Tooth
Extraction
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.
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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.
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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).
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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.
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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.
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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.
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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.
Dry socket
A painful condition following tooth extraction in which
a blood clot does not properly fill the empty socket. Dry
socket leaves the underlying bone exposed to air and food.
Extraction site
The empty tooth socket following removal of the tooth.
Impacted tooth
A tooth that is growing against another tooth, bone, or
soft tissue.
Luxate
To loosen or dislocate the tooth from the socket.
Nitrous oxide
A colorless, sweet-smelling gas used by dentists for mild
anesthesia. It is sometimes called laughing gas because
it makes some patients feel giddy or silly.
Oral surgeon
A dentist who specializes in surgical procedures of the
mouth, including extractions.
Orthodontic treatment
The process of straightening teeth to correct their appearance
and function.
