Simply put, dental extractions involve the removal of a tooth. However, it is not necessarily a simple process, and it is certainly not one to be taken lightly. Once primary or “baby” teeth have been replaced with permanent teeth, the shared goal between you, your dentist, and hygienist is to maintain the health of each tooth, as well as the surrounding gums. Extraction is typically a last resort measure.
Of course, this has not always been the case. Before we knew to treat infections with antibiotics, a variety of health issues were linked to tooth infections and the common answer was to pull the tooth. In the Middle Ages and well beyond, dental extractions were considered too menial of a task for a surgeon and so they were performed by barbers. It wasn’t until the mid-1800s that extractions and other dental procedures were done with the much-needed benefit of anesthesia.
Fortunately, we’ve come a long way. Not only are most dental procedures nearly painless, but dental hygiene practices are also designed to make extractions far less common.
When Are Tooth Extractions Necessary?
The human body has a pretty amazing design, and nowhere is that more apparent than in our teeth. The enamel covering our teeth is the strongest substance in the body, much stronger even than bone. This is why our teeth are able to withstand a tremendous amount of force.
Despite their considerable strength, teeth are not invulnerable. Unlike bone and other body parts, once the enamel is compromised, not only will it not heal, the damage is progressive. Without repair by your dentist, the eventual outcome will likely be the need for extraction.
There are several causes resulting in the need for the extraction of a tooth. Some of the most common of those reasons include:
- decay from cavities that has progressed beyond the point of repair
- significant trauma to one or more teeth or to the supporting bone
- periodontal disease, also referred to as gum disease or infection, that has caused a tooth to become so loose that the only option is extraction
- risk of infection, possibly while being immunocompromised due to chemotherapy or pending organ transplant, that tips the scale in making the decision to pull an infected tooth
- crowding, which can be caused by baby teeth not falling out soon enough, wisdom teeth being impacted or creating other complications, as well as additional room needed for braces or other dental prostheses
Types of Dental Extractions
There are basically two types of tooth extractions, which are referred to as simple or surgical. Determination is based on the position of the tooth and whether it is visible or impacted.
Your dentist will normally perform simple extractions and may do those that are considered surgical. Often, however, surgical extractions will be performed by an oral surgeon.
Preparations Prior to a Tooth Extraction
Once the decision has been made for tooth extraction, your dentist or oral surgeon will discuss the process and give you some basic instructions. It will be important for your dentist to have a thorough medical history. This will include a complete list of all medications and supplements that you are taking. Some medications, like blood thinners, may need to be stopped in the days immediately prior to the procedure.
Although it is important to list all medical conditions and issues, some that your dentist will particularly want to know about include:
- compromised or impaired immune system
- congenital heart defect, bacterial endocarditis, which is an infection of the lining of the heart and the heart valves or any heart valve replacements
- cirrhosis (liver disease)
- artificial joints
- thyroid disease
- hypertension (high blood pressure)
Depending upon your medical condition, you may be given antibiotics prior to the procedure. If you will be receiving general anesthesia, you will need to have someone available to drive you home and, even if a local anesthetic is used, it’s still a good idea. Also, because smoking can interfere with blood clotting, your dentist will advise you to stop smoking in the days preceding the extraction.
The Tooth Extraction Process
An X-ray taken of the tooth prior to the procedure will give your dentist the curvature and angle of any part of the tooth beneath the gum. If it is a simple extraction, the dentist will administer a local anesthetic to numb the area so that the most that should be felt will be some pressure. For a more complicated surgical extraction, a general anesthetic may be used. This will not only prevent pain, it will actually allow the patient to sleep through the entire procedure.
The tooth will then be removed with forceps. If it is impacted, some of the surrounding gum and bone may have to be cut so that the tooth can be released from the bone and soft tissue holding it in place. In some instances, it will be necessary to remove the tooth in pieces.
Once the tooth is out, the open socket will be packed with gauze to slow the bleeding and encourage blood clotting. A few stitches may be needed but are typically the self-dissolving type, so it will not be necessary for them to be removed.
Recovery Following Dental Extractions
Recovery following a tooth extraction will normally take a few days. It will be important to follow all post-procedure instructions in order to reduce risk of infection and make recovery as speedy as possible.
You should limit activity, especially during the first 24 hours and for the next day or two.
It will be important not to interfere with blood clotting, so do not do any forceful rinsing or spitting for a full 24 hours following the extraction. Once again, smoking is known to interfere with healing, so continue to not smoke for a few days.
Medication for pain should be taken as prescribed.
Try to eat only soft foods, like soups and puddings, at first, and slowly add back solid foods as healing progresses.
You should expect some pain, swelling and bleeding for the first day or so. If any is excessive or does not begin to subside after 24 hours, you should contact your dentist. You will also be instructed to immediately report any signs of infection, fever, chills, nausea, shortness of breath, coughing or chest pain.