Oral surgery - The tooth extraction procedure.
What takes place when you have a tooth pulled?
This page provides an overview of the process that a dentist uses when they extract a tooth for a patient.
Throughout, we explain the purpose of various instruments and steps. We also describe some of the routine sensations and sounds (both pain and non-pain related) that the patient has the potential to experience.
The more you know about the extraction process, the easier yours will be.
You're more likely to have a quick, uneventful extraction if you, the patient, contribute toward it. The contribution you need to offer is cooperation.
Patients who flinch, squirm, and moan at every routine, non-issue sound and sensation are simply making their procedure more difficult and prolonged.
Be intelligent. Take the time to learn what should be expected during a tooth extraction and what isn't (and therefore needs to be brought to the attention of your dentist). Doing so will help to insure that having your tooth pulled will go as quickly and smoothly as possible.
Having a tooth extracted - The procedure.
A) Your dentist will numb your tooth.
Your dentist will need to anesthetize ("numb up") both your tooth and the bone and gum tissue that surround it.
At this point in time, there is still no way for a dentist to predictably administer a local anesthetic except as an injection (a "shot").
We'll admit that this can hurt a bit. But we'll also emphatically state that it doesn't always.
Here's more information about this subject. It may help to put your mind at ease: Will my dental injection hurt?
B) The extraction process - What to expect.
1) Here's the overall game plan.
a) The root portion of a tooth is firmly encased in bone (its socket), and tightly held in place by a ligament.
b) During the extraction process, the dentist needs to both "expand the socket" (widen and enlarge it) and separate the tooth from its ligament, to the point where the tooth is loose and free to come out.
What does it mean to "expand" a tooth's socket?
If you have ever tried to remove a tent stake that has been driven deeply into the ground, you know that you can't just pull the stake straight up. Instead, you first have to rock the stake back and forth so to widen (expand) the hole in which it is lodged.
Once the hole has been enlarged enough, the stake will come out easily.
Teeth are somewhat the same.
The bone inside the jaw is relatively spongy. That means, when a dentist applies firm pressure to a tooth (forcing it against the sides of its socket), the bone will compress.
After repeated application of pressure, from many different angles, the entire socket gradually becomes enlarged (expanded).
Finally, at some point, enough space will have been created (and the ligament separated from the tooth enough) that the tooth will come out.
2) Here're the tools that your dentist will use.
Dentists have a variety of instruments that they use to manipulate and apply pressure to teeth. Some of them are specialized pliers called "extraction forceps." Others are levers (they look a bit like small screwdrivers) called "elevators."
a) Dental Elevators
During the extraction process, a dentist will usually use an elevator first.
These instruments are designed to be wedged in the ligament space between the tooth and its surrounding bone.
As the elevator is forced and twisted, the tooth is pressed and rocked against the bone. This helps to expand the socket. It also helps to separate the tooth from its ligament.
As this work is continued, the tooth will become more and more mobile. In some cases, the elevator may be able to shove the tooth on out. If not, the dentist will switch to the use of extraction forceps and remove the tooth with them.
b) Extraction Forceps
A dentist will usually keep a number of different extraction forceps on hand. Each one will have a design that's been specially made to grasp a certain type of tooth.
When they're used, the dentist will grasp the tooth with the forceps and then firmly and deliberately rock it back and forth as much as it will. Because the bone that surrounds the tooth is compressible, the socket will expand.
In addition to a rocking motion, a dentist will also rotate the tooth back and forth. This twisting action helps to rip and tear the tooth from the ligament that binds it in place.
At some point, the socket will be enlarged enough, and the ligament torn enough, that the tooth can be easily removed.