Tooth Extractions

Problem: Damaged tooth

Wisdom teeth extractions are a fairly common procedure. Wisdom teeth often cause problems as they are trying to protrude through the gums. When a wisdom tooth is impacted, it means the tooth is coming in at an angle and not straight through the gum line. This can cause pain, the tooth can come in unevenly, or the tooth may only emerge partially.

When a wisdom tooth only emerges partially a flap of skin, called an operculum may form over the tooth. This can make the tooth hard to clean, and pieces of food may be caught under the skin. This makes it easy for an infection, called pericoronitis, to develop. It will usually go away on its own, but it causes swelling and pain in the area.

Impacted teeth and wisdom teeth that can potentially cause problems, like infections, need to be removed. Extractions can range from a single tooth, to removing all four wisdom teeth at once. Based on the preference of the doctor and/or the patient, a local anesthetic could be used to numb the areas where the teeth will be extracted. Others will prefer to go under a general anesthetic so that they will be sedated during the procedure.

The gum tissue around the wisdom tooth is cut open to reveal the tooth. The tooth is loosened by gripping it tightly and wiggling it back and forth until it can be lifted out of the gums. Sometimes a tooth may be impacted so tightly that it cannot be simply lifted out of the gums. In cases like this, the tooth will be broken up into pieces first before being removed. Depending on the incision and extraction site, sutures may be needed to close the area. Soluble sutures are the best option, which will dissolve on their own.

After the surgery, you will need to rest. You need to be driven home by a friend or family member because of the anesthesia. You can expect for the extraction site to bleed for a little while after the surgery. Gauze will be applied at the completion of the surgery, and you will need to change it when it becomes soaked. If bleeding continues for longer than 24 hours you should call your dentist. Rest when you return home, but do not lie flat. This could prolong the bleeding. Prop your head up on a pillow when lying down. Your dentist will prescribe you pain medication, so if you become sore take as directed. You can also use an ice pack for the pain. Your dentist might also provide you with a cleaning solution to clean the extraction site.

You will be limited to soft foods for a few days after your surgery. Some recommended foods are:

  • Gelatin
  • Pudding
  • Yogurt
  • Mashed Potatoes
  • Ice Cream
  • Thin Soups
  • and other food you can eat without chewing.

When drinking, make sure you do not use a straw. The sucking motion can loosen your sutures and slow the clotting process. The same goes for smoking. If you have prolonged pain, bleeding, irritation, or don’t feel that the extraction site is healing properly call your dentist for a follow-up.

Extraction Site Preservation

When removing a tooth it is important to consider what will be done with the empty space after that tooth is removed. Wisdom teeth are in the back of the mouth, so that site will heal on its own with no complications. If it is necessary to remove another tooth, plans must be made. If a tooth is removed and nothing is done with the extraction site, the jaw bone will degenerate and change shape during healing and can cause your teeth to shift. This can create problems in your bite and affect your ability to speak and chew.

If you want to fill the space with a dental implant, a sturdy jaw bone is necessary to install the implant. If you opt for a dental bridge, the bridge must be molded and placed before the teeth shift.

Your dentist is always open to a conversation on what you would like to do with your extraction site before removing a tooth. They will be able to make a recommendation and layout of a treatment plan. Make sure to schedule follow up appointments to properly care for your extraction site.

Problem:

Reasons for Pulling Teeth

Although permanent teeth were meant to last a lifetime, there are a number of reasons why tooth extraction may be needed. A very common reason involves a tooth that is too badly damaged, from trauma or decay, to be repaired. Other reasons include:

