When a tooth is damaged from decay, a blow to the face or grinding on hard substances, your dentist will first examine your tooth and try to fix it. This may involve a filling, root canal, crown or any other possible treatment. However, if the tooth can no longer be treated due to severe damage, it will have to be extracted. If your tooth is too loose and cannot be saved, you may also require tooth extraction.
Other reasons include:
Your mouth is too crowded
Your dentist may pull your teeth out to prepare your mouth for braces. If your teeth are too big for your mouth, proper alignment may not be possible. Similarly, the dentist may recommend pulling out a tooth that does not erupt from the gum due to lack of room in the mouth. Extra teeth and baby teeth that do not fall off may have to be removed sometimes as well.
Sometimes the wisdom teeth may have to be removed if they cause pain, or are decayed or infected. Wisdom teeth often get stuck in the jaw (are impacted) and do not come in, causing irritation, swelling and pain in the gum.
If damage or decay extends to the pulp of the tooth, where nerves and blood vessels are found, bacteria from the mouth may enter it, causing an infection. This can be rectified with root canal therapy (RCT). However, if RCT and antibiotics cannot treat the infection, extraction may be required to prevent the infection from spreading.
This is an infection of the tissues and bones that surround the teeth and support them. If the condition loosens the teeth, they may have to be pulled out.
Suppressed immune system
If your immune system is supressed, for example from chemotherapy or if you are having an organ transplant, a possible risk of infection of a particular tooth may be a good enough reason to extract it.
Before tooth extraction
Although a tooth extraction is very safe, it may allow the entry of harmful bacteria into the bloodstream. If you have a condition that increases your risk of an infection, you may have to take antibiotics before and after the procedure. Talk to your dentist about your complete medical history, the medicines and supplements you take. Make sure you let your dentist know if you have any of the following:
- Liver disease
- Supressed immune system
- Congenital heart disease
- Damaged or manmade heart valves
- Artificial joint (for example, hip replacement)
- History of bacterial endocarditis
How it’s done
The dentist may perform one of two types of extractions depending on the condition of the tooth/teeth:
Simple tooth extraction
The area where the tooth is to be removed will be numbed using an injection with local anaesthetic. In a simple extraction, the tooth is loosened using an instrument called the elevator, after which, forceps are used to extract the tooth.
Surgical tooth extraction
If your tooth is impacted, or is broken off at the gum line, the dentist may perform a surgical extraction with a local anaesthetic. In this case, a small cut is made in the gum and bone tissue that cover the tooth. The tooth will then be loosened from the jawline and ligaments by rocking it back and forth with forceps. If the tooth is hard to remove, it may have to be cut in half for the extraction to take place.
After the extraction, a blood clot may form in the empty socket. The dentist will pack a gauze pad over it and ask you to bite down to stop bleeding. In some cases, the dentist may close the gum with a few self-dissolving stitches.
The dentist will most likely send you home after the extraction. Recovery often takes a few days, during which you can ease pain and discomfort and reduce risk of infection with the following:
- Take painkillers to ease pain. The first pills should be taken before the anaesthesia wears off.
- Use ice packs on your face to improve swelling and discomfort. Apply ice packs for 20 minutes and then remove them for another 20 minutes. Try warm compresses if the jaw feels to stiff or sore with the ice pack.
- Consume soft foods only for a few days and resume having your regular meals once you feel comfortable and pain-free.
- Starting from 24 hours after the surgery, rinse your mouth with salt water to keep it clean. Make the saltwater solution with half a teaspoon of salt in one cup of water.
- Relax for the first 24 hours after the extraction and limit activity for at least 1-2 days.
- Avoid smoking as it can interrupt healing.
- Continue brushing and flossing. Brush the tongue as well but avoid the extraction site.
Tooth Extraction Risks
At times, the blood clot in the extracted site may break off, exposing the bone. This may result in a painful condition called dry socket than develops in 3 to 4% of extractions. In such a situation, the dentist will place a sedative dressing on the socket for a few days to allow a new clot to form. Smokers and women taking birth control pills have a higher risk of dry socket.
In addition, there is a risk of infection following an extraction, but this is unlikely if your immune system is healthy.