Tooth Extractions

We offer Dental Care, not just dental treatments.

Why I May Need a Tooth to be Pulled Out

Our philosophy is to save and restore the natural teeth to maintain the optimum function of the oral cavity. Nevertheless, there may be some situations where tooth extractions is the only option. These may include:

Gross Decay in Tooth

If the tooth is badly damaged, from decay or trauma and beyond repair

Infection

Gross decay (cavity) in a tooth may penetrate the pulp tissue of the tooth and may produce infection and abscess in the tooth or surrounding gum and bone. While our conservative approach would be to save the tooth with antibiotic therapy and root canal therapy (RCT), in some cases, tooth extraction is the only choice to prevent the spread of the infection

Further, risk of infection spread from a grossly decayed tooth may be greater in patients who are undergoing chemotherapy or organ transplant, due to compromised immunity. This may be a reason for extraction

Periodontal (Gum) Disease

Chronic gum disease will lead to loss of gum and bone tissue around teeth, thus causing loosening of the teeth. It may warrant for tooth extraction.

Crowding in the Dental Arches

Misaligned teeth may create crowding in the mouth and may need Orthodontic treatment to align them straight. Thus, some teeth may be extracted to make space for others to come in normal position. Similarly, if a tooth is not erupting because of lack of space, it may need extraction

Extraction of even a single tooth has an impact on chewing ability, drifting of the teeth and sometimes on the jaw joint. This may have a considerable impact on your dental health. Thus, we will discuss all the options for replacement of extracted tooth before we schedule your extraction appointment.

Medical History Review:

Like any other surgical procedure, tooth extraction is also an oral surgical procedure. Thus, thorough review of your medical history including medications and recent surgeries must be discussed with your dentist. Certain medical conditions may warrant for prophylactic antibiotics in order to reduce the risk of bacteria travelling to blood stream. In some cases, you may need to take antibiotics before and after the extraction. You must inform your dentist if you have one of the following:

• History of bacterial endocarditis
• Artificial joint, such as a hip replacement
• Impaired immune system
• Damaged or man-made heart valves
• Congenital heart defect
• Liver disease (cirrhosis)

Tooth Extraction Appointment

Before extraction, dentist will review your medical history. A local anesthetic injection will be given in the area where the tooth has to be removed in order to numb the tooth and surrounding gum and bone tissue. This will reduce/eliminate pain during the procedure. Sometimes gum and bone tissue might need to be removed in the case of impacted (unerupted tooth) to facilitate the tooth removal. Using elevators and tooth forceps tooth is rocked back and forth to loosen it from the bony socket. Occasionally, tooth might have to be removed in pieces by sectioning the tooth if it is grossly decayed or fused to the bony socket.

After extraction, dentist will place a gauze pad on the socket to stop the bleeding and facilitate stabilization of blood clot.

Sometimes, if clot gets destabilized, it may expose the bone in the socket. This condition called “dry-socket” is very painful and could happen in 0.5–5.6% following surgical extraction of third molars (wisdom tooth). If this happens, your dentist will irrigate the socket, place a sedative dressing and may prescribe you some pain medication.

After the Tooth Extraction:

During recovery phase, please follow the post-op instructions given verbally and in written. This will help to minimize discomfort, reduce the risk of infection, and speed recovery.

• Immediately following surgery, maintain pressure on the surgical area by biting down on the provided gauze pad or roll until the bleeding stops. A certain amount of bleeding is to be expected following a surgical procedure. Placing the gauze pad over the area and biting firmly will help prevent excessive bleeding. Replace the gauze as necessary until the bleeding stops.
• For a few days following surgery, you may become dizzy when getting up. Sit up slowly, and give yourself a minute to adjust before getting up and walking.
• Avoid vigorous activities for three to four days after surgery. You may go back to your normal routine as tolerated.
• Please fill any prescriptions you have been given and take as directed. If you have been prescribed pain medication other than aspirin, Tylenol or ibuprofen (Advil or Motrin), do not drive, operate heavy equipment, work around machinery or tools, or engage in any other activity that may be unsafe when groggy, as your reflexes and judgment will be affected by the medication.
• Antibiotics may be prescribed to help prevent infection. If you have been placed on antibiotics, take the medicine as directed.
• Swelling and stiffness are to be expected the first 24 hours after surgery. Swelling around the face, eyes, and surgical site is not uncommon and may become more noticeable two to three days following surgery. Applying a cold compress to the face near the extraction site will help minimize swelling. If using an ice pack, please do not apply ice directly to your skin but place a cloth between the ice and your skin at all times.  You may apply the cold compress for up to 20 minutes on and at least 20 minutes off as needed. After 36 hours the cold compress will have no further impact on swelling. After this period, the application of moist heat to the sides of the face can help reduce swelling.
• For 24-48 hours following your surgery, do not suck on a straw, drink from a bottle, rinse, spit, or smoke. Avoid hot and spicy foods, carbonated and alcoholic beverages.
• During the first few days after surgery, restrict your diet to liquids and soft foods such as soups, yogurt, juice, and smoothies.
• Do not rinse, spit, or brush your teeth on the day of surgery. Resume brushing the day after surgery, avoiding surgical sites with the toothbrush.
• After brushing, rinse gently with warm salt water (1/2 teaspoon of salt mixed with eight ounces of warm water). Start the salt water rinse the day after surgery and repeat 3 times a day for 7-10 days. This will help keep the surgical areas clean and will also help dissolve the sutures.
• Please do not use the irrigating syringe for the first five days. After five days, fill the syringe with warm salt water and flush out the socket. This will flush out any food or debris.
• If you are experiencing numbness of the lip, chin, or tongue, be aware that this is usually temporary in nature and normal feeling should return after a few days. Until then, please be cautious while eating and chewing in order to avoid accidentally biting your tongue, cheek or lip.
• A dry socket can develop when blood clot gets dislodged prematurely from the walls of the tooth socket. Symptoms of a dry socket include throbbing pain at the surgical site, the ear, chin, adjacent teeth, and/or jaw. These symptoms indicate a dry socket when they occur three to four days following surgery and do not respond to pain medication.
• Please call our office if you experience severe pain, excessive bleeding or swelling, or if you have any questions or concerns. If you are experiencing a serious or life threatening emergency, please call 911 or visit the nearest emergency room.

When to Call the Dentist

You may feel some pain, swelling and residual bleeding after the anesthesia wears off. This is normal. However, if either bleeding or pain has not subsided in 4-6 hours after extraction, contact our office and speak to the dental team. You should also call your dentist if you experience any of the following:

• Redness, swelling, or excessive discharge from the affected area
• Signs of infection, including fever and chills
• Nausea or vomiting
• Cough, shortness of breath, chest pain, or severe nausea or vomiting

During recovery phase, initial healing will take place in about one to two weeks with formation of new bone and gum tissue around the socket.

It is recommended to consult your dentist with the options to replace the missing tooth to prevent shifting of other teeth and thus restore your bite, chewing and esthetics. Dentist may advise replacing the space with a fixed bridge; dental implant or removable partial denture.

 

References:

1. WebMD Medical Reference Reviewed by Alfred D. Wyatt Jr., DMD on August 15, 2018
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4060391/#:~:text=Incidence%20of%20dry%20socket%20has,%25%20%5B4%E2%80%938%5D.