Tooth extraction, the removal of a tooth from its socket, is a common procedure performed to preserve overall oral health. While modern dentistry prioritizes saving natural teeth, certain situations necessitate removal. Understanding the process, including who performs it and the recovery involved, helps patients approach the procedure with clarity.
Reasons Why a Tooth Needs Removal
A tooth must be removed when its condition threatens the health of the surrounding bone, gums, or adjacent teeth. Severe decay necessitates extraction when infection has destroyed too much tooth structure for repair with a filling or crown. This prevents the infection from spreading deeper into the jawbone or to other parts of the body.
Advanced periodontal disease, or gum disease, also causes tooth loss by destroying the bone and ligaments supporting the tooth. When supporting tissue is compromised, the tooth becomes loose, and removal may be required to resolve the infection.
Impacted teeth, such as wisdom teeth that fail to fully erupt, must often be extracted because they can cause pain, cysts, or damage to neighboring molars. Extraction is also performed as a preparatory step for orthodontic treatment to create space and correct severe overcrowding. Finally, a tooth with a traumatic injury or fracture extending far beneath the gumline often cannot be restored and must be removed to prevent chronic pain.
General Dentist or Specialist?
Both a general dentist and an Oral and Maxillofacial Surgeon (OMS) are qualified to perform extractions, but their roles depend on the complexity of the case. General dentists routinely perform simple extractions on teeth that are fully visible and accessible. These straightforward procedures usually involve a tooth with a single, straight root and are completed using local anesthesia.
An OMS is a dental specialist who completes an additional four to six years of hospital-based surgical residency. This specialized training equips them to handle complex extractions requiring surgical intervention. Cases involving impacted teeth, such as wisdom teeth trapped beneath the gumline, or teeth with curved or multiple roots often require referral to an OMS.
The specialist is also the preferred choice for patients with significant underlying medical conditions or those requiring deeper sedation, such as intravenous (IV) sedation or general anesthesia. Complex procedures may require the surgeon to make an incision, remove bone, or section the tooth into pieces. The general dentist makes the initial assessment and refers the patient when the procedure is anticipated to be surgical or high-risk.
What Happens During Tooth Extraction
The extraction appointment begins with administering a local anesthetic to thoroughly numb the tooth and surrounding tissue. A topical gel may be applied first, followed by an injection of the numbing agent. The dental professional confirms the area is completely numb before proceeding, though the patient may still feel pressure.
Once the anesthetic takes effect, the dentist or surgeon uses a specialized instrument called a dental elevator to gently loosen the tooth. The elevator expands the socket and separates the tooth from the periodontal ligament fibers. Forceps are then used to grasp the crown and remove the tooth from the socket.
For a simple extraction, a gauze pad is placed to control bleeding. If a surgical extraction was necessary, the surgeon may place self-dissolving stitches (sutures) to close the incision and stabilize the blood clot.
Taking Care of the Extraction Site
Post-operative care promotes healing and prevents complications like alveolar osteitis, commonly known as dry socket, which occurs when the protective blood clot is lost. For the first hour after the procedure, the patient must bite down firmly on the gauze pad to apply pressure and encourage blood clot formation. If bleeding persists, replace the gauze and maintain firm pressure for another 30 minutes.
Pain is managed with prescribed or over-the-counter medication. Swelling can be minimized by applying an ice pack to the cheek for the first 24 hours in 15-minute intervals. Patients should limit their diet to soft foods, such as yogurt, mashed potatoes, and soup, and avoid anything hard, crunchy, or spicy that could irritate the wound. Refrain from drinking hot beverages during the initial 24 hours, as heat can increase bleeding.
To preserve the blood clot, patients must avoid activities that create suction in the mouth for at least 48 hours. These activities include smoking, spitting, and drinking through a straw. Vigorous rinsing should be avoided for the first day, but gentle rinsing with warm salt water can begin after 24 hours to keep the area clean. Strenuous physical activity should also be avoided for several days.