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When it concerns dental procedures, tooth extraction — or having teeth “pulled” — is amongst patients’ most dreaded prospects.
Also referred to as exodontia, tooth extraction involves removing a tooth from its socket in the jaw bone. Before your dental expert considers extraction, every effort will be made to aim to repair and restore your tooth. However, in some cases a tooth extraction is essential.
Reasons for Tooth Extraction
There are several reasons for drawing out a tooth. These include:
- Severe Tooth Damage/Trauma: Some teeth have such substantial decay and damage (broken or cracked) that repair work is not possible. For example, teeth impacted by advanced gum (gum) disease may have to be pulled. As gum disease worsens, the tooth– supported by less surrounding bone– typically loosens to such an extent that tooth extraction is the only solution.
- Malpositioned/Nonfunctioning Teeth: To avoid possible complications that may lead to an ultimate, unfavorable impact on oral health, your dental practitioner may recommend removing teeth that are malaligned and/or basically useless (teeth that have no opposing teeth to bite against).
- Orthodontic Treatment: Orthodontic treatment, such as braces, may require tooth extraction to make needed space for enhanced teeth alignment.
- Additional Teeth: Likewise described as supernumerary teeth, extra teeth may block other teeth from emerging.
- Radiation: Head and neck radiation therapy might require the extraction of teeth in the field of radiation in order to assist prevent possible complications, such as infection.
- Chemotherapy: Chemotherapy deteriorates the immune system, increasing the risk of tooth infections, heightening the risk of extraction.
- Organ Transplant: Immunosuppressive medications prescribed after organ hair transplant can increase the probability of tooth infection. As such, some teeth require elimination prior to an organ transplant.
Commonly Extracted Teeth
Wisdom teeth elimination is one of the more typical categories of tooth extraction. Many dental specialists will suggest eliminating wisdom teeth (3rd molars) prior to they are fully established– typically in the adolescent years– to assist remove possible issues. One problem that might take place is advancement of an impacted tooth that has appeared and has no space in the mouth to grow. Other issues associated with affected teeth include infection, decay of surrounding teeth, bite disturbance and gum disease.
Extractions of some permanent teeth that have not appeared– such as the canines, which are also known as fangs or eye teeth– might be required in order to make area for orthodontic treatment.
Types of Tooth Extractions
There are two types of tooth extractions:
- Basic Extractions: These are performed on teeth that are visible in the mouth. General dentists commonly do simple extractions, and most are generally done under a local anesthetic, with or without anti-anxiety medications or sedation.
- Surgical Extractions: These include teeth that can not quickly be seen or reached in the mouth, either due to the fact that they have actually broken off at the gum line or they have not totally emerged. Carried out by dental practitioners or oral cosmetic surgeons, surgical extractions require some type of surgical procedure, such as bone elimination, removing and/or raising and folding back all or part of the gum tissue to expose the tooth, or breaking the tooth into pieces (called tooth sectioning). Surgical extractions can be maded with regional anesthesia and/or conscious sedation. Patients with special medical conditions and kids may get basic anesthesia.
Preparing for Your Tooth Extraction
Prior to a tooth extraction, your dentist or oral cosmetic surgeon will discuss your medical and dental histories and take X-rays. Some dental experts will prescribe antibiotics to be taken in the past and after surgery. Antibiotics are most likely to be given to patients with infection or weakened body immune systems at the time of surgery, those undergoing longer surgeries, or young or elderly people.
To prevent possible complications, inform your dentist about all the medications– prescriptions, over-the-counter (OTC) and natural– you are taking. For example, aspirin slows the blood-clotting procedure; gingko biloba and ginseng also impact clotting.
Lots of people like to be sedated for a tooth extraction. Possible sedation dentistry choices include nitrous oxide (” laughing gas”), an oral sedative (such as a Valium tablet) or an intravenous sedative that is administered into your veins by injection. If you opt for laughing gas, you can drive yourself home. If you choose among the other types of sedation, you will require somebody to drive you to and from your dental check out.
