TOOTH EXTRACTIONS WOODSTOCK

What Is It?

Tooth removal is the removal of a tooth from its socket in the bone.

What It’s Used For

In the event that a tooth has been broken or damaged by decay, your dentist will aim to fix it with a filling, crown or other treatment option. Sometimes, though, there’s far too much damage for the tooth to be repaired. In this specific scenario, the tooth has to be extracted. A considerably loose tooth also will require extraction if it can’t be preserved, even with bone replacement surgery (bone graft).

Here are other reasons:

Some people have extra teeth that obstruct other teeth from coming in.

Sometimes baby teeth never fall out in time to allow the permanent teeth to come in.

People acquiring braces may need teeth pulled out to create room for the teeth that are being shifted into place.

Individuals receiving radiation to the head and neck may have to have teeth in the field of radiation extracted.

People receiving cancer prescriptions may develop infected teeth because these drugs diminish the immune system. Infected teeth may need to be extracted.

Some teeth may have to be extracted if they could become a source of infection after an organ transplant. Individuals with organ transplants have a high risk of infection because they must take drugs that decrease or subdue the immune system.

Wisdom teeth, also called third molars, are often extracted either before or after they appear. They commonly come out during the late teens or early 20s. They need to be removed if they are rotted, cause discomfort or have a cyst or infection. These teeth often get stuck in the jaw (impacted) and do not come in. This can inflame the gum, causing pain and swelling. In this case, the tooth must be removed. If you need all four wisdom teeth removed, they are usually extracted at the same time.

If you expect to have treatment with intravenous drugs called bisphosphonates for a medical condition, make sure to see your dentist first. If any teeth need to be extracted, this should be done just before your drug treatment begins. Having a tooth extraction after bisphosphonate treatment increases the risk of osteonecrosis (death of bone) in the jaw.

Preparation

Your dentist or oral surgeon will utilize an X-ray of the area to help prepare the best way to extract the tooth. Make certain to give your full medical and dental history and a list of all medicines you utilize. This should include both prescription and otc drugs, vitamins and supplements.

If you are having wisdom teeth removed, you may have a panoramic X-ray. This X-ray takes an image of each of your teeth simultaneously. It can show several things that help to guide an extraction:

The relationship of your wisdom teeth to your other teeth
The upper teeth’s connection to your sinuses
The lower teeth’s relationship to a nerve in the jawbone that gives feeling to your lower jaw, lower teeth, lower lip and chin. This nerve is called the inferior alveolar nerve.
Any infections, tumors or bone disease that may be present

A number of doctors prescribe antibiotics to be taken prior to and following surgery. This practice varies by the dentist or oral surgeon. Antibiotics are more likely to be given if:

You come with infection at the time of surgery
You have a weakened immune system
You will have an extensive surgery
You have specific medical conditions

You may have intravenous (IV) anesthesia, which can differ from conscious sedation to general anesthesia. If so, your doctor will have give you directions to follow. You should wear clothing with short sleeves or sleeves that could be rolled up easily. This allows access for an IV line to be placed in a vein. Don’t ever eat or drink anything for six to eight hours before the operation.

If you have a cough, stuffy nose or cold up to a week before the surgery, call your doctor. He or she may want to avoid anesthesia until you are over the cold. If you had nausea and vomiting the night before the procedure, call the doctor’s office first thing in the morning. You may need an adjustment in the planned anesthesia or the extraction may have to be rescheduled.

Do not smoke on the day of surgery. This can escalate the risk of a very painful problem called dry socket.

Following the extraction, someone will have to drive you home and stay there with you. You will be given post-surgery instructions. It is crucial that you follow them.

How It’s Done

There are two types of extractions:

A basic extraction is performed on a tooth that can be seen in the mouth. General dentists typically do simple extractions. In a simple extraction, the dentist loosens the tooth with an instrument called an elevator. Then the dentist uses an instrument called a forceps to remove the tooth.

A surgical extraction is a more complex procedure. It is used if a tooth may have broken at the gum line or has not entered the mouth yet. Surgical extractions regularly are done by oral surgeons. However, they are also done by general dentists. The doctor makes a miniature incision (cut) into your gum. Sometimes it’s required to remove some of the bone surrounding the tooth or to cut the tooth in half just to extract it.

Most simple extractions can be performed using just an injection (a local anesthetic). You may or may not receive drugs in order to help you relax. For a surgical extraction, you will receive a local anesthetic, and you may also have anesthesia through a vein (intravenous). Some people may need to have general anesthesia. They include patients with specific medical or behavioral conditions and young children.

