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Dental Extractions

Reasons for Pulling Teeth

Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired.

Other reasons include:

Severe Tooth Damage/Trauma: Some teeth have such extensive decay and damage (broken or cracked) that repair is not possible. For example, teeth affected by advanced gum (periodontal) disease may need to be extracted. As gum disease worsens, the tooth (supported by less surrounding bone) often loosens to such an extent that tooth extraction is the only solution.

A crowded mouth: Sometimes dentists pull teeth to prepare the mouth for orthodontics. The aim of orthodontiacsis is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Also, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend pulling it.

Infection.  If tooth decay or damage extends to the pulp (the center of the tooth containing nerves and blood vessels), bacteria in the mouth can enter, leading to infection. Often this can be corrected with root canal therapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.

Risk of infection: If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant), even the risk of infection in a particular tooth may be reason enough to pull the tooth.

Periodontal (Gum) Disease: If periodontal disease(an infection of the tissues and bones that surround and support the teeth) has caused loosening of the teeth, it may be necessary to the pull the affected tooth or teeth.

What to Expect With Tooth Extraction

Dentists and oral surgeons (dentists with special training to perform surgery) perform tooth extractions. Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed. If you are having more than one tooth pulled or if a tooth is impacted, your dentist may use a strong general anesthetic. This will prevent pain throughout your body and make you sleep through the procedure.

If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a tooth, which is difficult to pull, must be removed in pieces.

Once the tooth has been pulled, a blood clot usually forms in the socket. The dentist will pack a gauze pad into the socket and have you bite down on it to help stop the bleeding. Sometimes the dentist will place a few stitches (usually self-dissolving) to close the gum edges over the extraction site.

Sometimes, the blood clot in the socket breaks loose, exposing the bone in the socket. This is a painful condition called dry socket. If this happens, your dentist will likely place a sedative dressing over the socket for a few days to protect it while a new clot forms.

Types of Tooth Extractions

There are two types of tooth extractions:

Simple Extractions: These are performed on teeth that are visible in the mouth. General dentists commonly do simple extractions, and most are usually done under a local anesthetic, with or without anti-anxiety medications or sedation.

Surgical Extractions: These involve teeth that cannot easily be seen or reached in the mouth, either because they have broken off at the gum line or they have not fully erupted. Performed by dentists or oral surgeons, surgical extractions require some type of surgical procedure, such as bone removal, removing and/or lifting and folding back all or part of the gum tissue to expose the tooth, or breaking the tooth into pieces (called tooth sectioning). Surgical extractions can be done with local anesthesia and/or conscious sedation. Patients with special medical conditions and young children may receive general anesthesia.

Having a tooth extracted is not a procedure that you or your dentist should take lightly. To give you an idea of the potential risks associated with the procedure, I will share with you an excerpt from a consent form that a patient signs before an extraction is performed.

“Potential risks of the treatment include (but are not limited to) bleeding, swelling, pain, infection of the extraction site, dry socket, and damage to other teeth or tissue (gum or cheek) in the mouth. More remote risks include jaw fracture, temporary or permanent injury to the TMJ (jaw-joint), temporary or permanent numbness of the mouth, and life-threatening complications to the treatment or anesthesia”.

Due to the potential risks associated with an extraction, you should always make sure that your dentist has a complete understanding of your medical history. This includes all disorders that you may suffer from, as well as all the medication that you are taking. Some of the ailments that may be of particular concern to your dentist include heart disease, bleeding disorders, diabetes and other diseases affecting the immune system. Some of the medications that can increase the risk during an extraction include many of the medications used to treat hypertension and diabetes, cortisone, and blood thinners (anticoagulants) that are often used after a person has had a stroke, or used to prevent one. Please also inform you dentist about any over the counter medications you may be taking.

The safe completion of an extraction requires a dentist with both technical skill and excellent knowledge of the medical risks associated with the procedure. In some cases, it is wise for your dentist to discuss your medical condition with your family doctor who can have input into the procedure. With certain types of extraction, including wisdom teeth that are lodged into the jawbone, teeth that are fractured, and those that have unusually curved roots, a dental specialist known as an oral surgeon may be consulted or referred to by your dentist. An oral surgeon should also be considered for a person who has serious and complicated medical problems and requires an extraction.

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