TEETH EXTRACTIONS & DENTAL SURGERY
Dental surgery is a broad subject that consists of many dental procedures, such as bone grafting, biopsies, cyst removal, sinus augmentation, implants and gum/periodontal surgery.
A dental extraction (also referred to as exodontia) is the removal of a tooth from the mouth. Extractions are performed for a wide variety of reasons, including tooth decay that has destroyed enough tooth structure to render the tooth non restorable. Extractions of impacted or problematic wisdom teeth are routinely performed, as are extractions of some permanent teeth to make space for orthodontic treatment (braces). Sometimes baby teeth are removed to allow for proper eruption of the permanent teeth. Very often extractions are discussed as a last alternative.
WHAT IS A TOOTH EXTRACTION?
Tooth extraction is the removal of a tooth from its socket in the bone.
WHAT ARE THE TYPES OF EXTRACTIONS?
There are two types of tooth extractions:
• Simple Extractions: These are performed on teeth that are visible in the mouth. General dentists commonly do simple extractions, and most are usually done under a local anesthetic.
• Surgical Extractions: is a more complex procedure .These involve teeth that cannot easily be seen or reached in the mouth, either because they have broken off at the gum line or they have not fully erupted. The doctor makes a small incision (cut) into your gum. Sometimes it’s necessary to remove some of the bone around the tooth or to cut the tooth in half in order to extract it.
IS TOOTH EXTRACTION PAINFUL?
During a tooth extraction, you can expect to feel pressure, but no pain. If you feel any pain or pinching, tell your doctor.
Most simple extractions can be done using just an injection (a local anesthetic). You may or may not receive drugs to help you relax.
For a surgical extraction, you will receive a local anesthetic, and you may also have anesthesia through a vein (intravenous). Some people may need general anesthesia. They include patients with specific medical or behavioral conditions and young children.
REASONS FOR TOOTH EXTRACTION
There are several reasons for extracting a tooth. These include:
- Infection: if the infection is so severe that antibiotics or root canal therapy do not cure it, extraction may be needed to prevent the spread of infection.
- Wisdom teeth removal – to help eliminate potential problems.One problem that could occur is development of an impacted tooth that has surfaced and has no room in the mouth to grow. Other problems associated with impacted teeth include infection, decay of adjacent teeth, bite interference and gum disease
- Severe Tooth Damage/Trauma: Some teeth have such extensive decay and damage (broken or cracked) that repair is not possible. For example, teeth affected by advanced gum (periodontal) disease may need to be pulled.
- Nonfunctioning Teeth: To avoid possible complications that may result in an eventual, negative impact on oral health, your dentist may recommend removing teeth that are maligned and/or essentially useless (teeth that have no opposing teeth to bite against).
- A crowded mouth: Orthodontic treatment, such as braces, may require tooth extraction to make needed space for improved teeth alignment.
- Extra Teeth: Also referred to as supernumerary teeth, extra teeth may block other teeth from erupting.
- Radiation: Head and neck radiation therapy may require the extraction of teeth in the field of radiation in order to help avoid possible complications, such as infection.
- Chemotherapy: Chemotherapy weakens the immune system, increasing the risk of tooth infections, heightening the risk of extraction.
- Organ Transplant: Immunosuppressive medications prescribed after organ transplantation can increase the likelihood of tooth infection. As such, some teeth require removal prior to an organ transplant.
STEPS OF TOOTH EXTRACTION PROCEDURE
1)Preparation for the procedure
- Do not smoke on the day of surgery. This can increase the risk of a painful problem called dry socket.
- Before having a tooth pulled, let your dentist know your complete medical history. This should include both: prescription and over-the-counter drugs, vitamins and supplements.
- Antibiotics may be prescribed to be taken before and after surgery. Antibiotics are more likely to be given to patients with infection or weakened immune systems or with specific medical conditions.
- Dr. Pomerantz will take an X-ray of the area to help plan the best way to remove the tooth.
2)During the procedure
- Before pulling the tooth, your dentist will give you an injection of a local anesthetic to numb the area where the tooth will be removed.
- Using forceps dentist will grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place.
- Once the tooth has been pulled, a blood clot usually forms in the socket. The dentist will pack a gauze pad into the socket and have you bite down on it to help stop the bleeding.
- Surgical extraction is needed when gum and/or bone tissue cover or surround a tooth in a way that makes it difficult to view and/or access it. If so, your dentist will need to cut and lift back or remove this tissue.
