Tooth Removal (Extraction) - Reasons, Complications, and Recommendations

Sometimes, people need to have one or more of their teeth pulled out. This tooth extraction may be advised by the dentist for one of the following reasons:

• Severe gum disease that makes the tooth wobbly, which cannot be fixed.

• Severe tooth decay involving the nerve inside the tooth called the pulp. In this case, the only alternative treatment to save the tooth is root canal treatment or endodontic treatment, which is a complex and costly procedure and may not be feasible.

• A badly broken tooth that cannot be restored with a filling or a cap.

• Crowding or malposition - When a tooth is out of the arch or not in its correct position, it may hinder proper tooth cleaning and aid food accumulation and plaque retention. In this case, its removal is recommended for better dental health and maintenance of the rest of the teeth.

• Braces - Sometimes the orthodontist recommends the removal of certain teeth before braces to facilitate placing the remaining teeth in their proper position and achieve a proper bite.

• Problems with a wisdom tooth - Wisdom teeth, also called third molar teeth, are the last adult teeth to come through (erupt) into the mouth and there are four of them, one in each side of each jaw. If there is not enough room for a wisdom tooth it may get stuck inside the jaw bone and require removal to avoid future problems. Sometimes, it cannot grow properly because of lack of space and erupt only partially in the mouth or get stuck against the nearby tooth causing infection and swelling of the gum around it. In this situation and to avoid recurrence of the infection or further complications, it may be better to have the tooth pulled out by the dentist or an oral surgeon.

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What Happens During Tooth Removal?

The procedure of tooth removal is a simple surgical procedure performed under local anesthesia. The dental practitioner may first apply a topical anesthetic gel or cream to the gum tissue so that there is no pain while injecting the local anesthetic. During the local anesthetic injection itself, there may be a feeling of a small scratch after which, the tooth and surrounding tissue become numb and there should be no pain during the procedure though there may be a feeling of some pressure and pulling.

When the mouth is numb, the dentist starts loosening the tooth from the gum with a special tool and then pulls it out with forceps. The procedure usually takes from a few minutes to less than an hour, depending on the difficulty of the procedure and how many teeth are removed. After the tooth has been removed, the dentist might put stitches to close the wound or place a piece of gauze over the wound to stop the bleeding.

What Are the Risks and Complications of Extraction?

As with any medical and dental treatment, tooth extraction is associated with some risks and complications. Common risks and complications include:

1. Tooth breakage during extraction.

2. Damage to lips and cheeks - you may bite or rub the numbed area without realizing the damage you may be causing. Children are particularly more prone to this and may need to be supervised until the numbness has worn off.

3. Short term minimal to moderate pain, including jaw pain, due to the irritation of the nerves and the movement of the jaw during extraction.

4. Short term swelling or infection - signs of post-extraction infection include pain and swelling that is worsening or not improving 48 hours after tooth removal, purulent discharge from the wound or the tooth socket (the hole where the tooth was), and cellulitis adjacent to the extraction site.

5. Dry socket - occurs when a blood clot does not form in the hole where the tooth was or the blood clot is disrupted. The bone underneath will be exposed to air and food, which can be very painful and can cause a bad taste and/or odor in your mouth. This is more likely to occur if you smoke.

6. Temporary numbness.

7. Pain or difficulty opening your mouth.

Some uncommon risks and complications include:

1. Prolonged or permanent nerve damages - a small percentage of people may, in spite of all precautions, experience partial or total loss of feeling in the area served by the nerves in close proximity to the extraction site. Irritation to these nerves during extraction can cause permanent or prolonged numbness or a tingling sensation to the lip, tongue, cheek, chin, gums, or teeth.

2. Bone and root fragments remain in your gum.

What to Do Following Tooth Removal?

• You will normally have a gauze swab placed over the wound and you need to keep pressing on it for 30 minutes. If bleeding recurs, you can apply another piece of gauze and bite on it for another 30 minutes. The bleeding usually stops after that, unless there is a serious problem.

• You should not rinse your mouth for the first 24 hours after your tooth has been removed, then rinse gently with salty warm water a few times a day for a few days until the wound heals.

• You should avoid smoking and drinking alcohol or any strenuous activity for at least 24 hours.

• For the first 24 hours, avoid hot drinks and food, and eat a soft diet, such as mashed potatoes and scrambled eggs, on the other side away from the wound.

• Do not place fingers, pens or any other objects in your mouth to avoid injury and infection.

• You can take an over-the-counter painkiller such as Paracetamol or Ibuprofen before the numbness wears off to avoid any postoperative pain.

If pain continues or increases the next day, consult a dentist online for further advice and treatment.

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