Dental Extractions
In the past, people often had teeth extracted due to dental problems. These days, teeth are extracted less frequently because retention of teeth is nearly always better than extraction. However, there are times when extraction is the best treatment option.
The aim is to achieve the best outcome over the long term, while giving you the most satisfactory function and appearance possible. Your dentist is in the best position to evaluate your situation.
For the extraction of wisdom teeth, also called third molars, refer to the Wisdom Tooth or ADA patient education pamphlet "Wisdom teeth and what to do about them", available from your dentist.
TOOTH EXTRACTION IN CHILDREN: The primary (deciduous) teeth, sometimes called baby teeth or milk teeth, are rarely extracted as they are important for the proper eruption of secondary (permanent) teeth.
REASON FOR EXTRACTION
Teeth may have to be removed for several reasons, as follows.
EXTENSIVE DAMAGE TO A TOOTH
If a tooth is badly decayed or damaged due to trauma, extraction may be necessary.
PERIODONTAL DISEASE
Due to poor dental hygiene and a build up of plaque and calculus (tartar) on a tooth, the gums may become inflamed and infected (periodontal disease). If not treated promptly, periodontal disease is likely to damage the underlying bone and other tissues around the tooth's root. The infection may cause the tooth to become loose in its socket. Despite treatment, saving the tooth may not be possible.
PREVENTION OF COMPLICATION
If badly diseased teeth are not extracted promptly, complication such as infection or abscess in the teeth or roots, or the spread of infection through the blood stream to other parts of body may occur. This may affect the general health of the patient.
TO IMPROVE APPEARANCE
As part of orthodontic treatment or a treatment plan to improve the appearance of teeth, your dentist may recommend removing a tooth which interferes with another.
TEETH WITH NO FUNCTION
A tooth without an opposing partner to grind against during chewing may be better removed.
VERTICAL CRACKS IN A TOOTH ROOT
A root may shift and split, and crack upwards or downwards. If repair is not possible, extraction may be necessary.
THE DECISION TO REMOVE A TOOTH
Removal of a tooth or teeth is only done after careful consideration and discussion with your dentist. Every effort is made to preserve teeth because they function better than artificial teeth such as dentures, bridges or implants.
In an attempt to save a tooth, your dentist may recommend a root canal treatment. However, it is not suitable in every case and is recommended only if successful treatment is likely.
A missing tooth can cause nearby teeth to move out of their normal position and tilt into the gap. This often makes chewing and biting difficult. It may also cause more decay and gum disease around the tilted teeth as thorough cleaning can be difficult. To prevent neighbouring teeth from moving into the gap, a bridge, plate or dental implant may be necessary.
X-RAY EXAMINATION
The dentist may taken an X-ray film of the tooth and the jaw. The film may help the dentist to plan the best and safest way to remove the tooth.
ANAESTHESIA
Local anaesthesia: A local anaesthetic is injected into the gum to numb the area around the tooth or teeth to be extracted. A tablet may be given to help the patient relax.
Conscious sedation with local anaesthesia: The patient is sedated with a medication but remains awake and can cooperate with the dentist.
General anaesthesia: The patient is asleep for the extraction. The patient should not eat or drink anything for six hours before surgery. The dentist will provide full instructions.
Modern anaesthesia is safe with few risks. However, a few people may have serious reactions to an anaesthetic. If you have ever had a reaction to an anaesthetic drug, tell your dentist.
THE EXTRACTION OF TEETH
The method of extraction will vary depending on type of tooth and its roots, and its position in the jaw.
Some teeth are relatively easy to remove, while others can be difficult. Difficult extractions are usually due to:
HOMECARE AFTER EXTRACTION
POSSIBLE SIDE EFFECTS OF EXTRACTION
All types of surgery, including the extraction of teeth, are associated with some risk. Despite the highest standards of practice, complications are possible.
It is not usual for dentist to dwell at length on every possible side effect or rare but serious complication of any dental procedure. However, it is important that you have enough information to weigh up the benefits and risks of extraction. Most patients will not have complications, but if you have concerns about possible side effects, discuss them with your dentist. The following list of possible complications is intended to inform you, not to alarm you. There may be others that ar not listed.
PAIN
Pain may occur once the effect of the anaesthetic has worn off. Your dentist will advise you about pain relief and prescribe the best tablets to take.
NUMBNESS OR ALTERED SENSATION
If a nerve may become bruised or injured during extraction, numbness, tingling and loss of feeling in teeth, gums, cheeks, lips, chin, tongue may occur. This effect will usually disappear over a few weeks as the nerve recovers. In some people, complete healing of the nerve may take six months to 18 months. In rare cases, the nerve may not heal completely, and numbness or altered sensation may be permanent.
