Oral surgery: Tooth extractions

From experience, we know that the more a dental patient knows about what takes place during the tooth extraction procedure the less eventful the experience of having their tooth out, and the healing process that follows, will be.

That's because having this information can help them to be more relaxed, more cooperative and more likely to understand the importance of following their dentist's postoperative instructions.

To round our coverage out, our pages also discuss ...

Planning a tooth extraction -

1) The pre-treatment examination.
    a) Reasons why teeth are extracted.
    b) Why some extractions are a bad idea.

2) Taking the patient's medical history.
    a) Current medications / Concerns.
    b) Pre-medication with antibiotics.

A) The pre-extraction dental examination.

Your dentist will need to examine your teeth and mouth before a determination can be made that a tooth extraction is warranted.

1) An x-ray will be required.

As a part of this examination, your dentist will need to take an x-ray (radiograph). It will allow them to evaluate changes within the tooth as well as its root(s) and the bone that surrounds it.

A tooth with dental decay can abscess.

The information that your dentist obtains from their clinical examination and the x-ray will help them formulate an opinion as to why the tooth should, or should not, be extracted.

If a determination is made that an extraction is needed, depending on the anticipated degree of difficulty of the procedure, your dentist might offer to perform the extraction for you, or else suggest that an oral surgeon should perform your work.

2) If infection is present, you may need to take antibiotics before your extraction can be performed.

If a significant level of active infection is observed during your pre-extraction examination (usually evidenced by the presence of swelling), your dentist may decide that you need to take a course of antibiotics (starting several days before your surgery is performed).

Doing so will make it less likely that complications, either during the extraction procedure or its subsequent healing process, will occur.

Any antibiotics that are prescribed should be taken as directed. If you have any problems with taking them (including the development of a generalized rash or itching), you should report them to your dentist or physician immediately.

B) Taking the patient's medical history.

During your pre-extraction examination, your dentist will need to collect your relevant medical information.

Even if they don't ask, make sure to report if you have had any problems with previous tooth extractions, if you have any bleeding problems, and identify any and all medical conditions you have, both treated and untreated, just to make sure nothing is overlooked.

1) Your current-medications list.

Make sure your dentist is aware of all of the medications, including supplements, that you take (prescription, over-the-counter, and herbal) because some can cause complications with the extraction procedure or its healing process. As examples:

You may need to take antibiotics before your tooth extraction.
  • Aspirin retards the blood clotting process (ibuprofen, ginko biloba, and ginseng can have an effect on clotting too).
  • Women who take oral contraceptives seem to be at greater risk for developing "dry sockets" after tooth extractions than those who don't.
  • Persons (usually women) who have a history of taking bisphosphonate drugs (such as Fossmax®) can be at greater risk for complications associated bone healing.

2) You may need to "pre-medicate" with an antibiotic before your extraction.

Some medical conditions place patients at risk for developing a bacterial infection after having any type of dental procedure that involves bleeding.

In these cases, it's mandatory that the patient take "prophylactic" antibiotics before their dental surgery is performed. Doing so helps to minimize this risk. Some of the medical situations where antibiotic pre-medication may be required include:

  • Various cardiac conditions.
  • Prosthetic joints.
  • Patients on renal dialysis.

Of course, our list is not all-inclusive and is purposely vague. Research findings, as well as the opinions of doctors and organizations that evaluate these studies when formulating recommendations and guidelines, are constantly evolving. In some instances, your dentist may feel that they need to consult with your physician before they can make a determination regarding what precautions are needed.

3) If you're nervous, let your dentist know.

Be up front with your dentist if you have any concerns or fears about your upcoming surgery. Knowing as much as possible about you personally will help your dentist know how to treat you more effectively.

Their goal is to have as many considerations dealt with and out of the way before that time when the extraction is performed. This way they can focus more of their attention on performing the actual work of the extraction process and less on managing you as a patient. (Related page: Medications dentists use to manage patient anxiety.)

Reasons why teeth are extracted.

There are a number of reasons why a person might need a tooth, or even multiple teeth, extracted. They include:

1) Damaged teeth.

a) Broken, cracked, or extensively decayed teeth.

The obstacles associated with repairing some teeth that have extensive decay or else have broken or cracked in an extreme manner may make extraction the only choice. In other cases, the needed treatment's cost, or else a question of its long-term success, may make extraction the most reasonable option.

b) Teeth that are unsuitable candidates for root canal treatment.

If the option of receiving needed root canal treatment is not possible, the only alternative is to extract the tooth.

c) Teeth that have advanced gum disease.

In those cases where periodontal disease (gum disease) has caused a significant amount of bone damage and the affected teeth have become excessively mobile, extraction may be the only option.

2) Malpositioned or nonfunctional teeth may need to be extracted.

Non-functional teeth are often extracted.

a) Malpositioned teeth.

Some teeth are extracted because they have a poor alignment or positioning. For example, some third molars are extracted because they are a constant source of irritation to a person's cheek (they either rub against it or causing the person to bite it).

b) Non-functional teeth.

Some teeth are extracted because they just provide minimal benefit but place the person at substantial risk for experiencing dental problems.

As an example, some third molars come into place but have no matching tooth to bite against. Since these teeth lie in a region of the mouth that is hard to clean, both it and its neighboring 2nd molar are at increased risk for developing tooth decay and/or periodontal disease. In this type of situation, it may make sense to have the tooth extracted.

c) Impacted teeth.

Impacted teeth are malpositioned and usually non-functional. This combination of factors makes them common candidates for extraction.

3) Tooth extractions may be required for orthodontic reasons.

When orthodontic treatment is performed, the dentist may be limited by the amount of jaw space (length) they have to work with. If so, some strategically-located teeth may need to be sacrificed.

A missing tooth allows the neighboring teeth to shift.

When can having an extraction be a bad idea?

The simplicity of having a tooth extracted might seem to be an attractive choice in comparison to the cost and effort involved with salvaging it. But this solution is unlikely to be the best, or even the cheapest, choice over the long run.

When one tooth is extracted, neighboring teeth will tend to shift.

Once a tooth has been removed, its neighboring teeth will tend to drift into its vacant space, sometimes significantly so. And any alignment changes that do take place can have a major impact on your dental health and appearance.

Removing even a single tooth can lead to problems with chewing ability or jaw-joint function. Additionally, the spaces that form between shifted teeth can become traps for food and debris. Their presence can place your teeth at greater risk for the formation of tooth decay and gum disease.

Having an extraction may not really be the cheapest solution.

Choosing an extraction may seem to be the least expensive option initially. But this determination may not be accurate when the larger picture is considered.

So to avoid the types of complications mentioned above, in most cases your dentist will recommend to you that you replace your extracted tooth. Replacement teeth can easily cost more than the alternative of not extracting a tooth and instead rebuilding it.

 All FYI's ► 

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