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Tooth Extraction; Reasons, Procedure, Before and After

A tooth extraction is an outpatient procedure performed by a dentist. In some cases pulling teeth (removing a tooth completely from its spot in the jaw bone), may be necessary to preserve or improve your dental health. The procedure maybe done in simple or surgical methods.

Reasons for Extracting a Tooth



Trauma or Disease


In both of these situations, we can try to save the tooth in several ways. The damaged tooth might need a full-coverage crown, a root canal treatment, or both. But sometimes even these methods are not enough to keep the tooth functioning well and looking good; it might be better to remove the tooth and replace it with a strong and lifelike dental implant.


Orthodontic Treatment



Teeth are sometimes extracted when there are too many of them for the size of the dental arches (jaws), a situation known as crowding. After an adequate amount of space is opened up through the extraction of one or more teeth, the remaining teeth can be aligned properly. The teeth most frequently removed for orthodontic reasons are the first premolars, which are right next to the eyeteeth (canines).

Infection/decay


Infection within teeth is often as a result of decay. Decay breaks down the tooth surface and bacteria can get inside the tooth where there are nerves and blood vessels. Once this infection gets to the nerve area of the tooth, action needs to be taken to remove the bacteria. If this is not done soon enough you may develop an abscess. Temporary fillings/dressings, root fillings, and (in rare cases) antibiotics are ways to manage infection. The first course of action is physically removing the bacteria and infection with a dressing into the root (pulp extirpation). Antibiotics are only required for severe swellings and where the infection is spreading. Once an infection is within the tooth it can get into the bloodstream. Ultimately this could result in sepsis. Severe infection may require tooth removal if a dressing cannot be placed, or if the tooth is not suitable for a root filling.

Impacted Wisdom Teeth


Early removal of impacted wisdom teeth can prevent damage to neighboring healthy teeth, bone, gum tissue, even nerves and blood vessels. If an impacted wisdom tooth is in a bad position, it's best to remove it before its roots are fully formed.

Baby Teeth



If a baby tooth is out of position or not lost in the right sequence, the permanent tooth underneath it might not erupt normally. In this case, removing the baby tooth could prevent a need for orthodontic treatment later on.

Preparation for tooth removal



Should tooth extraction be the course of action that you chose, before the dentist takes out the tools and begins the process, there are some steps that need to be completed.The exact process will vary from one dental clinic to another but most will follow steps that include:

Assessment


 A detailed assessment of your mouth and teeth condition should be made prior to an extraction.
 X-rays will be taken to give a different view on the teeth causing concern.

Diagnosis/consideration of alternative treatment


 The diagnosis will explain the cause of the problem.
 The treatment options may be tooth removal, but extraction is not always the only option.
 Make sure consideration has been made for possible alternative options.

Medical history


 Your medical history should be checked to ensure you are able to have the treatment and any risks are known.
 Let your dentist know of any medical history that may affect the extraction process or recovery. Examples include:
 Damaged or man-made heart valves
 A congenital heart defect
 An impaired immune system
 Liver disease (cirrhosis)
 An artificial joint, such as a hip replacement
 A history of bacterial endocarditis
 Medications that thin the blood, e.g. warfarin
 Medications that affect your immune response

Tooth Extraction Procedure: Getting a Tooth Pulled




When you undergo a tooth extraction procedure, your dentist will numb the area with a local anesthetic. You may also receive an anti-anxiety medication or an intravenous sedative. If the dental extraction involves an impacted tooth, the tooth may be broken into pieces before it is removed.
Pulling teeth falls into two basic categories: simple and surgical. Here’s what to expect from each:

Simple


A simple tooth extraction involves the removal of a tooth that is visible in the mouth. This could mean removing a badly damaged or decayed tooth, or removing teeth prior to getting braces. General dentists can do simple tooth extractions. When you undergo simple tooth extraction, you will receive local anesthesia. In addition, some dental professionals administer anti-anxiety medication or use conscious sedation for simple cases of pulling teeth. In most cases, over-the-counter pain medication is sufficient for pain management after these procedures.

Surgical


Surgical tooth extraction is an operation by an oral surgeon involving removal of teeth that are not visible in the mouth, because they have not come in or because the tooth has broken off. Individuals with special medical conditions may receive general anesthesia when pulling teeth involving surgery. You may also receive prescription pain medication for use immediately after surgical teeth-pulling procedures.

