A tooth extraction is the procedure of removing a tooth from its socket within the jawbone, often called “pulling a tooth.” While modern dentistry aims to preserve natural teeth, extraction is necessary when a tooth cannot be saved by restorative treatments like fillings or crowns. A general dentist can perform this oral surgery to maintain overall oral health and prevent infection.
The Scope of a General Dentist
A general dentist is qualified to perform what is known as a simple extraction, which involves removing a tooth that is fully visible and accessible above the gumline. This procedure is typically performed on teeth with straightforward root structures. The dentist administers a local anesthetic to numb the area, ensuring the patient feels pressure but no pain during the removal.
The process begins with a dental elevator, a specialized instrument inserted between the tooth and the surrounding bone to loosen the tooth from its periodontal ligament fibers. This mobilization expands the socket and separates the tooth from the tissue holding it in place. Once the tooth is sufficiently loosened, the dentist uses extraction forceps to grip the crown, gently rocking and removing the tooth from the socket.
When Specialist Intervention is Needed
More complex removals, classified as surgical extractions, often require a referral to an Oral and Maxillofacial Surgeon (OMS). These specialists possess advanced training for dealing with teeth that are not easily accessible or present complicating factors. A surgical extraction is necessary when the tooth is fractured at or below the gumline, or when it is impacted (trapped within the jawbone or soft tissue and unable to fully erupt).
The OMS handles teeth with challenging anatomy, such as roots that are severely curved, long, or multi-pronged, which increase the risk of complication if removed by traditional means. Surgical intervention typically involves making a small incision in the gum tissue to access the tooth and may require removing small amounts of surrounding bone. Patients with complex medical conditions, such as heart problems or bleeding disorders, are also referred to an OMS for specialized care.
Reasons Why a Tooth Must Be Pulled
Severe dental decay, or caries, is one of the most frequent reasons for extraction, particularly when the structural damage is so extensive that a root canal or crown cannot restore the tooth’s function. When decay compromises the inner pulp, extraction may be the only way to prevent the infection from spreading into the jawbone or bloodstream.
Advanced periodontal disease is another common indication, causing significant bone loss and loosening of the tooth in its socket. This disease progresses when chronic infection destroys the ligaments and bone supporting the tooth, making it unstable and unsalvageable. Extractions are also performed to resolve irreparable trauma, such as a vertical root fracture extending deep below the gumline.
Orthodontic treatment sometimes requires removing permanent teeth to alleviate severe crowding and create space for proper alignment. Furthermore, teeth with deep-seated infections that do not respond to root canal therapy must be removed to eliminate the source of inflammation.
Preparing for and Recovering from Extraction
Prior to the procedure, the dentist reviews the patient’s medical history, and sometimes a prophylactic antibiotic is prescribed, especially for patients with specific health risks. The recovery phase focuses on promoting the formation and stability of the blood clot in the empty socket, which is foundational for healing. Dislodging this clot results in a painful condition known as alveolar osteitis, or dry socket.
To prevent dry socket, patients must avoid any sucking motion for several days, including using a straw or smoking, as negative pressure can pull the clot out. Sticking to a soft-food diet and avoiding crunchy or hard items prevents physical disruption of the healing site. After the first 24 hours, gentle rinsing with a warm salt water solution helps keep the area clean without disturbing the protective clot.
Patients should refrain from vigorous spitting or rinsing and strenuous physical activity for at least the first two days, as these actions can increase bleeding and dislodge the clot. Swelling can be managed by applying an ice pack to the cheek near the extraction site for 15-minute intervals during the first day. Prescribed pain medication should be taken as directed to manage discomfort once the local anesthetic wears off.