  • A crowded mouth. Sometimes dentists pull teeth to prepare the mouth for orthodontia. The goal of orthodontia is to properly align the teeth, which may not be possible if your teeth are too big for your mouth. Likewise, if a tooth cannot break through the gum (erupt) because there is not room in the mouth for it, your dentist may recommend pulling it.
  • Infection. If tooth decay or damage extends to the pulp — the center of the tooth containing nerves and blood vessels — bacteria in the mouth can enter the pulp, leading to infection. Often this can be corrected with root canal therapy (RCT), but if the infection is so severe that antibiotics or RCT do not cure it, extraction may be needed to prevent the spread of infection.
  • Risk of infection. If your immune system is compromised (for example, if you are receiving chemotherapy or are having an organ transplant), even the risk of infection in a particular tooth may be reason enough to pull the tooth.
  • Periodontal (Gum) Disease. If periodontal disease — an infection of the tissues and bones that surround and support the teeth — have caused loosening of the teeth, it may be necessary to pull the tooth or teeth.

What to Expect With Tooth Extraction

Dentists and oral surgeons (dentists with special training to perform surgery) perform tooth extractions. 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. If you are having more than one tooth pulled or if a tooth is impacted, your dentist may use a strong general anesthetic. This will prevent pain throughout your body and make you sleep through the procedure.

If the tooth is impacted, the dentist will cut away gum and bone tissue that cover the tooth and then, using forceps, grasp the tooth and gently rock it back and forth to loosen it from the jaw bone and ligaments that hold it in place. Sometimes, a hard-to-pull tooth must be removed in pieces. 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. Sometimes the dentist will place a few stitches — usually self-dissolving — to close the gum edges over the extraction site. Sometimes, the blood clot in the socket breaks loose, exposing the bone in the socket. This is a painful condition called dry socket. If this happens, your dentist will likely place a sedative dressing over the socket for a few days to protect it as a new clot forms.

What to Tell Your Dentist Before You Have a Tooth Pulled

Although having a tooth pulled is usually very safe, the procedure can allow harmful bacteria into the bloodstream. Gum tissue is also at risk of infection. If you have a condition that puts you at high risk for developing a severe infection, you may need to take antibiotics before and after the extraction. Before having a tooth pulled, let your dentist know your complete medical history, the medications and supplements you take, and if you have one of the following:

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

After You’ve Had a Tooth Pulled

Following an extraction, your dentist will send you home to recover. Recovery typically takes a few days. The following can help minimize discomfort, reduce the risk of infection, and speed recovery.

  • Take painkillers as prescribed.
  • Bite firmly but gently on the gauze pad placed by your dentist to reduce bleeding and allow a clot to form in the tooth socket. Change gauze pads before they become soaked with blood. Otherwise, leave the pad in place for three to four hours after the extraction.
  • Apply an ice bag to the affected area immediately after the procedure to keep down swelling. Apply ice for 10 minutes at a time.
  • Relax for at least 24 hours after the extraction. Limit activity for the next day or two.
  • Avoid rinsing or spitting forcefully for 24 hours after the extraction to avoid dislodging the clot that forms in the socket.
  • After 24 hours, rinse with your mouth with a solution made of 1/2 teaspoon salt and 8 ounces of warm water.
  • Do not drink from a straw for the first 24 hours.
  • Do not smoke, which can inhibit healing.
  • Eat soft foods, such as soup, pudding, yogurt, or applesauce the day after the extraction. Gradually add solid foods to your diet as the extraction site heals.
  • When lying down, prop your head with pillows. Lying flat may prolong bleeding.
  • Continue to brush and floss your teeth, and brush your tongue, but be sure to avoid the extraction site. Doing so will help prevent infection.

When to Call the Dentist

It is normal to feel some pain after the anesthesia wears off. For 24 hours after having a tooth pulled, you should also expect some swelling and residual bleeding. However, if either bleeding or pain is still severe more than four hours after your tooth is pulled, you should call your dentist. You should also call your dentist if you experience any of the following:

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

The initial healing period usually takes about one to two weeks. New bone and gum tissue will grow into the gap. Over time, however, having a tooth (or teeth) missing can cause the remaining teeth to shift, affecting your bite and making it difficult to chew. For that reason, your dentist may advise replacing the missing tooth or teeth with an implant, fixed bridge, or denture.