Tooth extraction is the process of completely removing a tooth from its socket in the jawbone. Advances in dental techniques and pain management have made this common procedure manageable, despite potential anxiety. Extraction is only recommended when a tooth poses a threat to overall oral health or cannot be saved through other restorative methods. Understanding the procedure and the professionals involved helps set expectations for a smooth recovery.
The Dental Professionals Who Perform Extractions
The professional performing the extraction depends on the complexity of the removal. General dentists routinely handle simple extractions where the tooth is visible, fully erupted, and has a straightforward root structure. These quick procedures typically use only local anesthesia to numb the immediate area.
For more complicated cases, a referral is made to an oral and maxillofacial surgeon. This specialist has an additional four to six years of surgical residency after dental school. Surgeons handle surgical extractions involving teeth that are not easily accessible, such as impacted wisdom teeth or teeth broken off below the gumline. They are also trained to administer a broader range of sedation options, including intravenous (IV) sedation or general anesthesia.
Common Reasons for Tooth Removal
Removing a tooth is typically a last resort to preserve long-term oral health. A primary reason is severe tooth decay or infection that has progressed beyond the point where a filling or root canal therapy can save the tooth. Extraction becomes necessary when the internal structure is too compromised or the infection risks spreading to the jawbone.
Advanced periodontal disease, also known as gum disease, is another frequent cause for tooth removal. This condition destroys the bone and soft tissues that support the teeth, causing them to become loose and unstable. If the supporting bone loss is too significant, removing the tooth is required to prevent further damage to adjacent teeth and structures.
Extractions are also common for impacted teeth, most famously the wisdom teeth, which cannot fully erupt through the gums. Impacted teeth can cause pain, infection, or damage to neighboring teeth and often require surgical removal. Furthermore, a dentist may recommend removing teeth to create necessary space in the jaw for orthodontic preparation, allowing the remaining teeth to be properly aligned.
What to Expect During the Extraction Procedure
Before the procedure begins, the dental professional will review recent X-rays to assess the tooth’s position, the shape of its roots, and the condition of the surrounding bone. For a simple extraction, the area around the tooth is thoroughly numbed with a local anesthetic, which ensures you will not feel pain, though you will still feel pressure. The dentist then uses a specialized instrument called an elevator to gently loosen the tooth from the periodontal ligament that holds it in the socket.
Once the tooth is adequately loosened, forceps are used to grip the tooth and remove it from the socket. This process is quick and non-surgical, with minimal manipulation of the gum tissue.
If the tooth is impacted or fractured at the gumline, a surgical extraction is necessary, which begins with the oral surgeon making a small incision in the gum tissue to fully expose the tooth and underlying bone.
In a surgical extraction, the surgeon may need to carefully remove a small amount of bone surrounding the tooth or divide the tooth into smaller pieces, a technique called sectioning, to facilitate its removal. After the tooth is completely removed, the surgeon cleans the site and may place dissolvable sutures, or stitches, to help the gum tissue heal over the socket.
Essential Steps for Recovery and Healing
Proper aftercare is important following an extraction to encourage healing and prevent complications like a dry socket, which occurs when the protective blood clot is dislodged from the socket. Immediately after the procedure, you will be instructed to bite down firmly on a gauze pad for 30 to 45 minutes to help a healthy blood clot form. Continue to change the gauze as directed until the bleeding subsides.
Managing discomfort and swelling is achieved by taking prescribed or over-the-counter pain medication as directed and applying an ice pack to the cheek near the extraction site in 15-minute intervals for the first 24 hours. For the first week, you must maintain a soft diet, avoiding hard, crunchy, or hot foods that could irritate the wound.
It is necessary to avoid creating suction in your mouth, which means no smoking or drinking through a straw, as this can easily dislodge the blood clot and lead to a dry socket.
After the first 24 hours, gently rinse your mouth with a warm salt water solution several times a day to keep the area clean, but avoid vigorous spitting or swishing. Continue to brush and floss your other teeth, taking care to avoid the extraction site itself. If you experience severe pain that radiates to your ear or neck several days after the procedure, contact your dentist immediately, as this may signal a complication.