3)After the procedure
- Most swelling and bleeding end within a day or two after the surgery. Initial healing takes at least two weeks.
- Apply an ice bag to the affected area immediately after the procedure to keep down swelling. Apply ice for 10 minutes at a time.
- You can expect some discomfort after even simple extractions. Usually it is mild.
- Drugs that include ibuprofen, such as Advil, Motrin can greatly decrease pain. Take the dose your doctor recommends, 3 to 4 times a day.
- After an extraction, you’ll be asked to bite on a piece of gauze for 20 to 30 minutes. This pressure will allow the blood to clot. You will still have a small amount of bleeding for the next 24 hours or so.
- A gentle rinse with warm salt water, started 24 hours after the surgery, can help to keep the area clean. Use one-half teaspoon of salt in a cup of water.
- For the first 24 hours :Do not drink from a straw, do not smoke, which can inhibit healing, stick to a soft or liquid diet.
Drs. Pomerantz, Garri, or Hennessy will give you detailed instructions on what to do and what to expect after tooth extraction.
WISDOM TEETH REMOVAL
Depending on the shape, size, and the formation of the wisdom teeth, the removal process can vary from easy to hard. If the root tips have managed to wrap themselves around the bone, the removal process can be very time consuming and quite painful.
When should wisdom teeth be removed and when not?
They should be removed in the case of:
- an acute or chronic infection in the area of the wisdom tooth (dentition difficilis)
- advanced caries with involvement of the dental nerve (teeth damaged beyond repair by caries or inflammation of the dental nerve which cannot be treated)
- indications that the wisdom tooth is clearly the source of pain
- untreatable radiographic changes in the wisdom tooth (e.g. development of cysts)
- reabsorption of the neighboring tooth
- as part of the treatment of and limitation of the progress of periodontal illness
- disturbance of the teeth in orthodontic and/or reconstructive surgery
- teeth which are in the break of a broken jaw and which would hinder the treatment of the break
- use of the teeth for transplantation purposes
- elongated or tilted wisdom teeth which disturb one’s bite
An indication can exist due to:
- tooth extraction due to unavoidable circumstances (e.g. unavailability of medical treatment in the past)
- when other procedures will be done under anesthetic and a repeat of the anesthetic would be required for the extraction of a wisdom tooth
- in planned prosthetic treatment, if a later eruption of the tooth due to further atrophication of the bone and/or the pressure load due to a removable prosthesis is expected to occur
- to simplify orthodontic tooth movement and/or to reduce orthodontic retention
An indication to extract doesn’t exist:
- as long as an unassisted, regular position of the wisdom tooth in its row is to be expected
- when the extraction of other teeth and/or orthodontic treatment including correction of the position of the tooth makes sense
- in the case of deeply impacted and deep-lying teeth without associated illness, where a high risk of operative complications exists
Generally speaking outpatient treatment is enough. The extraction can take place singly, more than one or all together.
Treatment under (general) anaesthetic/sedation may be indicated in the case of expected problems when it comes to cooperation of the patient, of large dento-alveolary interventional measures, of manifest risk-factors or because of the express wish of the patient.
In-patient treatment may sometimes be indicated in the case of serious illness or because of particular operational requirements.
The significance of treatment with antibiotics before and after the operation has not been consistently evaluated scientifically. A general recommendation cannot therefore be ruled out. Antiphlogistic (pain-reducing) prophylaxis is effective in reducing swelling though it is not always required in every case.
Signs of Wisdom Teeth Problems
Some people may not experience any wisdom teeth pain despite complications with the teeth. These signs and symptoms, while sometimes subtle, can let you know when it might be time to talk to your dentist about wisdom teeth removal:
- Discomfort from a tooth emerging at an awkward angle and rubbing against your cheek or tongue.
- Development of an infection where a partially impacted wisdom tooth may have emerged.
- Stiffness of the jaw or wisdom teeth pain.
- Teeth begin to shift due to crowding in the mouth.
- Development of tooth decay or gum disease due to inability to clean teeth.
Are you looking for a teeth extractions surgery specialist in your area? Call us at 954 726 4511 or complete the online form to schedule a consultation with Tamarac dentist Dr. Seth Pomerantz. Our dental practice in Tamarac welcomes patients from: Coral Springs, Margate, North Lauderdale, Tamarac, Coconut Creek and Parkland.