What to Expect During a Tooth Extraction Procedure
At the extraction appointment, your dental practitioner will numb, or anesthetize, the tooth to be drawn out, in addition to the jawbone and gums surrounding it. Generally, a local anesthetic such as novocaine or lidocaine is injected to get rid of pain.
- Basic Extraction: Your dental practitioner will comprehend the tooth with specialized pliers called extraction forceps and move them back and forth to loosen the tooth before eliminating it. Sometimes, a surgical cutting instrument called a luxator — which fits in between the tooth and the gum– is used to help loosen the tooth. Dental practitioners likewise use “elevators,” which are levers that look just like little screwdrivers. Usually a dental practitioner will first use an elevator to wedge between the tooth and the surrounding bone. The elevator places pressure on the tooth, which helps to broaden the tooth’s socket and separate its ligament.
- Surgical Extractions: These treatments generally are more complicated, so your dental expert might sedate you before numbing your tooth, then use a dental drill, apply pressure to your tooth with an elevator or extraction forceps, and eliminate your tooth. Greater surgical effort might be needed in other cases. For example, gum and/or bone tissue may cover or surround a tooth in a way that makes it challenging for your dental expert to view and/or gain access to it. If so, your dental professional will have to cut and raise back or remove this tissue. Sometimes a tooth is so securely anchored in its socket that your dentist need to cut the tooth into pieces in order to remove each portion separately.
Your dental professional might need to place stitches and/or add bone (natural or synthetic) in the extraction site after the procedure. Some stitches are absorbable and will break down on their own; others require elimination by your dentist, generally about a week after the extraction.
Modern Tooth Extraction
While surgical cutting instruments like scalpels and dental drills are still typically used in surgical extractions, using dental lasers and electrosurgery in such procedures is growing.
Lasers use high-energy beams to cut, while electrosurgery uses regulated heat to cut. Advantages of laser surgery and electrosurgery as a help in tooth extraction compared with traditional scalpels and dental drills consist of greater precision, less opportunity of damage to surrounding structures, less bleeding and pain, and quicker healing time. However, the disadvantages of their use include greater expenses, the smell of burning flesh during the procedure, and the failure to use them to directly extract teeth.
Tooth Extraction Aftercare
Considering that bleeding is typical after an extraction, your dental expert will have you bite on a piece of gauze for about 45 minutes to put pressure on the area and enable the blood to clot. Some swelling and pain are normal after a tooth extraction.
Cold compresses or ice packs can assist reduce the swelling. If your jaw is sore and stiff after the swelling dissipates, use warm compresses. Sleeping with your head face up to eliminate pressure on the jaw, and keeping your head raised with extra pillows also may assist. In addition, your dentist might suggest you take an OTC pain reliever such as ibuprofen (Motrin or Advil) for numerous days. With surgical extractions — which normally cause more pain afterwards– your dental practitioner might recommend a prescription pain medication.
Other aftercare tips include:
- Do not rinse your mouth for the first 24 hours right away following a tooth extraction.
- Stick to a soft or liquid diet (milk, ice cream, mashed potatoes, pudding) the day of and the day after a tooth extraction, slowly progressing to eating other easy-to-chew foods. Chew with teeth that are far from the extraction site.
- Brush and floss the other teeth as normal, but prevent the teeth and gum beside the extraction socket.
- After the first 24 Hr, for at least 5 days after extraction, carefully rinse the socket with warm salt water (1/2 teaspoon of salt in a cup of water) after meals and prior to bed.
Things to Avoid After Tooth Extraction
In addition to the aforementioned aftercare considerations, tooth extraction aftercare likewise includes avoiding certain foods and activities.
- Prevent anything that might remove the embolism and delay or avoid normal recovery.
- Do not smoke, intensely rinse or spit, participate in laborious activities, or drink through a straw for at least two days after an extraction.
- Stay away from hot liquids, foods that are crunchy or consist of seeds or small grains, alcohol, and carbonated sodas for two to three days after tooth extractions.
