Tooth extraction is defined as the removal of a tooth from its socket in the bone.
When is it necessary to extract a tooth?
If a tooth is broken or severely damaged by decay, the dentist will try to fix it with a filling, crown or other restoration. However, there may be too much damage for the tooth to be repaired. In these instances, the tooth will need to be extracted. In addition, a very loose tooth will need to be pulled if cannot be saved with a surgical bone graft procedure.
Here are other reasons to extract a tooth:
- When a tooth is blocking other teeth from erupting
- When baby teeth don’t fall out in time to let permanent teeth come in
- Before braces are put on to create room for teeth that are being moved into place
- When a patient is receiving radiation to the head or neck and has teeth in the field of radiationWhen cancer drugs are being administered, the immune system is impacted, making it possible for teeth to become infected
Wisdom teeth may need to be extracted, either before or after they come in. They need to be removed if they are decayed, become a source of infection or are causing pain. Wisdom teeth often become impacted or stuck in the jaw, causing irritation in the gum, pain and swelling. In this case they would need to be surgically removed. Dr. Tara and her staff at Dublin Dental Center are very experienced in the area of urgent tooth extraction.
Preparation for tooth extraction
An x-ray will be taken of the affected area in order to plan the best course of action for an emergency extraction. Before the procedure, be sure to inform the dentist of your full medical and dental history, as well as a list of the medicines you take.
If you are having wisdom teeth removed, a panoramic X-ray may be required. This type of X-ray shows all of your teeth in one image and it can help guide the dentist in planning the extraction.
Some dentists and oral surgeons will prescribe an antibiotic to be taken before and after surgery, but this practice is not always necessary. Expect to receive antibiotics in the following situations:
- You will have an especially long surgery
- You have an infection at the time of surgery
- Your immune system is weakened by another health condition
- You have specific medical conditions
Two types of extractions
Simple extraction – this type of procedure is performed on a tooth that can be seen in the mouth. General dentists are able to perform a simple extraction with a local anesthetic. The dentist will use a device called an elevator to loosen the tooth, and then a forceps for removal of the tooth.
Surgical extraction – a more complex procedure than a simple extraction, surgical extractions are required when a tooth is broken off at the gum or has not yet come into the mouth. While many of these extractions are referred out to oral surgeons, they can also be done by a general dentist. A small incision is made in the gum and it may be necessary to cut the tooth or remove some of the bone around the tooth in order to extract it.
During a tooth extraction, you can expect to feel pressure, but no pain. If you feel any pain or pinching, tell your doctor.
What happens after a tooth extraction?
You can expect to have some discomfort, even after a simple extraction but it is usually mild. Some patients avoid pain entirely by taking non-steroidal anti-inflammatory drugs (NSAIDs) 3 to 4 times a day, immediately following the procedure. These drugs include brand names of Ibuprofen, such as Motrin and Advil. In addition to pain management, the emergency dentist will provide detailed instructions on what to expect after a tooth extraction and how to prevent infection.
Surgical extractions generally cause more pain after the procedure than simple extractions. The level of discomfort and how long it lasts will depend on how difficult it was to remove the tooth. Your dentist may prescribe pain medicine for a few days and then suggest an NSAID. Most pain disappears after a couple of days.
After a surgical procedure, you can expect a longer recovery time. A cut in the mouth tends to bleed more than a cut on the skin because it cannot dry out and form a scab. Until the bleeding subsides, you'll be asked to bite on a piece of gauze for 20 to 30 minutes. This pressure allows the blood to clot, but you still might have some minor bleeding for the next 24 hours. Be careful not to disturb the clot that is forming around the wound.
To reduce swelling that follows a tooth extraction, use ice packs for 20 minutes on and 20 minutes off. Warm compresses may also be used to ease jaw stiffness after the swelling goes away.
For the first few days after the procedure, eat only soft and cool foods, then you may introduce other foods as you feel comfortable.
A gentle rinse with warm salt water should be started 24 hours after the surgery, as this helps keep the area clean. Use one-half teaspoon of salt in a cup of water.
You should never smoke, use a straw or spit after a surgical tooth extraction. These actions can pull the blood clot out of the hole where the tooth was and cause a painful condition known as dry socket.
What is dry socket?
A problem known as dry socket develops in about 3% to 4% of all tooth extractions. This occurs when a blood clot doesn't form in the hole or the blood clot breaks off or breaks down too early. It is more likely to happen after a difficult extraction and it is more common among smokers and women taking birth control pills.
The reason this condition is so painful is that with a dry socket, the underlying bone is exposed to air and food. Not only will this require an aggressive pain management routine which includes a medicated dressing; it can also cause a bad odor or taste. Dry sockets typically begin to cause pain about three days after surgery.
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