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Teeth Extractions

By Joseph Preziosi Jr., DMD

When teeth are unable to be restored (fixed with a filling or crown) or are impacted they need to be extracted (removed from the mouth). Extractions can range from a simple extraction of an erupted tooth (one that is above the gum line) to complex surgical extractions of teeth that are impacted entirely within the jaw bone or residual roots of broken down teeth that remain in the bone.

The more complex the surgery the longer the treatment time for the extraction, the more bone that has to be removed to facilitate the extraction, the greater likelihood of needing sutures (stitches) as a part of the extraction treatment, the more post extraction discomfort and the longer the post extraction healing time will be required until the patient is completely comfortable again.

All tooth extractions have many common treatment procedures. To facilitate tooth extractions the area of the mouth the extraction is going to be performed in is first anesthetized (numbed) with a local anesthetic that is usually Lidocaine (novocaine). This is true whether or not intravenous (IV) sedation (putting the patient to sleep) or nitrous oxide (laughing gas) for conscious sedation is used in the extraction treatment or not. This is because conscious sedation doesn't stop nerve pain signals from reaching the brain and IV sedation only lasts as long as the extraction treatment lasts. To allow the patient to be comfortable long enough to get their prescribed pain control medications and reach home a local anesthetic is always administered. It is always advisable to avoid IV sedation if possible because of the risks involved. Most patients like the idea of being asleep for the extraction treatment but fail to appreciate the added inherent risks systemic IV sedation is associated with. Morbidity and mortality risk factors should always be weighed heavily before choosing IV sedation.

Home care for extracted teeth is also an important part of the extraction treatment. Direct pressure from biting on gauze pads helps stop the bleeding from the extraction site and helps a blood clot to form in the extraction site especially when sutures are not used to close the extraction site. To avoid dislodging the blood cot and getting a dry socket, which is an extremely painful complication of extraction treatment, patients should avoid smoking, spitting or drinking through a straw for at least 48 hours and longer if possible. Cessation of smoking is paramount. Not only can sucking on a cigarette cause the blood clot to dislodge but the aerosolized and vaporized components of the tobacco smoke can make post extraction infections much more likely. Sometimes antibiotics will also be prescribed by your doctor to help prevent an infection or to clear up an infection that is already present. It is of the utmost importance to comply with your doctor's instructions that are given to you in the office and those that appear on the medication's container to ensure the optimal efficacy from these prescribed medications.

All extracted teeth except third molars (wisdom teeth) need to be replaced to prevent the remaining teeth from shifting. This tooth shifting will cause your occlusion (bite) to collapse and the unopposed teeth to start erupting again giving a roller coaster shape to your bite. The extracted teeth can be replaced by implants, bridges or removable partial dentures. Replacing extracted teeth promptly avoids collapse of your occlusion preserving your natural bite while keeping the cost and time to a minimum. Implants and bridges allow for fixed restorations to be used to replace the extracted teeth. These restorations can not be removed by the patient from their mouth, are the most durable, most esthetic and consequently the most costly restorations. A removable partial denture is designed to be removed and cleaned daily by the patient and should not be left in while sleeping. This type of restoration is less durable, less esthetic, can be bent out of shape so it no longer fits or even lost since it comes out of the patient's mouth. The only redeeming quality it has is that is less costly initially, but often times becomes more costly over the patient's life time because it needs to be replaced more frequently.