in a smaller jaw, for instance, can contribute to unwanted crowding.

Impacted Wisdom Teeth

 Occasionally, there will not be enough space inside of the jaw for the final set of molars — otherwise known as wisdom teeth — to erupt properly. When they become impacted against other teeth, it can lead to infections, tooth damage, or changes in the bite alignment.

Advanced Gum Disease

 Without healthy gums and bone to support teeth, loss of attachment leads to them becoming mobile and sore. The infected areas around them can lead to subsequent infections. Removing teeth from severely infected areas can prevent additional tooth loss.

Planning for Full Mouth Reconstruction

 When only a few natural teeth remain, it’s up to the patient and his or her dentist to decide if it’s in their best interest to create a full denture. If so, any remaining teeth will need to be extracted before a “plate” fits into the mouth.

Emergency Tooth Removal

If you’ve ever experienced a severe toothache, it’s likely one of the most painful situations that you’ve ever found yourself in. The throbbing pain can make it impossible to work through or even go about normal daily activities. All you can think about is getting the tooth out.

Although it’s usually preferable to save your tooth through some type of therapeutic or restorative methods, there are also situations when pulling the tooth is best. Especially if you need emergency pain relief. Same day tooth extractions can help you eliminate the discomfort and start on the road to recovery.

Wisdom Tooth Extraction

The most common dental extraction performed is the removal of wisdom teeth. Also known as the third molars, wisdom teeth are traditionally a problematic set of teeth. Eventually, most people, approximately 85% of the population, will need to have their third molars removed. Wisdom teeth are frequently impacted, unable to fully extend into place, and are much more susceptible to decay due to their positioning. If a cavity develops on a wisdom tooth, we frequently can not restore it due to its positioning.

Having your wisdom teeth removed younger, in your teenage years, is ideal. We recommend having them removed at the time when the roots are long enough to have something to pull, and yet short enough that the roots havent not extended to the nerve, creating a hook shape, making the process more difficult and painful. Having your wisdom teeth pulled before the age of 25 has been shown to be less painful, with faster healing.

The Two Types of Extraction

dentists generally refer to extraction in two different categories, either simple extractions or surgical extractions.

Simple Extraction

 Simple extractions are done if a tooth is fully erupted, and dentists can visually see the tooth in the patient’s mouth. dentists will use a dental tool, known as an elevator to loosen the tooth and then extract it using forceps. Extraction is not entirely pain free, but the patient will be prepared anesthetized using a local anesthetic and then advised on some post-op tips to reduce pain and swelling. A simple extraction can quickly turn into a surgical extraction.

Surgical Extraction

 Surgical extractions are more complex extractions. dentists use the term surgical because cuts need to be made in order to remove the tooth. Surgical extraction is required when the tooth is not fully erupted, or has fractured at the gum line. Wisdom teeth extractions are often surgical extractions. The process to surgically remove a tooth involves making the necessary incision, in some cases, dentists may need to remove some bone around the tooth. In some cases, dentists may need to section the tooth and remove it piece by piece. This procedure is most often done with local anesthetic, but in some situations, dentists may recommend general anesthesia. Surgical extractions often require an extra day or two of healing versus simple extractions, and we may prescribe medication to relieve pain.

How are teeth removed?

Before a tooth is removed, your dentist will thoroughly review your medical and dental history and take the appropriate X-rays. X-rays reveal the length, shape, and position of the tooth and surrounding bone. From this information, your dentist can estimate the degree of difficulty of the procedure and decide whether to refer you to a specialist called an oral surgeon.

Before removal, the area around your tooth will be anaesthetised. Dentists use a local anaesthetic to numb the area of the mouth where the extraction will take place.

For a simple extraction, once the area is anaesthetised, the tooth is loosened with the help of a tool called an elevator, then extracted with dental forceps. When he or she is finished, they may choose to close the area with a stitch. Ask your dentist for more details.

Tooth Extraction Risks

Having a tooth extraction is relatively simple and really doesn’t involve much risk. It what comes after the extraction that can create some problems? The neighboring teeth will start to move into the gap. If that was not the desired goal of the tooth extraction then that becomes a problem. Having that tooth gone can change how you chew your food and can change how you speak. If a tooth is removed from the front of the mouth and is quite visible it will change how you look and how you smile. You could experience a dry socket which is when the area where the tooth was removed doesn’t heal properly and an infection sets in. If you cannot replace the extracted tooth with an implant it is possible you will experience some bone loss which will could affect the surrounding teeth.

Recovery after Tooth Extractions

There are a number of reasons that your dentist might recommend a tooth extraction. Some dental patients suffer from tooth decay; others need to remove teeth hindering orthodontic treatment, whereas various patients simply need wisdom teeth removal. While a tooth extraction can be a serious dental procedure, aftercare is just as critical as the procedure itself. As the dental patient, it is important to understand that pain and the risk of infection can be lessened with proper care.

Care immediately following surgery:

  • Keep pressure on the gauze pad that your doctor placed over the surgical area by gently biting down. Dampen the gauze sponge with water if it begins to dry out. Try to maintain constant pressure in intervals of 45-60 minutes, repeating as often as needed, or until bleeding lessens.  Change the gauze as needed. 
  • Keep your head elevated and try to lower your activity level as much as possible.
  • 48 hours after surgery, rinse mouth with warm salt water every 1-2 hours. Avoid using any mouthwash containing alcohol as it can irritate the wound.
  • Keep your mouth clean by brushing areas around the surgical site, but be sure to avoid sutures. Touching the wounded area in any fashion should be prevented.
  • Use ice packs to control swelling by placing them on facial areas near extraction.
  • Take all prescribed medications accordingly. If any itching or swelling occurs, contact the practice immediately, or go to the nearest emergency room.
  • Try to eat softer foods, preferably high in protein.
  • Keep your body hydrated by drinking plenty of fluids, but do not drink through a straw for the next 5-7 days.
  • If you are a regular tobacco user refrain from smoking for the next 3-4 days as smoking increases your chances of getting a dry socket as well as an infection.

After your tooth has been extracted, healing will take some time. Within 3 to 14 days, your sutures should fall out or dissolve. For sutures that are non-resorbable, your doctor will schedule a follow-up appointment to remove the stitches for you. Your tooth’s empty socket will gradually fill in with bone over time and smooth over with adjacent tissues.

Options After Tooth Extraction

After you have healed from your tooth extraction you’ll want to schedule a consultation with your dentist to review your options in replacing that tooth and maintaining functionality and appearance if necessary. The three most common solutions today are putting in a dental implant, designing a dental bridge or introducing a removable and partial denture. The benefits of each will be addressed and the location of your tooth may dictate which solution will be best for you after your tooth extraction. If it was an upper back molar you may decide to not replace it. If it one of your front teeth you may choose to pursue an implant based on appearance. If the tooth extraction was a bottom molar a bridge may work just fine. So, even though a tooth extraction is not an ideal scenario there are options to recover and restore your bite and smile successfully.