April 26, 2020

Can you pull your own tooth? Should you try?

We get this question every once in a while in our comments section. Most recently it was asked by a person whose dentist's office was closed due to the COVID-19/Coronavirus pandemic. And then just a few days ago, we saw this article about a man who actually did pull his own tooth, a molar.

So, is doing a DIY extraction possible?

Your dentist probably has at least one patient who has.

We expect that probably every dentist has been told by at least one of their patients that they've pulled one of their own teeth.

The usual details.

The classic scenario is one where the tooth involved was a lower front incisor that had extensive gum recession. And was so loose that it practically flapped in the breeze.

The story usually continues with ...
  • The tooth had been loosening up over the years (the person is often elderly). Sometimes, there's been a traumatic event (like biting into hard food) that's finally loosened it up severely.
  • The person tested the waters by wiggling and twisting on it, gradually more and more, and found that doing so didn't really hurt very much.
  • They then finally decided to just go for it, and twisted the tooth back and forth until it came out.

 

How a dentist would interpret this story.

When hearing their patient's narrative, any dentist who might have been alarmed initially about the level of pain that must have been endured soon begins to understand what took place and why they were able to get it out.

The situation that existed.
  • Their patient has simply described a lower front tooth that's been severely compromised by the effects of advanced gum disease.
  • The extensive gum recession that took place as a result was an indication that there was very little bone still encasing the tooth, meaning it was primarily just anchored in gum tissue.
  • Twisting the tooth back and forth stripped that attachment away from its root, with the tooth then coming out simply and quickly.

 

Every dentist knows how easy these (small, good access, single-rooted) teeth can be to take out. In fact, when removing multiple teeth, including some in this condition, a dentist may feel sheepish about charging full price for extracting them.


So, is it OK to pull your own tooth?

No, despite what can be or is sometimes done, we can't imagine a scenario where a dentist, carte blanche, would recommend to their patient that they should just go ahead and extract their own tooth. Here are some explanations why:

Reasons why pulling your tooth yourself makes a poor idea.

Some of the biggest concerns a dentist would have with condoning self-extraction have to do with all of the unknowns involved.

Some of these are issues that must be known before the process of extracting a tooth is even considered. Others are things a layperson won't know to do, or how to do, either as a part of the extraction process or post-operatively. Here are some details.

a) Do you understand your tooth's condition?

Being able to physically remove a tooth by yourself is one thing. Understanding why the tooth has developed the problem that it has, and understanding the ways that issue affects you, your oral health and the extraction process, is equally important.

A dentist's diagnosis of your situation is needed. (It's common that dental x-rays are necessary to be able to form that conclusion, something that no layperson can provide on their own.)

b) Are you expert enough to interpret factors associated with your health history?

Dentists never perform a tooth extraction without taking a complete health history first. That's because there are a number of pre-existing situations and conditions (active infection, medical/health issues, taking medications, etc...) that may need to affect the way the procedure is approached.

Two common, possibly significant, issues ...
  • A person planning to extract their tooth on their own may have a recent history of taking aspirin to control the pain they've been experiencing, without understanding that doing so can interfere with controlling post-extraction bleeding.
  • The bacteremia (the presence of bacteria in the bloodstream) that occurs following a tooth extraction can result in serious complications for people who have certain medical issues.

c) Removing the tooth - How?

With very loose teeth, it's pretty simple for someone to mimic the action of a dentist's extraction instruments just using their fingers. But beyond that, using any type of tool to pull or work a tooth loose would seem a recipe for disaster.

In the hands of a novice, even the use of actual dental extraction instruments could easily result in tooth fracture, or damage to neighboring teeth. The use of makeshift instruments would seem astoundingly fool-hearty.

Knowing the entire tooth is out is important.

Every dentist has a general idea of the size and shape of the tooth they're getting ready to extract. (And, of course, they'll take an x-ray to confirm their expectations.)

In lieu of having that level of knowledge, a layperson could do a web search to get an idea of the usual form, and even average root length, of the tooth they plan to self-extract (along with common variations). But even so, a question of if all of a tooth's root(s) had actually been removed might exist.

