Tooth Extraction - All We Need to Know

Introduction:

Tooth removal, known as extraction, is a procedure to remove the tooth from its gum socket. This procedure is carried out in the dental office under local anesthesia. Tooth extraction is done when the tooth cannot be saved with other treatments and to prevent infection from spreading to other parts of the mouth. It is done in cases of severe tooth decay, when the tooth becomes mobile, for orthodontic treatment purposes, teeth with root caries, impacted teeth, and infections surrounding the teeth.

What Are the Causes of Tooth Extraction?

There are many causes for the extraction of teeth. They are:

• If the teeth are grossly decayed. That is, dental caries got severe, half of the crown got damaged, and even root canal treatment will not be successful. The teeth need to be extracted.

• If the teeth are mobile, then extraction of the teeth should be done. The mobility of the teeth can be due to periodontitis or trauma. If the mobility is less, then splinting can be done. If more mobility is present, then extraction of those teeth is recommended.

• If the teeth have root caries, then root canal treatment will not be successful. In that case, teeth have to be extracted.

• If the crown is decayed completely and only if the root is present, that is root stumps. These root stumps can be extracted. But in rare cases, if the root stump is strong and the root pulp is safe, then root canal treatment and a crown can be placed. But it is not very successful in all patients.

• If the patient has impacted teeth, then those teeth have to be removed. This kind of removal of impacted teeth involves surgical extraction and not normal extraction.

How to Prepare for a Tooth Extraction?

• An X-ray is taken for the teeth to be extracted. The intraoral periapical radiographs are taken and verified for any infections, the position of the teeth, and the anatomy of the roots.

• The patient's medical history is looked into regarding the medication and past hospitalization. Certain medication has to be stopped before extraction and should be continued one day after the extraction. The antiplatelet drugs are stopped for at least five days prior to extraction. But the medication is stopped under the supervision of the general physician and not by the patient himself or herself.

• The patient should provide the details about the medication, vitamin supplements, and over-the-counter drugs. Then the patient should say if he or she has any medical condition, such as, diabetes, heart disease, kidney disease, bleeding disorder, thyroid disorder, hypertension, low sugar, liver disease, immune deficiency disease, and adrenal disease.

In case the patient has heart disease and is on medication, the patient has to stop those medicines under the supervision of a general physician. After the stoppage of the medicines, only then extraction can be done. The fitness certificate for extraction is also needed before extraction. The fitness certificate should be given by the general physician.

So medical conditions are important before going for extraction.

• The patient should avoid smoking before tooth extraction.

• The patient should also not drink alcohol on the day of the extraction.

• If the infection is more, the patient will be prescribed antibiotics and painkillers before extraction.

• It is always advised to come to extraction along with a family member or friend to drive home.

• If the patient has a cold, then the patient is advised to come after a complete cure of the cold.

What Is the Procedure for a Tooth Extraction?

Dental extraction can be a simple extraction or surgical extraction. It depends on the teeth' position, patient's age, and health.

Simple Extraction:

A simple extraction involves the usage of local anesthesia and the removal of teeth. The local anesthesia is injected into the area of the teeth to be extracted. If the patient feels discomfort with the injection, then the local anesthetic gel or local anesthetic spray can be used before local anesthetic injection. The teeth to be extracted are luxated using elevators and removed with forceps. The usage of elevators and forceps varies from patient to patient, depending on the teeth, their mobility, and their location. The teeth are extracted, and even after the extraction, the patient may feel numbness in the surrounding tissues. This numbness will be present for around three hours. The numbness varies depending on the age and dosage.

Surgical Extraction:

A surgical extraction is the removal of teeth which is difficult to extract in a normal, simple extraction. The difficulty score depends on the position of the teeth and their bone coverage. If the teeth need surgical extraction, local anesthesia is usually given. If needed, sedation anesthesia and general anesthesia are given. But mostly, local anesthesia is enough for surgical extraction procedures. But general anesthesia can be used for fracture reduction procedures.

Local anesthesia is administered. Then vertical and relieving incisions are given. The flap is elevated, the bone is trimmed, and then the teeth are luxated and removed. The sutures are given and asked to come for review after five days and for removal of the suture after one week. The bone is trimmed in surgical extraction, which is not done in a simple extraction procedure.

What Are the Complications After Extraction?

The patient may feel some discomfort following extraction as follows,

• Pain in the extraction socket.

• Swelling around the extraction socket.

• Numbness in the injected region.

• Difficulties in opening the mouth.

• Difficulties in closing the mouth.

• Fever associated with pain.

• Bleeding for more than 20 minutes.

• Dry socket formation.

What Are the Instructions Given After a Tooth Extraction?

• The patient is advised to bite the cotton for one hour. Then the patient can dispose of the cotton. He or she can take a soft diet like curd rice and then take medicines.

• The patient is advised not to spit saliva for one day.

• He or she should avoid sleeping on that side.

• The patient should not touch the socket area with the tongue or finger. The patient can brush their teeth softly.

• The patient is advised not to smoke for three days.

• The patient is advised not to lift heavy weights.

• The patient should not use a straw for drinking any juice.

• If the patient experiences any kind of swelling or other complications, they can visit the dentist.

• The patient can give ice packs for around 2 minutes thrice a day extra orally.

• The medicines usually prescribed are an antibiotic tablet for three to five days, twice a day, and a pain killer thrice a day for three to five days, along with a proton pump inhibitor tablet twice a day for three to five days. These proton pump inhibitors are taken before food.

The healing takes place within seven to 14 days for normal extraction and an average of 15 to 30 days for surgical extraction. But the healing periods vary according to the health of the patient, including diabetes, hemoglobin, and many factors. Generally, the socket will heal within 15 days. But the patient can wait till one month to replace the extracted teeth.

Conclusion:

Tooth extraction is a commonly performed procedure in dental clinics. It has been shown that the reasons for and pattern of tooth extraction vary across geographical regions.In spite of the fact that permanent teeth are meant to last a lifetime, there are various reasons for getting them extracted. It normally takes a few days to recover after tooth extraction. Following all the instructions given by the dentist aids in better and quick healing.