- Do not brush your gums or use an OTC mouth rinse (you can use homemade water-and-salt washes).
Possible Tooth Extraction Complications
There are a number of prospective complications that may occur as an outcome of a tooth extraction. These complications might include:
- Unexpected damage to nearby teeth.
- Insufficient extraction, where a tooth root remains in the jaw. Your dentist generally gets rid of the root to prevent infection, however often it’s less dangerous to leave in a little root pointer.
- Alignment problems associated with chewing capability or jaw joint function. Misaligned teeth might cause pain, teeth grinding (bruxism) and cracking or splintering of teeth holding up against the force of the jaw.
- Furthermore, misaligned teeth can trap food and be harder to clean, consequently increasing the risk for dental caries and gum disease.
- Fractured jaw (usually occurring in older individuals with osteoporosis of the jaw) triggered by the pressure placed on the jaw during extraction.
- If an upper tooth was extracted, a hole may have been made into one of the sinus areas. Normally, it will heal rapidly on its own; but if it doesn’t, you might have to return to your dental expert.
- Infection, while unusual, does periodically occur. Your dental practitioner might recommend antibiotics before and after the extraction if identified you may be at risk of infection.
- Nerve injury — while mostly a concern with extractions of lower wisdom teeth– can occur with the elimination of any tooth if the nerve is near the extraction site. Generally caused by damage from a surgical drill, nerve injuries are unusual and generally temporary.
- Bisphosphonates — drugs used to prevent/treat osteoporosis, numerous myeloma, bone cancer and bone metastasis from other cancers– might put patients who undergo tooth extractions at risk for developing osteonecrosis of the jaw (a rotting of the jaw bones). It is thought that bisphosphonates attack the teeth and bone, and may prevent cells that break down bone from working. If you are taking an osteoporosis medication such as Fosamax, try to avoid extraction whenever possible, rather than select removal of the tooth/teeth.
- Without an opposing tooth, the tooth above or below the extraction socket will, gradually, move out of its socket, likely exposing its roots and ending up being conscious temperature changes. Especially when numerous teeth have been extracted, another possible long-term problem is thinning of the jawbone, which then becomes easier to break.
- Tooth extractions — especially of front teeth — might negatively affect your appearance.
Unless it is a wisdom tooth, your dental expert likely will advise changing any drawn out tooth to prevent possible complications, such as moving of the teeth, gum economic crisis and bone loss. Dental implants are the perfect tooth replacement; dental bridges and dentures are other options.
Dry socket, a common problem after a tooth extraction, takes place when an embolism has actually failed to form in the socket, or the blood clot that did kind has been dislodged. This leaves the underlying bone and nerves exposed to air and food. Typically quite painful, dry socket usually appears two to five days after extraction and can cause a bad smell or taste.
Dry socket is most regularly connected with tough or terrible tooth extractions, such as the extraction of lower wisdom teeth. It takes place regularly with individuals over the age of 30, smokers, those with poor oral hygiene routines and women (especially those taking contraceptive pills). Unless there is an emergency situation, professionals advise that women using contraceptive pills arrange their extractions during the recently of their menstruation, when estrogen levels are lower.
In most cases, if you develop dry socket, your dental professional will place a medicated dressing into the socket to soothe the pain and encourage recovery. The dressing is replaced every 24 hours till the symptoms of dry socket minimize (about 5 to seven days).
Healing Time for Tooth Extractions
Healing from a tooth extraction takes about five to seven days. The gum area ought to be fully healed in three to 4 weeks. If the jaw is damaged during tooth extraction, full healing may take up to six months.
Cost of Tooth Extractions
Generally, the more difficult the tooth is to remove, the more the procedure costs. Tooth extraction costs range from roughly $130 to $400. An easy tooth extraction of a long-term tooth can range from $100 to $250. Surgical extractions of long-term teeth cost $180 to $400; an easy tooth extraction of a primary teeth ranges from $90 to $150.