A dental infection, often a periapical abscess, is caused by bacteria reaching the tooth’s inner pulp chamber, causing significant pain and anxiety. While extraction is sometimes the quickest path to eliminating the source of the infection, modern dentistry prioritizes saving the natural tooth whenever possible. The decision to pull an infected tooth is complex, involving an immediate assessment of the infection’s severity and the tooth’s salvageability. The approach ultimately depends on the extent of structural damage and whether the infection is localized or has begun to spread systemically.
When Dentists Extract Infected Teeth
Dentists proceed with immediate extraction when the tooth is deemed non-restorable due to extensive damage, even with active infection present. This typically occurs when decay or trauma has destroyed so much of the tooth structure that a root canal and a crown cannot effectively rebuild it, or if the root is fractured beyond repair. Removing the tooth eliminates the source of the bacteria permanently.
Another factor supporting immediate removal is when the infection is acute and confined to the tooth and surrounding bone, without signs of widespread involvement like fever or facial swelling. The presence of an acute, localized infection, which may cause severe pain, is not necessarily a reason to postpone extraction. During the procedure, the dentist can effectively drain the abscess through the socket, removing the pus and relieving pressure on the surrounding tissues.
The decision to extract is also influenced by the patient’s overall health, especially for those who are immunocompromised or have specific cardiac conditions. For these patients, a rapid resolution of the dental infection is often prioritized to prevent bacteria from entering the bloodstream and causing systemic complications. Extraction can be a safer, more definitive option when the risk of prolonged treatment outweighs the benefit of saving the tooth.
Controlling the Infection Before Extraction
In many scenarios, particularly when a severe infection shows signs of spreading, dentists will take steps to control the bacteria before performing an extraction. If a patient presents with systemic symptoms like a fever, significant facial swelling, or difficulty breathing, the initial focus shifts to stabilization. Extracting a tooth in the presence of a widespread infection can introduce a large bacterial load directly into the bloodstream, potentially worsening the condition.
Antibiotics are frequently prescribed for a period of three to seven days prior to the procedure to reduce the bacterial count and minimize the risk of spreading the infection during the surgery. Commonly used medications include amoxicillin or clindamycin, which target the types of bacteria typically found in oral infections. This pre-treatment helps to localize the infection and make the area more responsive to local anesthesia.
Incision and drainage (I&D) is a common procedure used to manage a significant abscess before extraction. The dentist makes a small cut into the swollen tissue to allow the pus to drain, which immediately relieves pressure and pain. By removing the bulk of the infected material, I&D substantially reduces the bacterial load, making the subsequent extraction safer and promoting better healing of the socket.
Saving the Tooth: Alternatives to Removal
Extraction is generally considered a last resort because preserving the natural tooth maintains jawbone integrity and proper alignment of the bite. The primary alternative is Root Canal Treatment (RCT), which aims to eliminate the infection while retaining the tooth’s structure. This procedure involves accessing the pulp chamber, removing the infected nerve tissue and bacteria from the root canals, and then disinfecting the internal space.
Once cleaned and shaped, the canals are filled with an inert material called gutta-percha and sealed to prevent re-infection. Following a root canal, the tooth often requires a restorative crown to protect the now-brittle structure from fracture, restoring its full function. The high success rate makes RCT the preferred method for dealing with a contained dental abscess.
For less severe decay that has not fully infected the entire pulp, a procedure like a pulpotomy may be performed, removing only the infected pulp in the crown of the tooth. If infection persists at the root tip after a root canal, a minor surgical procedure called an apicoectomy can be performed. This involves removing the end of the tooth’s root and sealing the canal from the bottom.