Extractions

Question: I have to get a tooth out, what do I need to know?

Over the course of a person's life, most people will have to get a tooth out. Some of the reasons for tooth loss include: 1. Extensive decay making the tooth unrestorable, 2. Periodontal disease making the tooth loose, 3. Breakage below bone level making the tooth unrestorable, 4. Too many teeth in too little space, and 5. Wisdom teeth erupting where there is not room or at an odd angle. Extraction is something that nearly everyone will have to undergo on at least one occasion in a lifetime.

Some of the situations requiring tooth removal involve infection. Because of this, it is advisable that if a person has a broken down or loose tooth, he should see the dentist to have it examined before it is painful. Local anesthetic (freezing) is not as effective in an area that is infected as it is in a non-infected area. Sometimes an antibiotic or other medication is needed for a few days before an extraction to maximize the effect of the local anesthetic (freezing) or to shorten the healing period. The dentist may prescribe a medication for a few days and get the patient back later for the extraction. There is no extra fee for the work done in this way and it is usually less convenient for the patient and the dentist, but if suggested by the dentist, the time interval is designed to minimize patient discomfort either during the extraction or after it is done.

Before the extraction, the dentist will ask several medical questions. Each condition or disease mentioned has a direct impact on the work about to be done. The tooth is still an integral part of the whole body at this point, and its removal will cause systemic effects. The medical questions asked are specifically designed to minimize complications during and after the extraction. An extraction is arguably the most invasive procedure done in routine dentistry. More medical information is required to carry out an extraction than most other dental procedures. In order to assure the best outcome for yourself, answer the questions as completely as you can.

The regulatory bodies that govern quality control in dentistry have deemed that a radiograph (x-ray) is required before extraction of a tooth. There are few exceptions to this policy so nearly always an x-ray will be done at this point if it has not already been done. The dentist is interested in seeing the roots of the tooth. This helps in the decision of which instrument (tool) might best be used and at what angle to extract the tooth with the least chance of breakage. Removal of a tooth is a bit like removal of a fence post. Every effort is made to remove it completely and in one piece. The tooth is brittle but strong. The surrounding bone is usually malleable (movable) to some extent due to its ability to be compressed some without fracture. Because of this, the dentist will often attempt to move the tooth in its socket a little before taking it out. Again, think of removing a fence post. If some sideways motion is gained, much less force is required to lift the post out of the hole than if only upward force is applied. The most common complication is breakage of the tooth. It is important to remove the entire tooth if at all possible because root tips left in place can become infected and require removal later.

If the dentist believes fracture or some other complication is likely, he may decide that referral to an Oral Surgeon would be the best option. If an Oral Surgeon is advised, the patient has every right to know why, and the dentist is usually eager to share the reasons in detail. We in Kenora are fortunate to have an Oral Surgeon available several days a month in our town. He also has the capability to provide IV Sedation (put the patient to "sleep") if the patient wants the job done in that way. The most important factors determining the length and severity of the recovery period after extraction are: 1. The amount of bone removed to allow the tooth to be extracted, and 2. How long the extraction took. The Oral Surgeon will minimize both of these factors. There is absolutely no “kickback” to the dentist who referred you to the Oral Surgeon when an extraction is done by the surgeon. The only reason a dentist will refer a patient to an Oral Surgeon is to make the extraction go easier for the patient.

After the extraction, the immediate concern is to stop the bleeding. Direct pressure is the most common way to stop bleeding and is usually quite effective. Unless a large number of teeth are removed at the same time, usually stitches are not placed. This is because the gums around a tooth are held to the bone by periosteum. This is the same thing holding your fingernails to your fingers. It hurts after a fingernail is pulled away from the finger. Similarly, unless excessive bleeding is to be expected, the dentist will attempt to forego separation of gums from underlying bone to gain the tissue mobility required to sew the opening of the socket closed. Ask the dentist about medication he suggests for relief of expected discomfort after the anesthetic wears off.

It is important that a strong blood clot forms in the socket where the root used to be. The body heals fastest using the clot as sort of a pattern for gum growth over the bone. Avoid things that may dislodge the clot like sucking through a straw or spitting forcefully. Smoking causes a clot to not have as much strength. The clot forms soft and jellylike when smoke is in the area. It's best to avoid smoking for at least 24 hours after an extraction if possible. After the first 24 hours, an extraction site should feel better every day. If after 2 or 3 days, the site was feeling a lot better and then starts to feel worse, contact your dentist. You may be getting a dry socket (no blood clot in the socket) or an infection. Your dentist can do something to help you if he knows there is a problem. In the first 24 hours after the extraction, the body tends to over-react to what has been done causing swelling and pain. Both of these can be minimized by use of ice packs on the outside of the face at the location of the extraction. By 24 hours after the extraction, the blood clot in the socket is sufficiently strong to allow salt water rinses. This reduces swelling and pain. Sometimes the dentist will suggest heat on the outside of the face starting a day or so after the extraction. Remember that after the first 24 hours, the site should feel better every day. Call your dentist if instead of feeling better, it starts to feel worse than the day before. Usually the extraction site will cover over with soft tissue in a week or so. For bone to fill the socket, months of healing are required.

This article was written by Dr. Mike Christensen and published in the Daily Miner and News, and Enterprise. Local Kenora News Publicatons (1998-2006)