The Dentists - General Dentistry // Extractions

Tooth Extraction.

A dental extraction, is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay, impacted or problematic wisdom teeth, for orthodontic treatment, and periodontal disease.

What is the History of removing teeth?

Historically, dental extractions have been used to treat a variety of illnesses, as well as a method of torture to obtain forced confessions! Before the discovery of antibiotics, chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries.

What are the reasons for extracting teeth?

The most common reason for extracting a tooth is tooth damage due to breakage or decay. Some other possible reasons for tooth extraction are as follows:

Extra teeth which are blocking other teeth from coming in.
Severe gum disease which may affect the supporting tissues and bone structures of teeth.
Severe tooth decay or infection.
In preparation for orthodontic treatment (braces).
Insufficient space for wisdom teeth (impacted wisdom teeth).
Receiving radiation to the head and neck may require extraction of teeth in the field of radiation.

Extractions are often categorized as "simple" or "surgical".

Simple extractions are performed on teeth that are visible in the mouth, usually under local anesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and subsequently using dental forceps, rocked back and forth until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove.

Surgical extractions involves the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or they have not erupted fully or they have roots that lock into your jaw bone. In a surgical extraction the dentist may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding bone tissue with a drill. Frequently, the tooth may be split into multiple pieces to facilitate its removal.

Complications:

Infection: although rare, it does occur on occasion. You may need to have antibiotics prescribed to help treat or prevent this. Sometimes the socket needs to be flushed out and dressed. This is sometimes known as a drysocket.
Prolonged bleeding: The dentist has a variety of means at his/her disposal to address bleeding, however, it is important to note that small amounts of blood mixed in the saliva after extractions are normal--even up to 48 hours after extraction.
Swelling: Often dictated by the amount of surgery performed to extract a tooth. Generally, surgical extraction you will get minor to moderate swelling after a surgical extraction.
Sinus exposure and oral-antral communication: This can occur when extracting upper molars and upper premolars. The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The risk is evaluated from x-rays. In the event of a sinus exposure, the dentist may decide to let it heal on its own or may need to surgically obtain closure using stitches. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period.
Nerve injury: This is primarily an issue with extraction of third molars, however, can technically occur with the extraction of any tooth should the nerve be in close proximity to the surgical site. Two nerves are typically of concern, and are found in duplicate (one left and one right side): 1. the inferior alveolar nerve, which enters your lower jaw and gives you the feeling in your lip. 2. The lingual nerve (one right and one left side), which gives you the sense of touch and taste to front of your tongue. Such injuries can occur while lifting teeth (typically the inferior alveolar), but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but sometimes can be permanent.
Displacement of tooth or part of tooth into the sinus (upper teeth only). In such cases, almost always the tooth or tooth fragment must be retrieved. You will be referred onto the hospital for this.

	Tooth Extraction. A dental extraction, is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay, impacted or problematic wisdom teeth, for orthodontic treatment, and periodontal disease. What is the History of removing teeth? Historically, dental extractions have been used to treat a variety of illnesses, as well as a method of torture to obtain forced confessions! Before the discovery of antibiotics, chronic tooth infections were often linked to a variety of health problems, and therefore removal of a diseased tooth was a common treatment for various medical conditions. Instruments used for dental extractions date back several centuries. What are the reasons for extracting teeth? The most common reason for extracting a tooth is tooth damage due to breakage or decay. Some other possible reasons for tooth extraction are as follows: Extra teeth which are blocking other teeth from coming in. Severe gum disease which may affect the supporting tissues and bone structures of teeth. Severe tooth decay or infection. In preparation for orthodontic treatment (braces). Insufficient space for wisdom teeth (impacted wisdom teeth). Receiving radiation to the head and neck may require extraction of teeth in the field of radiation. Extractions are often categorized as "simple" or "surgical". Simple extractions are performed on teeth that are visible in the mouth, usually under local anesthetic, and require only the use of instruments to elevate and/or grasp the visible portion of the tooth. Typically the tooth is lifted using an elevator, and subsequently using dental forceps, rocked back and forth until the periodontal ligament has been sufficiently broken and the supporting alveolar bone has been adequately widened to make the tooth loose enough to remove. Surgical extractions involves the removal of teeth that cannot be easily accessed, either because they have broken under the gum line or they have not erupted fully or they have roots that lock into your jaw bone. In a surgical extraction the dentist may elevate the soft tissues covering the tooth and bone and may also remove some of the overlying and/or surrounding bone tissue with a drill. Frequently, the tooth may be split into multiple pieces to facilitate its removal. Complications: Infection: although rare, it does occur on occasion. You may need to have antibiotics prescribed to help treat or prevent this. Sometimes the socket needs to be flushed out and dressed. This is sometimes known as a drysocket. Prolonged bleeding: The dentist has a variety of means at his/her disposal to address bleeding, however, it is important to note that small amounts of blood mixed in the saliva after extractions are normal--even up to 48 hours after extraction. Swelling: Often dictated by the amount of surgery performed to extract a tooth. Generally, surgical extraction you will get minor to moderate swelling after a surgical extraction. Sinus exposure and oral-antral communication: This can occur when extracting upper molars and upper premolars. The maxillary sinus sits right above the roots of maxillary molars and premolars. There is a bony floor of the sinus dividing the tooth socket from the sinus itself. This bone can range from thick to thin from tooth to tooth from patient to patient. In some cases it is absent and the root is in fact in the sinus. At other times, this bone may be removed with the tooth, or may be perforated during surgical extractions. The risk is evaluated from x-rays. In the event of a sinus exposure, the dentist may decide to let it heal on its own or may need to surgically obtain closure using stitches. Patients are typically provided with prescriptions for antibiotics that cover sinus bacterial flora, decongestants, as well as careful instructions to follow during the healing period. Nerve injury: This is primarily an issue with extraction of third molars, however, can technically occur with the extraction of any tooth should the nerve be in close proximity to the surgical site. Two nerves are typically of concern, and are found in duplicate (one left and one right side): 1. the inferior alveolar nerve, which enters your lower jaw and gives you the feeling in your lip. 2. The lingual nerve (one right and one left side), which gives you the sense of touch and taste to front of your tongue. Such injuries can occur while lifting teeth (typically the inferior alveolar), but are most commonly caused by inadvertent damage with a surgical drill. Such injuries are rare and are usually temporary, but sometimes can be permanent. Displacement of tooth or part of tooth into the sinus (upper teeth only). In such cases, almost always the tooth or tooth fragment must be retrieved. You will be referred onto the hospital for this.