Dental extraction involves permanently removing an entire tooth from its socket in your jaw.
Extraction is commonly used when your teeth are fractured, extensively damaged by tooth decay or when they are loose or damaged as a result of severe gum disease. Other reasons can include extraction as a part of orthodontic treatment, or routine extraction of wisdom teeth or impacted teeth. It is often a treatment of last resort, as you can’t ever get your natural tooth back! We will often advise you to carefully consider other alternative treatments like root canal treatment, crowns and fillings and we will discuss their likelihood of success with you before you make a final decision to have a tooth extracted.
Extraction is often required when alternative treatments for tooth decay and gum disease are not likely to succeed, or have been tried and have already failed. Where patients have delayed treatment for too long, extraction may be the only option left. Therefore, it is important for you not to delay regular dental examinations and treatment. A minor case of tooth decay requiring minor filling, or gingivitis requiring simple dental cleaning, can both lead to you losing your teeth if left untreated.
Severe Tooth Decay – Sometimes, a tooth is just so badly damaged it can’t be saved. If your tooth is extensively damaged by decay, fillings may fail, as your weakened tooth may be more prone to chipping and fractures, which can let bacteria enter the inside of the tooth. Crowns may also fail, as the core of your tooth is too weak to support the crown.
Although root canal treatment is often considered, it may not be suitable if the decay is so severe that there is insufficient support from the jawbone and surrounding tissues. If your root canal treatment fails, performing a second root canal treatment on the same tooth is even less likely to succeed.
To avoid these complications, extraction may be the preferred option for you, especially if you have already undergone fillings, crowns or root canal treatment without success.
Severe Gum Disease (Periodontitis) – If you suffer from periodontitis, where you experience loose teeth, and the bone and surrounding soft tissues supporting your teeth are infected, surgical treatments like bone and flap surgery, bone and tissue grafts will be required. If they fail or are not likely to succeed, the only viable option for you is extraction.
If you delay extraction for too long, there is a high chance that infections will also spread to neighboring teeth.
Wisdom Teeth or Impacted Teeth – Wisdom teeth often need to be extracted if they do not erupt (break through the gum) and stay beneath the gums (impacted). Impaction can cause you irritation, pain and swelling. If teeth erupt in an improper position, it can increase the chances of tooth decay and gum disease. We can examine your wisdom teeth to determine if extraction will improve your condition.
Orthodontics – If you have overcrowded teeth or teeth that are out of place, we may extract your teeth as a part of implementing your braces or orthodontic treatment.
Cost and Efficiency – Simply choosing the relatively lower cost and speed of extraction over other treatments can sometimes be a false economy.
Most of the time, your missing tooth will need to be replaced in some way to avoid:
1) your neighbouring teeth moving out of place;
2) the opposing teeth over-erupting;
3) accelerated wearing of your remaining teeth as they bear additional pressure;
4) difficulty in chewing; or
5) being aesthetically undesirable.
Having dentures, bridges or implants done are often costly. Thus the cost of extraction itself should not be the main consideration.
Other Diseases – Your doctor may require your infected teeth to be extracted if you are undergoing organ transplant or radiation treatment for oral cancer, as your immune system will be weakened and you may become more susceptible to infection.
It is best for you to make a separate appointment for a general examination prior to getting an extraction done. This will allow us to carry out an assessment of the tooth, take any required x-rays to plan your extraction, and explain all options available to you. We will discuss the procedures, risks, complications, and associated fees to you. Extraction can be very unpredictable, but we will do our best to advise you whether the extraction will be a simple, complicated or a surgical extraction.
If you have a weakened immune system, an infection or if required by your medical doctors, we may prescribe antibiotics to be taken before and after surgery to help prevent you from getting infections after extraction.
Because extraction will be carried out under local anaesthetic and you may not be able to eat for a few hours, we recommend that you have something to eat before your visit.
We perform our extractions under local anaesthetic. During the extraction, you can feel the pressure we put on the tooth, but you will not feel pain.
Extracting your tooth may be more complicated if your tooth is severely decayed or has previously undergone root canal treatment. These weaken the tooth and may make it more likely to break when gripped. If the tooth breaks during extraction, we have to remove your tooth bit by bit. If the tooth breaks below the gum, surgery may even be required. The thicker and denser your tooth socket is, the more difficult it will be to remove your tooth.
