TOOTH EXTRACTIONS

What Is It?

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

What It’s Utilized For

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

Here are other reasons:

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

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

People receiving dental braces may need teeth pulled out to make room for the teeth that are being shifted into place.

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

Individuals receiving cancer drugs may develop infected teeth given that these drugs diminish the immune system. Infected teeth may need to be extracted.

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

Wisdom teeth, also called third molars, are often extracted either before or after they come in. They commonly come in during the late teens or early 20s. They need to be removed if they are decayed, cause pain 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 distress and swelling. In this case, the tooth must be removed. If you need all four wisdom teeth removed, they are usually removed at the same time.

If you anticipate to have treatment with intravenous drugs called bisphosphonates for a medical condition, be sure to see your dentist first. If any teeth have to be extracted, this should be done 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 take an X-ray of the area to help decide the best way to remove the tooth. Make sure to supply your full medical and dental history and a list of all medicines you take. This should include both prescription and over the counter drugs, vitamins and supplements.

If you are getting wisdom teeth removed, you may have a panoramic X-ray. This X-ray takes an image of all your teeth at once. It can show several things that help to advise an extraction:

The relationship of your wisdom teeth to your other teeth
The upper teeth’s relationship to your sinuses
The lower teeth’s connection 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 exist

Some doctors prescribe prescription antibiotics to be taken before and after surgery. This practice varies by the dentist or oral surgeon. Antibiotics are more likely to be given if:

You have infection at the time of surgery
You have a weakened immune system
You will have a long 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 conveniently. 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 and including a week a week before the surgery, get in touch with 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 a change 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 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 guidelines. It is vital that you follow them.

How It’s Done

There are two kinds of extractions:

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

A surgical extraction is a more challenging procedure. It is used if a tooth may have broken off at the gum line or has not come into the mouth yet. Surgical extractions commonly 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 in order to extract it.

Most simple extractions are accomplished using just an injection (a local anesthetic). You may or may not receive drugs to help you relax. For a surgical extraction, you will receive a local anesthetic, and you may also have anesthesia via 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 being given conscious sedation, you may be given steroids along with other medicines in your IV line. The steroids help to reduce swelling and keep you pain-free after the procedure.

In the course of a tooth extraction, you can anticipate to feel pressure, but no pain. If you feel any pain or pinching, tell your doctor.

Follow-Up

Your doctor will give you detailed guidelines on what to carry out and what to expect after your surgery. If you have any questions, make sure to ask them before you leave the office.

Having a tooth removed is surgery. You can expect some discomfort after even simple extractions. Usually it is minor. Research has shown that taking nonsteroidal anti-inflammatory drugs (NSAIDs) can significantly decrease discomfort after a tooth extraction. These drugs include ibuprofen, including 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 generally cause more pain following the procedure than simple extractions. The degree of discomfort and for how long it lasts will depend upon how difficult it was to remove the tooth. Your dentist may recommend pain medicine for a few days and afterwards suggest an NSAID. Most pain goes away after a couple of days.

A cut in the mouth tends to bleed more than a cut on the skin due to the fact that it can not dry out and develop a scab. After an extraction, you’ll be asked to bite on a piece 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 after that. Don’t disturb the clot that forms on the wound.

You can put ice packs 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 hurting and stiff after the swelling recedes, try warm compresses.

Eat delicate and cool foods for a few days. Then try other food as you feel confident.

A delicate rinse with lukewarm salt water, started 24 hours after the surgery, 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 operation. Initial healing takes at the very least two weeks.

If you need stitches, your doctor may use the kind that diffuse by themselves. This generally takes one to two weeks. Rinsing out with warm saline will help the stitches to diffuse. Some stitches will need to be removed by the dentist or surgeon.

You should not smoke, utilize a straw or spit after surgery. These actions can pull the blood clot out of the hole 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 problem 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 made vulnerable to air and food. This can be very painful and can cause a bad odor or taste. Typically dry sockets begin to induce pain the third day after surgery.

Dry socket occurs as much as 30% of the time when impacted teeth are taken out. It is also more probable after difficult 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 needs 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 most likely won’t get an infection if you have a healthy immune system.

Other potential problems include:

Unintentional damage to nearby teeth, namely fracture of fillings or teeth

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

A fractured jaw triggered by the pressure placed on 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 rear tooth (molar)– A small hole usually will close up by itself in a few weeks. If not, more surgery may be mandated.

Soreness in the jaw muscles and/or jaw joint– It may be tough 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 complication. 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 develop fever, chills or redness
You have trouble swallowing
You have uncontrolled bleeding in the area
The area continues to ooze or bleed after the first 24 hours
Your tongue, chin or lip seems numb more than 3 to 4 hours after the procedure
The extraction site becomes very unpleasant– This may be a sign that you have developed a dry socket.

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

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