Complications After Tooth Extraction



Pain



It is normal for you to have some pain after your surgery. This normally decreases over the first few days after surgery. The severity of pain can vary and depends on the type of surgery performed, your response to pain killers and your individual pain tolerance. Dentists do not prescribe pain killers routinely and would advise you to purchase over-the-counter medicine. The most effective pain killers for dental surgery are ibuprofen and paracetamol, which can be used in combination.

Swelling


After surgery, swelling of the mouth is normal, even for simple procedures. Swelling will tend to increase over the first 48 hours and last for a further five to seven days before resolving. It is a normal part of the healing process and does not mean you have an infection in the immediate post-surgery period. Swelling may be visible outside the mouth and may be associated with bruising.

Stitches


If stitches have been placed in your mouth as part of your surgery, these will normally dissolve away. This can take up to two weeks. It is possible that stitches may come loose or be lost immediately after surgery, this does not normally cause a problem. If we have used nondissolving stitches these will need to be removed either at a follow up appointment or by your local dentist or doctor.

Infection

There is normally a very low risk of infection after oral surgery procedures and as a result of this, plus evidence of increasing risk of resistance to antibiotics, we do not routinely prescribe antibiotics. From the day after your surgery, you can help avoid infection by rinsing your mouth with warm salt water (one teaspoon of salt in a glass of warm water, and remember to spit the water out). This should not be started until eight hours after your treatment. It should be done at least four times a day for four to five days. You should not rinse your mouth out on the day of surgery as this may wash out the blood clot and delay healing. If you have had an extraction and you suspect there is an infection in the socket, the pain and swelling will usually become worse about four to six days after surgery. If you are concerned then contact the Oral Surgery Department or your local dentist for further advice (contact details can be found at the end of this leaflet).

Bleeding


If bleeding occurs, take one of the gauze packs provided, moisten it lightly, place over the socket and bite firmly for at least 15 minutes or until the bleeding stops. See the emergencies section below for advice about what to do if the bleeding does not stop. The presence of blood staining of your saliva is normal for a few days after surgery.

Dry socket


This is a relatively common problem following tooth extraction. It is more likely in patients who smoke and/or those who are taking the contraceptive pill. The problem usually occurs about two days after the tooth has been removed with increasing pain, a foul taste and bad breath. This is treated by careful washing of the socket and placement of an antiseptic dressing by either our emergency team or your local dentist. This is not treated with antibiotics.

Tooth extraction healing, recovery and aftercare




Once the dentist has done their bit of removing the tooth or teeth in question, you then begin the healing process.

Tooth Removal healing stages


It doesn't take more than ten days to recovery after tooth extraction.
• Stage 1 – The first 24 hours – Immediate aftercare/blood clotting. This involves stopping the bleeding and forming the initial blood clot and ensuring the gum can heal.
• Stage 2 – The first 24-48 hours – Tissue granulation. This is usually within 24 hours or so, that the clot within the gum will be covered by a white or cream coloured granulation tissue.
• Stage 3 – Within 72 hours (3 days) – Gum closing. This is where the pink gum tissue begins to close up over the hole that was left behind by the extraction.
• Stage 4 – 7-10 days – Healed – For most teeth the gum will have closed or nearly closed entirely. Extractions of larger teeth like molars will take a little longer.

Aftercare


There are some things you should do after tooth extraction:
• Eat soft foods and avoid hot drinks and spicy foods. These may cause pain and start the bleeding again.
• Do not rinse or spit for the rest of the day, as this could cause bleeding.
• The following day, rinse your mouth in warm salt water after meals to keep it clean. You can still brush your teeth but if your gum feels too sensitive try dipping a clean handkerchief into some warm salt water and wiping the area.
• Don’t smoke.
• If the wound starts to bleed again, hold a piece of gauze or a clean handkerchief to the area and press tightly. This will eventually stop the bleeding.

FAQ



How long does tooth extraction take?


It shouldn’t take much more than 20-30 minutes, unless you have to have the general anesthetic which means you will have to spend a few hours at the hospital. You can usually go home the same day though.

Does tooth extraction hurt?


You will probably feel strange sensations of pressure as the tooth is coming out, but you won’t feel any pain because of the anesthetic. You might find that the injection is slightly sore but it is not too bad!

How much does tooth extraction cost?


If you focus just on the cost of actually removing a tooth and nothing more, the costs appear relatively good value, considering the skill and process involved. And it depends on the procedure and the reason of removing the tooth and how many teeth will be removed.

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