We have a number of options available to fix teeth that are decayed or damaged. Sometimes however, an extraction is required. This can happen when there is:
- severe tooth decay or infection around the tooth
- teeth that are blocking others from coming in
- periodontal disease that has damaged the tooth’s supporting tissues and bone structure, causing it to become loose
- a need to create space for orthodontic treatment (braces)
How is it done?
We start by numbing both your tooth and surrounding area. It is important that during the extraction process that this area is made as numb as possible. Because of this, we will use more anesthetic than we would for some other procedures. We will spend time prior to starting the extraction testing the area to make sure that it is completely numb.
The root portion of a tooth is firmly encased in bone (its socket), and tightly held in place by a ligament. During the extraction, we needs to both widen the socket and separate the tooth from its ligament with an instrument called an elevator. The tooth is now starting to move as we put pressure on the area.
At this point we use another instrument called a forceps to remove the tooth. We grasp the tooth with the forceps and then firmly and deliberately rock it back and forth. Because the bone that surrounds the tooth is compressible, the socket will expand. Once the socket is enlarged enough and the ligament separated, the tooth can be easily removed.
The anesthetic we use to numb up teeth are very effective at stopping the nerves that transmit pain. But they’re not effective on those that transmit the sensation of pressure. That means you should expect to feel a lot of pressure during your procedure even though it should not be painful.
More Difficult Extractions
Most extractions are very straight-forward. Some teeth can be more difficult to remove for instance if they are:
- Weak (often due to decay or fracture)
- In a difficult position in the mouth (this is often the case with wisdom teeth)
- A shape that makes a standard extraction difficult (more common in the molar teeth which have multiple roots)
This may involve the need to separate the tooth into different sections which are then removed one at a time, which generally involves some drilling. If an extraction has been difficult it may be that we have to place a stitch in the area to help with the healing. The fact that an extraction is more complicated does not mean that it would be painful during the procedure although it may take longer to settle down afterwards.
After an extraction
We give all our patients a written list of instructions so you know what to do afterwards. The most important of these are as follows:
Take painkillers! Having a tooth taken out is not painful while the anesthetic lasts but as it wears off you can expect to have some pain and swelling in the area. This is perfectly normal and standard over-the-counter painkillers such as ibuprofen should be fine to deal with it. If the extraction has been complicated we may prescribe a stronger painkiller. If the pain starts to worsen a couple of days after the extraction it may be a condition called dry socket – where the area hasn’t started to heal in the way that it should. While not a serious condition, it is painful and you should return to us to place a dressing in the area to help it to settle.
We routinely give patients gauze to bite on in case there is bleeding afterwards. We always confirm bleeding has stoppped prior to letting you leave the surgery and problems with bleeding after an extraction tends to be quite rare.
If you are a smoker its important to cut down or preferably stop smoking for a few days after the extraction. Smoking hinders the healing process and is more likely to lead to pain and infection in the area.
Other Complications/ Referrals
There are other potential complications to any extraction depending on where the tooth is in the mouth, but these tend to be rare. We will evaluate this with an x-ray prior to an extraction and discuss any risks that may be associated with it.
Sometimes an extraction can be more complicated and better suited to being done by a specialist oral surgeon . In these cases we will organise a referral. One advantage to this approach is that in difficult cases it may be possible to do the extraction under intravenous sedation or a general anesthetic.