extractions

What are dental extractions?

A dental extraction is the process in which a tooth is removed from the jaw bone. It is something we like to avoid where possible- since they don’t grow back- so we will discuss all the options and alternatives to allow you to try and keep your tooth. Sometimes the prognosis is so poor, or the financial side such that saving it is not an option, or the money would be better directed at having something to fill the gap. There are also instances where we may suggest extractions as part of your care- if we feel that not doing so would cause worse problems down the track. By far the most common example of this is wisdom teeth.

What are the types of tooth extractions?

The three types of tooth extractions are:

  • Simple extractions
  • Sectional extractions
  • Surgical extractions

Simple extractions, as what the name implies, are performed on fully erupted teeth. Sectional extractions involve splitting the tooth into pieces in order to remove it and surgical extractions are performed on teeth that haven’t fully erupted yet or have broken underneath the gum to allow us to access them. To you, the extraction won’t feel any different because you will be numb, but surgical extractions are slightly more complicated and involve reflecting the gum, and often removing bone to see the offending tooth or root in order to remove it before placing stitches to put the gum back for healing.

Why do I need to have my tooth extracted? extractions

As mentioned earlier, tooth extractions are usually done as a last resort. We only have one set of adult teeth so we want to keep them. If we have done all possible treatments to repair your tooth but to no avail, extracting the tooth may be the only option. Common reasons for having a tooth extracted are:

  • Gum disease
  • Severely decayed tooth
  • Abscessed tooth
  • Traumatised tooth
  • Failed root canal treatment
  • Fractured teeth
  • Cracked teeth
  • Can’t afford root canal treatment and the nerve in the tooth has been affected
  • Overcrowded mouth
  • Impacted tooth
  • Extra teeth
  • Removing baby teeth to make way for permanent teeth
  • Malpositioned tooth
  • Orthodontic treatments (such as some cases of having braces put in)
  • Before Radiation or Chemotherapy or IV bisphosphonates (only teeth with a poor prognosis)

What happens when I go to the dentist?

We will first ask for your dental and medical history, then proceed to examining your mouth and oral health. Some X-rays may also need to be taken to help with assessing your case: determining if your tooth needs extracting and if so the best way to approach it. The shape and number of roots plus their proximity to surrounding structures must all be assessed. It is important that you inform your dentist of any medical conditions you have and medications that you are taking, even contraceptive pills and herbal ones, prior to extracting your tooth. Some medications slow down the blood’s ability to clot, so extracting the tooth may lead to prolonged bleeding. In certain circumstances we may ask you to take antibiotics before or after having your tooth removed, depending on your case and your susceptibility to infection. This is not done routinely even for wisdom teeth.

What should I expect after having my tooth pulled out?

You may feel a little woozy from the experience and numb from anaesthetic, but this will wear off in a few hours. Once the anaesthetic wears off, you may feel some pain and sometimes you may notice some swelling (especially if it has been a surgical extraction). A little oozing and residual bleeding is to be expected. This is a normal part of the healing process. If you have prolonged bleeding or are worried, just give us a call. In the meantime, don’t do any strenuous activity and take lots of rest. Here are some general advice to follow after your extraction:

  • Keep your head up to avoid bleeding. Put a towel on your pillow to catch the little bit of blood that may be mixed in with your saliva
  • Avoid hot foods and beverages whilst you are numb and for the rest of the day.
  • Be careful not to bite your cheek, especially when eating
  • Take pain medications, as required
  • Rinse your mouth with lukewarm salt water after 24 hours to reduce swelling. Not before- as we will be waiting for the clot to form.
  • Maintain a soft food diet
  • Carefully and gently brush your other teeth but stay away form the extraction site till it feels OK to do so
  • Apply an ice pack over the extraction site to decrease swelling if need be

DON’T:

  • Rinse your mouth within 24 hours after extraction to give the socket time to heal
  • Play with the empty socket with your tongue
  • Eat on the side of the mouth where the extracted tooth was (do your best)
  • Smoke or drink alcoholic beverages for at least 24 hours after extraction to avoid unnecessary bleeding. Smoking for the next 3 days should be avoided to avoid getting a dry socket.
  • Use straws when drinking: the sucking motion may remove the clotted blood from the extraction site and expose the bone in the socket

Will I need to see my dentist again after the extraction?

Initial healing time usually takes around one to two weeks, full gum coverage will take about a month and after 3 months your bone will have had time to remodel underneath and stabilise. Expect discomfort for the first week- in day three, the pain seems to come back a bit, so be prepared. If you experience severe pain, nausea, fever, vomiting, excessive bleeding, or a lot of pain that won’t go away even after a few days of having your tooth pulled out, call us and arrange to come down to Maroubra so we can check everything is OK. Your dentist may also ask you to go back for follow-up appointments to remove the stitches that were put on after the extraction, or to simply see how the healing is going. Stitches as a general rule are removed at one week if they are not dissolvable: dissolvable stitches as the name suggests should come out on their own.