TOOTH EXTRACTIONS

What is a tooth extraction?

Tooth extraction is having one or more teeth completely removed from your mouth by a dentist. This can be accomplished in one or more (in case of numerous teeth being removed) sittings. The tooth/teeth that have been removed may or may not need to be replaced and the options for this will be discussed with you by your dentist.

Why will I need to have a dental extraction?

There are several reasons why teeth may need to be removed. The more common reasons are listed below:

·         Gross decay which causes infection of the pulp and bone which cannot be treated by a root canal treatment                                                                                           

·         Severe gum disease which may cause the tooth/teeth to become loose                        

·         Broken tooth that cannot be repaired                                                                          

·         Wisdom tooth problems                                                                                                      

·         Overcrowding of teeth which may require one or more teeth to be removed such that, the remaining teeth can then be aligned using orthodontics.

What are the alternative treatments?

If the infection in a tooth is discovered at an early enough stage it is often possible to do a root canal treatment and thus save the tooth. In more advanced cases the infection and pain can be eased by administering antibiotics and painkillers, in case you do not want to get the tooth removed. However, the use of oral medication is not a definitive solution, it merely eases the symptoms and the infection may flare up again at a later date.    

What does the procedure entail?

Your dentist will take a detailed medical and dental history. It is important that you mention allergies (including those to topical creams and ointments), current medication (including the use of inhalers and over the counter medication like oral contraceptives, aspirin etc.), any medical conditions and recent operations. Certain conditions may warrant that you get the tooth extracted in a medically supported environment such as a hospital. Your dentist will counsel you should this be required.

To ensure that the procedure itself and the immediate period after it are pain free the dentist will administer a local anesthetic injection which has a numbing effect and which will completely block sensations from the area. Once the local anesthetic has taken effect, the dentist will proceed to widen the tooth socket using an instrument called an elevator. Once the socket is widened the tooth will be grasped within specially designed forceps and moved from side to side until it is completely loose within the socket. Once completely loosened the tooth is grasped firmly and completely removed. During the procedure you may feel some amount of pressure but you should not feel any pain.

Once the tooth has been completely removed it is very important that a blood clot forms in the socket. This is imperative to the healing process. The dentist will clean the tooth socket, place a pack of sterilized gauze over the socket and ask you to bite down firmly on this soft padding to help stop the bleeding. You will also be given a list of verbal and written instructions which you must implicitly follow.

What are the instructions I must follow after having my tooth removed?

           ·          In the immediate postoperative phase because of the numbing effect of the local anesthetic lips, cheeks, gums and tongue may have no sensation. This lasts for about 3-4 hours. In this period you must be very careful not to cause any accidental trauma to the soft tissues by biting or burning.

           ·          Once the effect of the local anesthetic wears off (3-4 hours) there will be some pain and discomfort for which you will be prescribed some anti inflammatory painkillers such as Nurofen, Ibuprofen. Depending on the extent of infection, you may or may not be prescribed antibiotics. Please make your dentist aware of penicillin and other allergies so that an alternative medication can be prescribed. You must make sure that you take the medication on time as prescribed.

           ·          There is likely to be some oozing of blood from the socket. The dentist would have placed a gauze pack to help stop the bleeding. After 30-45 mins if there is still oozing then replace the old gauze pack with a fresh one (this will be provided to you) and bite down on it with firm pressure for another 30 mins. If the bleeding still does not stop then contact your dentist or the nearest A&E.

           ·          It is very important not to smoke, suck through a straw, rinse your mouth vigorously or to brush vigorously near the extraction socket. All these activities can dislodge the blood clot which is essential to the healing process.

           ·          It is also important to limit yourself to calm activities over the next 24 hours. This keeps the blood pressure low, reduces bleeding and thus aids in the healing process.

           ·          There is likely to be some discomfort and swelling for the first 48 hours. You can use an ice pack (20 mins on and 20 mins off) to keep this to a minimum.

           ·          Also on the day of extraction drink plenty of water, maintain a soft, nutritious diet, avoid hot, spicy food and do not consume alcoholic beverages. You can begin eating normally the next day.

           ·          It is important to keep the mouth clean and healthy so continue brushing your teeth. Gently rinse your mouth with warm salt water three times a day. Also rinse gently after meals. This helps keep food out of the extraction site. It is important to resume your normal dental routine after 24 hours. 

What happens if the dentist cannot completely remove the tooth?

This is a rare scenario and may occur when the tooth is very brittle, heavily restored, has long standing infection which causes the tooth root to fuse with the bone and also may occur due to complicated tooth anatomy (flaring roots, overly curved roots etc) as is commonly seen in wisdom teeth.

In such a situation the dentist may have to make a small cut in your gums and if necessary drill away a small amount of bone in the area so that the tooth can be removed. Sometimes based on the clinical conditions the dentist may wish to refer you to a specialist.

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