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Tooth extraction

Extractions are performed for a wide variety of reasons, including tooth decay that has ... Some other possible reasons for tooth extraction are as follows: ...

 
Definition

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

Purpose

Extraction is performed for positional, structural, or economic reasons. Teeth are often removed because they are impacted. Teeth become impacted when they are prevented from growing into their normal position in the mouth by gum tissue, bone, or other teeth. Impaction is a common reason for the extraction of wisdom teeth. Extraction is the only known method that will prevent further problems. Teeth may also be extracted to make more room in the mouth prior to straightening the remaining teeth (orthodontic treatment), or because they are so badly positioned that straightening is impossible. Extraction may be used to remove teeth that are so badly decayed or broken that they cannot be restored. In addition, patients sometimes choose extraction as a less expensive alternative to filling or placing a crown on a severely decayed tooth.

Precautions

In some situations, tooth extractions may need to be postponed temporarily. These situations include:

  • Infection that has progressed from the tooth into the bone. Infections may make anesthesia difficult. They can be treated with antibiotics before the tooth is extracted.
  • The patient's use of drugs that thin the blood (anticoagulants). These medications include warfarin (Coumadin) and aspirin. The patient should stop using these medications for three days prior to extraction.
  • Patients who have had any of the following procedures in the previous six months: heart valve replacement, open heart surgery, prosthetic joint replacement, or placement of a medical shunt. These patients may be given antibiotics to reduce the risk of bacterial infection.

Description

Tooth extraction can be performed with local anesthesia if the tooth is exposed and appears to be easily removable in one piece. An instrument called an elevator is used to loosen (luxate) the tooth, widen the space in the bone, and break the tiny elastic fibers that attach the tooth to the bone. Once the tooth is dislocated from the bone, it can be lifted and removed with forceps.

If the extraction is likely to be difficult, the dentist may refer the patient to an oral surgeon. Oral surgeons are specialists who are trained to give nitrous oxide, an intravenous sedative, or a general anesthetic to relieve pain. Extracting an impacted tooth or a tooth with curved roots typically requires cutting through gum tissue to expose the tooth. It may also require removing portions of bone to free the tooth. Some teeth must be cut and removed in sections. The extraction site may or may not require one or more stitches to close the cut (incision).

Preparation

Before an extraction, the dentist will take the patient's medical history, noting allergies and prescription medications. A dental history is also taken, with particular attention to previous extractions and reactions to anesthetics. The dentist may then prescribe antibiotics or recommend stopping certain medications prior to the extraction. The tooth is x-rayed to determine its full shape and position, especially if it is impacted.

If the patient is going to have deep anesthesia, he or she should wear loose clothing with sleeves that are easily rolled up to allow for an intravenous line. The patient should not eat or drink anything for at least six hours before the procedure. Arrangements should be made for a friend or relative to drive the patient home after the surgery.

Aftercare

An important aspect of aftercare is encouraging a clot to form at the extraction site. The patient should put pressure on the area by biting gently on a roll or wad of gauze for several hours after surgery. Once the clot is formed, it should not be disturbed. The patient should not rinse, spit, drink with a straw, or smoke for at least 24 hours after the extraction and preferably longer. Vigorous exercise should not be done for the first three to five days.

For the first two days after the procedure, the patient should drink liquids without using a straw, and eat soft foods. Any chewing must be done on the side away from the extraction site. Hard or sticky foods should be avoided. The mouth may be gently cleaned with a toothbrush, but the extraction area should not be scrubbed.

Wrapped ice packs can be applied to reduce facial swelling. Swelling is a normal part of the healing process. It is most noticeable in the first 48-72 hours. As the swelling subsides, the patient may experience muscle stiffness. Moist heat and gentle exercise will restore jaw movement. The dentist may prescribe medications to relieve the postoperative pain.

Risks

Potential complications of tooth extraction include postoperative infection, temporary numbness from nerve irritation, jaw fracture, and jaw joint pain. An additional complication is called dry socket. When a blood clot does not properly form in the empty tooth socket, the bone beneath the socket is painfully exposed to air and food, and the extraction site heals more slowly.

