What Is An Extraction?

Tooth extraction is the removal of a tooth from its socket in the bone.

Why Do I Need An Extraction?

If a tooth has been broken or damaged by decay, your dentist will try to fix it with a filling, crown or other treatment. Sometimes, though, there’s too much damage for the tooth to be repaired. This is the most common reason for extracting a tooth.

Here are other reasons:

• Some people have extra teeth that block other teeth from coming in.
• People getting braces may need teeth extracted to create room for the teeth that are being moved into place.
• People receiving radiation to the head and neck may need to have teeth in the field of radiation extracted.
• People receiving cancer drugs may develop infected teeth. These drugs weaken the immune system, increasing the risk of infection. Infected teeth may need to be extracted.
• People receiving an organ transplant may need some teeth extracted if the teeth could become sources of infection after the transplant. People with organ transplants have a high risk of infection because they must take drugs that decrease or suppress the immune system.
• Wisdom teeth, also called third molars, are often extracted either before or after they come in. They commonly come in during the late teens or early 20s. These teeth often get stuck in the jaw (impacted) and do not come in. They need to be removed if they are decayed or cause pain. Some wisdom teeth are blocked by other teeth or may not have enough room to come in completely. This can irritate the gum, causing pain and swelling. In this case, the tooth must be removed.

Why do I need to see a Specialist?

There are two types of extractions:

Simple Extractions:

• A simple extraction is performed on a tooth that can be seen in the mouth.
• General dentists commonly do simple extractions.
• Most of these can be done using just an injection (a local anesthetic), with or without anti-anxiety drugs.
• In a simple extraction, the dentist will grasp the tooth with forceps and loosen it by moving the forceps back and forth. Then the tooth will be pulled out.
• Sometimes the dentist will use a dental “elevator” to help loosen the tooth. This is an instrument that fits between the tooth and the gum.

Surgical Extractions

• Surgical extractions generally require specialist skills.
• A surgical extraction involves teeth that cannot be seen easily in the mouth.
• They may have broken off at the gum line or they may not have come in yet.
• To see and remove the tooth, the dentist or oral surgeon must cut and pull back the gums.
• Pulling back the gum “flap” provides access to remove bone and/or a piece of the tooth.
• Oral surgeons commonly do surgical extractions. They are done with injections (local anesthesia), and you can also have conscious sedation.
• Patients with special medical conditions and young children may be given general anesthesia.
• In a surgical extraction, the surgeon will need to make a cut (incision) in your gum to reach the tooth.
• In some cases, the tooth will need to be cut into pieces to be removed.
• If you are having teeth extracted and are receiving conscious sedation, you may be given steroids in your IV line to help reduce swelling after the procedure.

Follow-Up

Simple Extractions

• Most simple extractions do not cause much discomfort after the procedure.
• You may take an over-the-counter nonsteroidal anti-inflammatory drug (NSAID) for several days.
• You may not need any pain medicine at all.

Surgical Extractions

• Because surgical extractions are more complicated, they generally cause more pain after the procedure.
• The level of discomfort and how long it lasts will depend on the difficulty of the extraction.
• Your surgeon may prescribe pain medicine for a few days and then suggest an NSAID.
• Most pain disappears after a couple of days.

Aftercare for Surgical Extractions

• A cut in the mouth tends to bleed more than a cut on the skin because it cannot dry out and form a scab.
• After an extraction, you’ll be asked to bite on a piece of gauze for about 20 to 30 minutes. This will put pressure on the area and allow the blood to clot. It still may bleed a small amount for the next 24 hours or so and taper off after that.
• Don’t disturb the clot that forms on the wound.

• You can put ice packs on your face to reduce swelling after the operation.
• If your jaw is sore and stiff after the swelling goes away, try warm compresses.
• Eat soft and cool foods for a few days. Then try other food as you feel comfortable.
• 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.
• Most swelling and bleeding ends within a day or two after the surgery.
• Initial healing takes at least two weeks.

• You should not smoke, use a straw or spit after surgery. These actions can pull the blood clot out of the hole where the tooth was. That causes more bleeding and can lead to a dry socket, which occurs in about 3% to 4% of all extractions.
• Dry socket occurs 20% to 30% of the time when impacted teeth are removed.
• It happens more often in smokers and women who take birth control pills. It is also more likely after difficult extractions.

Risks

• Infection can set in after an extraction, although you probably won’t get an infection if you have a healthy immune system.
• A common complication called a dry socket occurs when a blood clot doesn’t form in the hole or the blood clot breaks off or breaks down too early.
• In a dry socket, the underlying bone is exposed to air and food. This can be very painful and can cause a bad odor or taste. A dry socket needs to be treated with a medicated dressing to stop the pain and encourage the area to heal.

When To Call a Professional

• Call your surgeon if the swelling gets worse instead of better.
• Also call if you have fever, chills, redness, trouble swallowing or uncontrolled bleeding in the area.
• If you have an infection, your surgeon will usually prescribe antibiotics.
• If your tongue chin or lip feels numb, tell your surgeon.
• Also call surgeon if the area of the extraction site becomes very painful. This is a sign that you may have a dry socket. If the area continues to bleed after the first 24 hours, notify your surgeon.