If you are receiving conscious sedation, you may be given steroids as well as other medicines in your IV line. The steroids help to reduce swelling and keep you pain-free following the procedure.

Throughout a tooth extraction, you can anticipate to feel pressure, but no pain. If you feel any pain or pinching, inform your doctor.

Follow-Up

Your doctor will give you detailed information on what to work on and what to expect after your surgery. If you have any questions, make certain to ask them before you leave the facility.

Having a tooth extracted is surgery. You can expect some discomfort after even simple extractions. Usually it is mild. Research has shown that taking nonsteroidal anti-inflammatory drugs (NSAIDs) can greatly reduce pain after a tooth extraction. These drugs include ibuprofen, such as Advil, Motrin and others. Take the dose your doctor recommends, 3 to 4 times a day. Take the first pills before the local anesthesia wears off. Continue taking them for 3 days. Ask your doctor for complete information.

Surgical extractions normally cause more pain following the procedure than simple extractions. The degree of discomfort and for how long it lasts will hinge on how tough it was to remove the tooth. Your dentist may assign pain medicine for a few days and afterwards suggest an NSAID. Most pain disappears after a few days.

A cut in the mouth tends to bleed more than a cut on the skin because it can not dry out and develop a scab. After an extraction, you’ll be asked to clamp on a portion of gauze for 20 to 30 minutes. This pressure will allow the blood to clot. You will still have a touch of bleeding for the next 24 hours or so. It should lessen afterwards. Don’t agitate the clot that forms on the wound.

You can put ice bags on your face to decrease swelling. Generally, they are left on for 20 minutes each time and removed for 20 minutes. If your jaw is aching and stiff after the swelling recedes, try warm compresses.

Eat delicate and cool foods for a few days. At that point try other food as you feel comfortable.

A mild rinse with warm salt water, started 24 hours following the surgical procedure, can help to keep the area cleansed. Use one-half teaspoon of salt in a cup of water. Almost all swelling and bleeding end within a day or two after the surgery. Initial healing takes approximately two weeks.

If you require stitches, your doctor may use the type that dissolve by themselves. This typically takes one to two weeks. Rinsing with warm salt water will help the stitches to diffuse. Some stitches will need to be removed by the dentist or surgeon.

You must not smoke, use a straw or spit after surgery. These actions can take the blood clot out of the gap where the tooth was. Do not smoke on the day of the surgery. Do not smoke for 24 to 72 hours after having a tooth extracted.

Dangers

A complication called a dry socket develops in about 3% to 4% of all extractions. This happens when a blood clot doesn’t form in the hole or the blood clot breaks off or breaks down too early.

In a dry socket, the underlying bone is exposed to air and food. This can be very agonizing and can cause a bad odor or taste. Typically dry sockets begin to cause pain the third day after surgery.

Dry socket occurs up to 30% of the time when impacted teeth are taken out. It is also more likely after troublesome extractions. Smokers and women who take birth control pills are more likely to have a dry socket. Smoking on the day of surgery additionally increases the risk. A dry socket requires to be treated with a medicated dressing to stop the pain and promote the area to heal.

Infection can set in as a result of an extraction. However, you likely won’t get an infection if you have a healthy immune system.

Other potential problems include:

Accidental damage to neighboring teeth, namely fracture of fillings or teeth

An incomplete extraction, by which a tooth root remains in the jaw– Your dentist typically removes the root to prevent infection, but occasionally it is less risky to leave a small root tip in place.

A broken jaw caused by the pressure applied to the jaw during extraction– This occurs more often in older people with osteoporosis (thinning) of the jaw bone.

A hole in the sinus during removal of an upper back tooth (molar)– A small hole usually will close by itself in a few weeks. If not, more surgery may be required.

Discomfort in the jaw muscles and/or jaw joint– It may be challenging for you to open your mouth wide. This can happen because of the injections, keeping your mouth open and/or lots of pushing on your jaw.

Long-lasting numbness in the lower lip and chin– This is an uncommon issue. It is triggered by injury to the inferior alveolar nerve in your lower jaw. Complete healing may take three to six months. In rare cases, the numbness may be permanent.

When To Call a Professional

Call your dentist or oral surgeon if:

The swelling gets worse instead of better.
You have fever, chills or redness
You have trouble swallowing
You develop uncontrolled bleeding in the area
The area continues to ooze or bleed after the first 24 hours
Your tongue, chin or lip feels numb more than 3 to 4 hours after the procedure
The extraction site becomes very painful– This may be a sign that you have developed a dry socket.

If you have a complication, your dentist usually will prescribe antibiotics.