DRY SOCKET
This occurs if the blood clot that normally forms in the socket is washed away or dissolves, exposing the bone underneath. This is called a "dry socket". The result is a constant throbbing pain that may last for many days. If you have pain like this, contact your dentist. To help prevent a dry socket:
INFECTION
An infection in the gum or bone may occur after extraction. If you develop a fever, bleeding or increasing pain, infection may be the cause. Contact your dentist at once. If you have ever had an allergic reaction to any antibiotic or other drug, tell your dentist.
BLEEDING (HAEMORRHAGE)
Although uncommon, haemorrhage may occur. It can be stopped by putting gauze over the wound and applying pressure by biting gently on the gauze for 15 minutes. If severe bleeding does not stop, tell your dentist at once.
DAMAGE TO NEARBY TOOTH OR FILLINGS
Although rare, the tooth or filling next to the tooth to be removed may be chipped or loosened during an extraction.
SINUS PROBLEMS
The roots of the some upper teeth are close to the sinuses. In some cases, a sinus may be opened when a tooth is removed. The opening will usually heal quickly without infection. However, if infection sets in or other problems start, more treatment may be neccesary.
However, if an infection sets in or other problems start, more treatment may be necessary.
THINNING OF JAW BONE
Bone at the base of the extracted tooth is likely to thin a little over time. Thinning and fragility of jaw bone can become significant if many teeth are missing. To reduce thinning, jaw bone needs to have the pressures of daily chewing exerted on it. Your dentist may recommend dental implants or dentures to help prevent thinning.
The aim is to achieve the best outcome over the long term, while giving you the most satisfactory function and appearance possible. Your dentist is in the best position to evaluate your situation.
For the extraction of wisdom teeth, also called third molars, refer to the Wisdom Tooth or ADA patient education pamphlet "Wisdom teeth and what to do about them", available from your dentist.
TOOTH EXTRACTION IN CHILDREN: The primary (deciduous) teeth, sometimes called baby teeth or milk teeth, are rarely extracted as they are important for the proper eruption of secondary (permanent) teeth.
REASON FOR EXTRACTION
Teeth may have to be removed for several reasons, as follows.
EXTENSIVE DAMAGE TO A TOOTH
If a tooth is badly decayed or damaged due to trauma, extraction may be necessary.
PERIODONTAL DISEASE
Due to poor dental hygiene and a build up of plaque and calculus (tartar) on a tooth, the gums may become inflamed and infected (periodontal disease). If not treated promptly, periodontal disease is likely to damage the underlying bone and other tissues around the tooth's root. The infection may cause the tooth to become loose in its socket. Despite treatment, saving the tooth may not be possible.
PREVENTION OF COMPLICATION
If badly diseased teeth are not extracted promptly, complication such as infection or abscess in the teeth or roots, or the spread of infection through the blood stream to other parts of body may occur. This may affect the general health of the patient.
TO IMPROVE APPEARANCE
As part of orthodontic treatment or a treatment plan to improve the appearance of teeth, your dentist may recommend removing a tooth which interferes with another.
TEETH WITH NO FUNCTION
A tooth without an opposing partner to grind against during chewing may be better removed.
VERTICAL CRACKS IN A TOOTH ROOT
A root may shift and split, and crack upwards or downwards. If repair is not possible, extraction may be necessary.
THE DECISION TO REMOVE A TOOTH
Removal of a tooth or teeth is only done after careful consideration and discussion with your dentist. Every effort is made to preserve teeth because they function better than artificial teeth such as dentures, bridges or implants.
In an attempt to save a tooth, your dentist may recommend a root canal treatment. However, it is not suitable in every case and is recommended only if successful treatment is likely.
A missing tooth can cause nearby teeth to move out of their normal position and tilt into the gap. This often makes chewing and biting difficult. It may also cause more decay and gum disease around the tilted teeth as thorough cleaning can be difficult. To prevent neighbouring teeth from moving into the gap, a bridge, plate or dental implant may be necessary.
X-RAY EXAMINATION
The dentist may taken an X-ray film of the tooth and the jaw. The film may help the dentist to plan the best and safest way to remove the tooth.
ANAESTHESIA
Local anaesthesia: A local anaesthetic is injected into the gum to numb the area around the tooth or teeth to be extracted. A tablet may be given to help the patient relax.
