WHY DOES A TOOTH NEED TO BE REMOVED?

Removal of a tooth, also known as an extraction or exodontia, are done for a variety of reasons.  Such reasons can include:

  • Decay that has caused such destruction that causes the tooth to be non-restorable
  • Severe infection that renders the tooth hopeless, or if such infection is so severe that removal is the only method to completely remove the infection
  • Severe periodontal and gum disease that has caused the supporting bone structure of the tooth to be rendered mobile and hopeless
  • A severely fractured tooth
  • A tooth that has been treated endontically without success
  • Wisdom teeth that is soft or hard tissue impacted, either symptomatic or asymptomatically
  • Insufficient space in such that orthodontically, removal of tooth is only way to gain enough jaw space to help align adjacent teeth via orthodontics (braces)
  • Supernumerary (excessive teeth) that interferes with the eruption pattern and position of the permanent dentition
  • When a tooth requiring endodontic treatment (root canals) and the patient does not want the root canal treatment performed

WHAT TO EXPECT DURING SURGERY

The general dentist or oral surgeon will first anesthetize the tooth with local anesthetic (ie. 1:100k lidocaine w/epinephrine).  Anesthetics containing epinephrine is ideal as the epinephrine enhances the properties of the anesthetic, and allows a longer lasting duration.  Depending on the patient’s anxiety level, anti- anxiety medications may be given to help provide additional comfort and to reduce stress.  The patient may also consult with the dentist to see if general anesthesia is necessary.

In general there are 2 types of extractions:

  • With a simple extraction, the tooth is usually grasped via a surgical grade steel dental forceps.  Using a rocking left & right and back & forth motion, the tooth is moved about such that the PDL (periodontal ligament) is severed and that the alevolar bone supporing the tooth is widened to allow the tooth to be loosened and removed
  • If it is a surgical extraction, such as when the has fractured or if the tooth is not able to be removed with ease, the dental surgeon will elevate the soft tissue away from the tooth and make a small incision to expose the tooth and its bony supporting structure.  Bone and tooth removal via a dental handpiece drill may also be required to facilitate tooth removal.  Sometimes the tooth is sectioned via the handpiece into multiple pieces to allow proper removal.

COMPLICATIONS

As with any surgery, complications may or may not arise due to the body’s varying levels of healing and how extensive the extraction process is.  Because each person’s response to the extration varies and the ability to recoup and heal differs, it is difficult to predict which, if any, complications will occur.  But as such, these may or may not include:

  • Bleeding: Extremely normal for the next 24 hours.  If there is excessive bleeding, additional compress and specialized packing may be used to promote clotting factors to form a blood clot.
  • Infection: Antibiotics may be prescribed depending on the severity of the existing tooth infection, or if the patient is prone to bacterial insults (ie. existing diabetes, cancer, HIV, etc.)
  • Pain: Medications may be prescribed to help relief the discomfort associated with the extraction.  Your dentist will help determine which medications would be appropriate.
  • Sinus Involvement: Occuring only with upper/maxillary molars and premolars. This is a rare occurrence when the roots extend into the maxillary sinus; upon removal of such teeth, the intra-oral cavity environment is exposed to the sinus.  The maxillary sinus is lined with a membrane called “Sniderian membrane.”  If this membrane is exposed but not perforated due to the teeth’s roots, then this “exposure” is often times left alone to heal.  If the Sniderian membrane is perforated, then additional surgery may be required to close this communication.
  • Bone Fracture: A very rare occurence, this complication results when the extracted tooth area is supported by a thin layer of cortical bone.  During the elevation process of the tooth and the expansion of the socket, the weakend bony structure separates along the vertical axis of the mandible or maxilla.  The oral surgeon will determine what additional procedures are necessary to allow proper healing.
  • Nerve Injury: Another rare occurence and the effects usually temporary, it tends to occur during third molar extractions (wisdom teeth).  The nerves affected are the inferior alveolar nerve and the lingual nerve.
  • Damage to adjacent teeth and restorations: At times when the tooth is luxated and during instrument usage, the instrument or tooth incidentally touches and damages the adjacent structure.
  • Dry Socket: An extremely painful side effect, its cause and etiology is not well understood.  A typical occurence is 1-3 days after the extraction, the site is “feeling well,” but after 3-4 days, a sudden onset of sharp and tremendous pain occurs in the site.  Termed alveolar osteitis, it has higher risk in smokers and those with poor blood flow.  It is usually managed with pain medication, and may require a duration of 2-3 weeks to have significant relief.
  • Sore Jaw: Due to the time spent keeping the moouth open during the extraction, the jaw muscles (specifically the masseter and lateral and medial pterygoids.  A warm moist towel along with NSAIDs such as ibuprofen and aspirin can help relieve the inflammation.
  • Boney and root fracture: Occasionally a very small piece of root will fracture and break off during the extraction procedure.  If this “root tip” dislodges and travels to the maxillary sinus, every effort will be made to retrieve the tip. A small “window” is made to open the sinus via the Caldwell-Luc procedure.  Other times it is intentionally left and not removed if the root is nearby root or blood vessel structures, and such effort would cause excessive harm to such structures.

AFTER SURGERY (POST-OP)

Your dentist will recommend constant pressure with gauze to promote blood clotting in the extraction site.  The pressure enhances the clotting factors to form a blood clot.  If the blood clot is dislodged, this may lead to dry socket and delayed healing.  Once the clot is in place for a duration of 10 days, the body then begins bone formation and remodeling through a combination of odontoblasts and odontoclasts. Within 2-3 months the extraction site begins to resemble its edentulous state as the bone remodeling process completes.

Antibiotics and pain medications may be described if deemded necessary.  A suture may or may not be placed to assist in the soft tissue healing and closure of the extraction site.

REPLACEMENT RECOMMENDATIONS

Your general dentist can recommend several options to replace the missing tooth.  Such options can include a dental implant, fixed bridge, partial or complete denture, or a hybrid combination (ie. fixed bridge supported by dental implants).  Another option is to leave the extraction site empty  and as is without replacement, which may be ideal in third molar extractions where there may not have any mastication or chewing function.

If you have any questions about tooth extractions and removal, its causes and treatment, your local Bellevue dentist is here to help.  Contact us today!

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