If your tooth has more than one root, or your roots have a complex shape, surgical extraction may be needed to remove the roots one by one.
We may need to leave a small bit of tooth root in its socket if more damage to the surrounding area will be caused by removing it. This is especially the case if the root is not infected, it is near to your dental nerves, or if removing it requires a lot of bone to be removed.
Rarely, a bit of root fragment may be unintentionally left in your socket. In those cases, your body may reabsorb them during healing. If not, we will have to remove it.
Bleeding is common during an extraction, but it usually stops quickly after the extraction is completed.
Some medical conditions can complicate an extraction.
We will assess your full medical history prior to an extraction. We will consider whether you are suffering from conditions that may increase the chances of your sockets not healing after extraction like smoking, osteoporosis, bone cancer and previous radiotherapy of the jaw. Certain medical conditions also increase the risk of infection such as leukemia or HIV.
If you have bleeding disorders, or are taking blood thinning medication, we will need to discuss with your medical doctors to ensure we can control the bleeding during and after the extraction.
We will discuss all your risk factors with you and give advice, recommendations and, where necessary, make appropriate specialist referrals.
Immediately after extraction, you will then need to bite on a piece of gauze cloth tightly for around thirty to sixty minutes to form a blood clot to stop your socket from bleeding.
When you leave our clinic, we will provide you with a gauze pack for you to bite on in case bleeding occurs again. If you continue to bleed after 24 hours following an extraction, please inform us immediately. You should not smoke nor consume alcohol on the day of extraction as it will encourage more bleeding. Exercise should be avoided for at least 24 hours or longer for surgical extractions. Swimming is not recommended until the wound has fully healed.
You may experience discomfort, pain and soreness as the local anaesthetic wears off. We will provide you with a recommended dosage of anti-inflammatory and/or pain killer drugs such as ibuprofen or paracetamol. Your first dose, usually taken about an hour after the extraction will help reduce pain. Your pain will mostly subside within the first few days. Swelling may be experienced depending on the intensity of the extraction procedure. Using ice packs and taking anti-inflammatories can help reduce any swelling.
As your mouth, lip and tongue may be numb until the anaesthetic wears off, do not consume any food or drinks until the anaesthetic wears off. You should not have any hot food or drinks on the day you have the extraction. Maintain a diet of soft foods for a few days and chew mainly with the unaffected side of your mouth, so that the extracted area is not disturbed.
Most importantly, all care should be taken to preserve the clot in your socket to prevent bleeding, damage and infection of your socket. If you smoke, avoid smoking for at least three days to a week as smoking increases the risks of a dry socket. A dry socket occurs when a clot does not form, or breaks off easily. A dry socket usually results in pain and increases the risks of infection as bone is being exposed to air and food.
The removal of impacted teeth can also increase the risks of a dry socket. If you experience lots of pain you may have a dry socket and we will need to medicate and dress the area to allow healing.
Do not spit forcefully, suck through a straw, forcefully rinse your mouth or exercise, as the pressure and movement caused by these activities can remove the blood clot. You can brush normally but be careful to avoid the area near the extracted tooth. Gently rinsing the area with warm salt water (one teaspoon of salt in a glass of warm water) at least 3 times a day, for 24-48 hours after the extraction will help to keep the area clean until the pain and swelling has subsided.
Whilst some pain and discomfort is completely normal after your extraction, if you experience the following conditions, be sure to inform us immediately:
• Fever or chills;
• Uncontrolled bleeding that does not stop with pressure being applied,or bleeding that continues after 24 hours;
• Pain and swelling that has worsened after the first few days;
• Numbness in your lip, tongue or chin more than 4 hours after extraction;
• Difficulties in swallowing or breathing.
Most of the time, extraction is a routine procedure and after a certain period of healing, you will be ready to consider various methods to fill the gap in your mouth.
The initial healing time for the socket is from a week to several weeks depending on how complicated your extraction is. After the socket has healed, you can consider having a temporary denture to help preserve your bite and for aesthetic reasons. As your bone and gum will heal and shrink over the next 6 months, you will be ready to consider bridges and implants after that.
At Dentist Mandy, we are here to guide you through the whole course of your treatment plan, making sure that you are making the right choices for your lifestyle, budget and your long-term oral health. Contact us today to find out if extraction is right for you.