Normal results

After an extraction, the wound usually closes in about two weeks. It takes three to six months for the bone and soft tissue to be restructured. Complications such as infection or dry socket may prolong the healing time.

Why might a person require a tooth extraction?

There are a number of reasons why your dentist might recommend that you have a tooth, or even several teeth, extracted. Listed below are some of these reasons:
A tooth extraction might be indicated if repairing a damaged tooth is not practical.
Broken, cracked, or extensively decayed teeth can be extraction candidates.

Some teeth will have extensive decay (dental caries) or else will have broken or cracked in such an extreme manner that an extraction might be considered the best, or at least a reasonable, solution. Of course there will be a number of factors that will come into play with any specific situation. In some cases the obstacles that present themselves might be so formidable that a repair for the tooth is simply not possible. In other cases the cost of needed dental treatment or else a questionable long-term outlook for the success of the treatment may be the reason an extraction is chosen.

Teeth that are unsuitable candidates for root canal treatment should be extracted.

Some teeth may require treatment of the nerve space that lies within them (root canal treatment) in order to make a repair. While most teeth typically are candidates for root canal treatment there can be complicating factors that remove this option. If this is the case and needed root canal treatment cannot be performed then the extraction of the tooth is indicated.

Teeth associated with advanced periodontal disease (gum disease) may need to be pulled.

By definition, teeth that have experienced the effects of advanced periodontal disease (gum disease) are teeth whose supporting bone has been damaged. In general, as periodontal disease worsens, a tooth is supported by less and less surrounding bone, often to the point where the tooth becomes loose. In those cases where significant bone damage has occurred and a tooth has become excessively mobile extraction of the tooth may be the only option.

Malpositioned or nonfunctional teeth may need to be extracted.

Some teeth are extracted because they are malpositioned. As an example, sometimes when wisdom teeth come in they lie in a position that proves to be a constant source of irritation to the person's cheek (by either rubbing against the cheek or causing the person to bite it). As a solution, a dentist may suggest that the offending wisdom teeth should be extracted.

Some teeth might be extracted because they provide very little service to the dental patient but do offer risk for becoming problematic. A common example is a wisdom tooth that has come in but has no matching tooth to bite against. Wisdom teeth are typically in a region of the mouth that is hard to clean, thus placing them and their neighboring tooth at greater risk for decay and periodontal disease. Depending on the precise circumstances that they find, a dentist may advise their patient that removing a nonfunctional tooth might be in that patient's best long-term interest in regards to maintaining good oral health.

Impacted teeth are often extracted. Impacted teeth are teeth whose positioning in the jaw bone is such that they cannot erupt into normal alignment. So by definition, impacted teeth are malpositioned and because they are malpositioned they are often nonfunctional. This combination of factors makes impacted teeth common candidates for extraction.

Tooth extractions may be required in preparation for orthodontic treatment (braces).

When orthodontic treatment is performed for a patient the dentist is trying to perfect the alignment of the patient's teeth but they can only do so within the confines of the size of the person's jaws. Especially in those cases where a large discrepancy exists between the size of the patient's jaws and the needed space required for the improved alignment of their teeth, some strategically located teeth may need to be extracted.

When might a tooth extraction be a bad idea?

During their examination of your teeth and mouth it is possible that your dentist will be able to recommend one or more alternative treatments to having a tooth extraction. While extracting a tooth might be less expensive than the other treatment options your dentist proposes, it may not be the least expensive treatment in the long-run.

When a tooth is removed its neighboring teeth will tend to shift, sometimes significantly. Any alignment changes that do occur can have a major impact on your dental health. Removing even a single tooth can lead to problems associated with chewing ability or jaw joint function. Additionally, teeth whose alignment has changed can become traps for food or be harder to clean thoroughly, thus placing them at greater risk for tooth decay and gum disease.

So to avoid these types of complications, in most cases your dentist will probably recommend to you that you replace any tooth that has been extracted. Replacing a tooth after an extraction with an artificial one can easily cost more than the alternative of not extracting a tooth and instead rebuilding it.

 

 

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