Conscious sedation with local anaesthesia: The patient is sedated with a medication but remains awake and can cooperate with the dentist.
General anaesthesia: The patient is asleep for the extraction. The patient should not eat or drink anything for six hours before surgery. The dentist will provide full instructions.
Modern anaesthesia is safe with few risks. However, a few people may have serious reactions to an anaesthetic. If you have ever had a reaction to an anaesthetic drug, tell your dentist.
THE EXTRACTION OF TEETH
The method of extraction will vary depending on type of tooth and its roots, and its position in the jaw.
Some teeth are relatively easy to remove, while others can be difficult. Difficult extractions are usually due to:
- Adjacent teeth having crowns or large restorations (fillings)
- the tooth being in an abnormal position and affecting neighbouring teeth.
- A nerve lying near the tooth to be extracted.
- Roots that are large and curved, or that penetrate deeply into the jaw bone.
- An unerupted or impacted tooth, or a tooth that is fused to the jaw bone (ankylosis).
HOMECARE AFTER EXTRACTION
- Rest at home after the extraction.
- Depending on the number of teeth removed, you may need to take time off work, school or other duties.
- Avoid drinking containing alcohol while you are taking pain killers or antibiotics.
- Eat soft foods such as soups, blended (pureed) vegetables and meat and jellies for the first two days.
- Drink a lot of fluids.
- Use ice packs to reduce any swelling and pain.
- If you have had any form of sedation, such as a tablet or injection, do not drive or ride a motorcycle or bicycle, operate machinery or engage in active exercise for the rest of the day.
POSSIBLE SIDE EFFECTS OF EXTRACTION
All types of surgery, including the extraction of teeth, are associated with some risk. Despite the highest standards of practice, complications are possible.
It is not usual for dentist to dwell at length on every possible side effect or rare but serious complication of any dental procedure. However, it is important that you have enough information to weigh up the benefits and risks of extraction. Most patients will not have complications, but if you have concerns about possible side effects, discuss them with your dentist. The following list of possible complications is intended to inform you, not to alarm you. There may be others that ar not listed.
PAIN
Pain may occur once the effect of the anaesthetic has worn off. Your dentist will advise you about pain relief and prescribe the best tablets to take.
NUMBNESS OR ALTERED SENSATION
If a nerve may become bruised or injured during extraction, numbness, tingling and loss of feeling in teeth, gums, cheeks, lips, chin, tongue may occur. This effect will usually disappear over a few weeks as the nerve recovers. In some people, complete healing of the nerve may take six months to 18 months. In rare cases, the nerve may not heal completely, and numbness or altered sensation may be permanent.
DRY SOCKET
This occurs if the blood clot that normally forms in the socket is washed away or dissolves, exposing the bone underneath. This is called a "dry socket". The result is a constant throbbing pain that may last for many days. If you have pain like this, contact your dentist. To help prevent a dry socket:
- You may rinse your mouth very gently with warm salt water to wash away the blood. Do not rinse vigorously or spit with force because you may loosen the blood clot and cause slow healing. Rinse every four hours or more often. This will help healing, reduce swelling and pain, and reduce the risk of infection.
- Do not smoke after surgery. Smoking interferes with healing.
- For the first day after surgery, do not brush your teeth around the area of surgery. After first day, brush gently
INFECTION
An infection in the gum or bone may occur after extraction. If you develop a fever, bleeding or increasing pain, infection may be the cause. Contact your dentist at once. If you have ever had an allergic reaction to any antibiotic or other drug, tell your dentist.
BLEEDING (HAEMORRHAGE)
Although uncommon, haemorrhage may occur. It can be stopped by putting gauze over the wound and applying pressure by biting gently on the gauze for 15 minutes. If severe bleeding does not stop, tell your dentist at once.
DAMAGE TO NEARBY TOOTH OR FILLINGS
Although rare, the tooth or filling next to the tooth to be removed may be chipped or loosened during an extraction.
SINUS PROBLEMS
The roots of the some upper teeth are close to the sinuses. In some cases, a sinus may be opened when a tooth is removed. The opening will usually heal quickly without infection. However, if infection sets in or other problems start, more treatment may be neccesary.
However, if an infection sets in or other problems start, more treatment may be necessary.
THINNING OF JAW BONE
Bone at the base of the extracted tooth is likely to thin a little over time. Thinning and fragility of jaw bone can become significant if many teeth are missing. To reduce thinning, jaw bone needs to have the pressures of daily chewing exerted on it. Your dentist may recommend dental implants or dentures to help prevent thinning.