As a check, a dentist will feel a tooth's root surface so to check that it's smooth and rounded (no sharp edges). But a novice's ability to definitively determine if their self-extracted tooth was entirely intact or not would be a point of question.

Experiencing minor fragments coming to the surface of the gums during the healing process is one thing but larger pieces that exist can pose a significant complication.

d) Can the pain be controlled? - Probably not.

A giant obstacle to performing a DIY tooth extraction is the obvious one. There's no way for the person to predictably/adequately control the associated pain.

We couldn't help but notice that in the news article mentioned above, the person stated that the pain associated with their experience (which took 1.5 hours) was "hideous" and at one point almost caused them to faint.

That's not really surprising to hear. Even after administering local anesthetic (dental shots), dentists still struggle with making tooth extractions a totally painless experience for their patients.

The only possibility - Topical anesthetic.

As compared to a dentist's ability to administer a local anesthetic via a dental injection, the only type of anesthetic that a layperson would have access to and the ability to use is a topical one, like benzocaine.

The word "topical" means that the medication (gel, ointment, liquid) is applied to the surface of the skin. And, unfortunately, that's all that this type of medication is good for, just numbing up the surface layer of gums.

It doesn't have the ability to penetrate into or through gum tissue. And because of that, applying it has no ability to numb up teeth, their surrounding bone tissue, or even the full thickness of gum tissue that lies around them.

The best hope for numbing things up.

Possibly, a person who has a very loose tooth that has extensive gum recession might be able to take the edge off the self-extraction process by slathering topical anesthetic around their tooth. Making sure to let it seep into the space between the gums and tooth as much as it will.

But while this approach might be fairly effective for pulling a loose baby tooth (that typically just has a minimal amount of root left), doing so is unlikely to be fully effective for extracting a permanent one.

e) Needed bleeding control and post-operative care instructions.

We'll wrap our list up with mentioning that someone pulling their own tooth may not have a proper grasp of what post-operative steps are needed.

All dentists provide their patients with a tailored set of instructions about clot formation and protection practices. They'll also tailor a set of post-op directions explaining the steps they should take during the first day, and then the days following, their extraction. Understanding and following all of these steps are important.

So for all of these reasons ...

The idea of pulling your own tooth is a hard one for any dentist to embrace.


What does dental literature say about performing do-it-yourself extractions?

When searching through published dental literature, we were surprised at how little mention there is of this topic.

We didn't find any studies that had specifically researched occurrences of or complications associated with self-extraction. Nor did we find any articles that provided how-to information (like might be appropriate as first aid for people in circumstances of extreme isolation).

What we did find were these articles ...
  • A case report (Di Hipolito 2003) that describes a person who made their own makeshift dental work using self-extracted lower front teeth ravaged by the effects of gum disease. (A situation like we describe above.)
  • A (humorous in our mind) letter to the editor of the Journal of the American Dental Association (Masillamoni 1989) where an event of self-extraction is mentioned.

    In this case, a patient at their dentist's office had evidently been numbed up for an extraction. Then, unexpectedly, they went ahead and pulled the tooth on their own. The dentist writing the letter felt strongly that the person should still be charged the full price for the extraction anyway.

  • A case report (Carvalho 2017) describing a do-it-yourself extraction of a lower front baby tooth (by the child's aunt). The tooth had a longer root than normally exists at the time of exfoliation. As the tooth was wrestled out, the extra leverage associated with the extraction process resulted in a portion of the jawbone immediately adjacent to the tooth breaking and coming out too.

    Had a dentist performed the extraction, their x-ray would have revealed the abnormal root length. A plan for minimizing the potential for the complication could have then been devised.

Section references - Carvalho, Masillamoni, Di Hipolito

 
 

 Page references sources: 

Carvalho FK, et. al. Alveolar Fracture Caused by Tooth Extraction at Home. J. Clin. Pediatric Dent. Vol. 41, No. 4. 2017

Di Hipolito O, et al. Do-it-yourself dentistry. British Dental J. Vol. 194. 2003

Masillamoni C. Self-extraction. The Journal of the American Dental Association. Vol. 118, No. 6. 1989


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